Medicare Compliance & Reimbursement

Tip: Ensure staff are aware of upcoming changes and re-train accordingly as new policies emerge.

Now that the feds have announced the end of the COVID-19 public health emergency (PHE), you may be scrambling to put a transition plan in place. Whether you’ve already created a plan or are in panic mode, consider these tips from the experts to unwind pertinent PHE-era policies and practices:

1. Start immediately. “Providers who are still relying upon waivers need to start acting now,” urges attorney Robert Markette Jr. with Hall Render in Indianapolis. Practitioners’ most important task, “especially now that we have a deadline, is to get moving,” Markette stresses.

“Once the PHE ends, unless otherwise noted, the waivers end,” Markette explains. “Providers need to be back to pre-PHE operations by May 11,” he warns.

“Providers have a little over three months,” Markette points out. “They should be using that time wisely. This will allow a planned, controlled rollout of new policies,” which are actually “the old pre-PHE policies.”

Bottom line: “We all remember the chaos around the waivers in 2020,” Markette recalls. “We can avoid that now, because we have ample warning,” he says.

2. ID affected policies. The first order of business is to identify those policies that your organization changed due to PHE waivers, so you can assess whether you will need to change them back — or transition to a new policy.

“As the PHE ends … flexibilities will go away and we will have to return to operating under the” original requirements and policies, Markette observes. Some providers have already transitioned back to their old policies, either because their state PHE ended and their licensure required it, or because they simply no longer needed the leeway and were eager to make their transition to a post-PHE environment smoother.

“Indiana is a prime example” of the former, Markette says. “We are a licensure state. At the beginning of the pandemic, the state moved to waive certain licensure requirements. When the state ended the PHE last year, all of the state license waivers went away. This meant providers had to return to following state licensure requirements without the waivers. At that point, the CMS waivers did not matter,” he relates.

Yet other practices never changed their policies to begin with, and now don’t have to switch back.

3. Narrow down expiring waivers. Once you’ve identified policies you revised for the PHE, check to see whether the changes were made permanent or extended either via legislation or Medicare rulemaking. Those include telehealth flexibilities and the expansion of clinicians allowed to order home health services, for example.

4. Move forward with your transition plan. When you have your final list of policies that need to revert to pre-PHE rules, it’s time to draw up a plan for doing so.

While your office administrator or practice manager is ultimately responsible for securing changes, a plan should designate who is in charge of the individual policy changes and deadlines for those to take place. Providers can use pre-PHE policies to guide them when needed, Markette suggests.

The plan also needs to set clear deadlines. “Make sure everyone involved understands that the deadline is a concrete deadline set by law,” Markette stresses.

5. Train staff. Begin educating staff on the new policies, making sure to shoot for compliance before the PHE expires, Markette recommends.

Keep in mind: Your staff have had two years to get into the habit of waiver-allowed policies. It may take time to get them compliant with the old requirements, especially when they add burden.

6. Scrutinize your plan. Audit to verify compliance with post-PHE procedures, then provide followup training based on the errors found, Markette advises. That training can be for all affected staff or focus on individuals, based on the pattern of errors detected.