Home Health & Hospice Week

Questions remain as PHE end date passes.

Federal officials in Medicare and many other programs have been issuing steady updates about the COVID-19 public health emergency’s wind-down process, but home health and hospice agencies are still left with questions at best and disappointments at worst as May 11 passes.

One Medicare waiver “allowed any rehabilitation professional (occupational therapists, physical therapists, speech-language pathologists) to perform the initial and comprehensive assessment for all [home health] patients receiving therapy services as part of the plan of care,” notes the National Association for Home Care & Hospice. “The waiver has been particularly helpful by ensuring patients are admitted to care in a timely fashion, especially considering the workforce shortages exacerbated by the COVID-19 pandemic,” NAHC praises.

NAHC sent Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure at March 31 letter, requesting the §484.55 waiver be made permanent, the trade group notes in its member newsletter. But CMS hadn’t taken action on that issue as of press time.

“The application of this waiver into home health agency operations during the PHE has had the same effect as a three-year demonstration project,” NAHC insists. “During this time there have been no adverse effects on the quality of care for home health patients. Coupled with the fact that therapists were conducting the assessments in certain circumstances prior to the PHE, there does not seem to be any reasonable rationale for CMS to not continue this waiver with the aim for a permanent change in the regulation.”

Another area of confusion is regarding mandatory COVID vaccinations for Medicare-certified providers. On May 1, the Biden administration announced it would be ending the requirement along with the PHE, and CMS issued a related survey memo that same day (see HHHW by AAPC, Vol. XXXII, No. 16).

The memo says CMS will “share more details regarding ending this requirement at the anticipated end of the public health emergency,” but no details have been forthcoming as of press time on May 11.

Telehealth is yet another area that's a mixed bag. “During the PHE, individuals with Medicare had broad access to telehealth services, including in their homes, without the geographic or location limits that usually apply,” CMS notes in its Frequently Asked Question set about CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency. CMS updated the FAQ set again on May 5. “These waivers were included as provisions of The Consolidated Appropriations Act, 2023, which extended many telehealth flexibilities through December 31, 2024,” CMS allows.

However: “If an individual receives routine home care via telehealth under the hospice benefit, this flexibility will end at the end of the PHE,” CMS clarifies in question 16.

Of course, home health agencies haven’t been able to bill directly for any telehealth services, which continues after the PHE’s end. Reporting of telehealth visits will be required starting July 1, however, in what is widely seen as a likely precursor to allowing billing of such visits.

Note: The survey memo is at www.cms.gov/files/document/qso-23-13-all.pdf. The updated FAQ set is at www.cms.gov/files/ document/what-do-i-need-know-cms-waivers-flexibilities-and-transition-forward-covid-19-public-health.pdf.