Home Health & Hospice Week

A May 1 Medicare state survey memo about the COVID-19 PHE’s end on May 11 lists a number of the flexibilities that are ending. Most of them appear to duplicate what the Centers for Medicare & Medicaid Services has already said in its provider-specific flexibility fact sheets, last updated in February.

For instance: Under the PHE, “CMS waived the requirement that hospices must use volunteers (at least 5 percent of total patient care hours of all paid hospice employees),” notes memo QSO-23-13-ALL. CMS says the same in the flexibilities fact sheet and notes that “this waiver will terminate at the end of the COVID-19 PHE.”

But the fact sheet says “it is anticipated that hospice volunteer availability and use will be reduced related to the COVID-19 surge and anticipated quarantine.” The memo notes “that hospice volunteer availability and use may still be reduced” (emphasis added).

Back on Feb. 1, CMS noted that “this flexibility is currently set to return to pre-PHE requirements at the end of the calendar year that the PHE ends” — i.e., Dec. 31, 2023 (see HHHW by AAPC, Vol. XXXII, No. 8).

The memo doesn’t spell out that date, but it should hold, observers expect.

Given the guidance, “it is expected that hospices will work towards full compliance with the 5 percent level of activity requirement,” the National Association for Home Care & Hospice believes.

Do this: “Hospices not meeting this requirement should document all attempts to recruit and retain volunteers, and it is expected that CMS surveyors will be able to use their discretion to determine a hospice’s compliance,” NAHC says in its member newsletter.

Medicare also recognizes the wider issue of staffing shortages hampering compliance with reinstated requirements.

“CMS acknowledges concerns raised by stakeholders related to staffing challenges that continued during the PHE,” it says in the May 1 memo. “These waivers were intended to be temporary, but we recognize that some providers/suppliers are still constrained by workforce shortages.”

As a result, “CMS will utilize our enforcement discretion on a case-by-case basis for circumstances beyond the provider’s/ supplier’s control according to the timeframes for each waiver,” the memo says.

In addition to the volunteer requirement, home health and hospice waivers listed under that statement include the 12-hour annual in-service training requirement for home health aides (extended to Dec. 31, 2023) and hospice annual competency training and evaluation (extended to Sept. 30). v

Note: The memo is at www.cms.gov/files/document/qso-23-13-all.pdf.