Alert! Review Your PHE Policy “Waivers and Flexibilities” to Stay Compliant

Posted February 15, 2023

CMS has issued detailed guidance regarding the end of the PHE, and its effects on Home Health and Hospice Agencies.

Yes, the end of the public health emergency (PHE) on May 11 will signal the end of the difficult COVID-19 era of healthcare for home health and hospice agency providers. However, many of the PHE “waivers and flexibilities” that were provided to ease the burden on providers will end, while others will be made permanent because they have expanded access, improved quality and shown to have lasting value.

In particular, agencies need to be alert for imminent deadlines regarding the end of relaxed provisions, also known as waivers and flexibilities, that will revert back to more stringent reporting and operating requirements as the PHE ends. A few things to note:

  • Not all waivers and flexibilities end on May 11. Some roll off over the following months, so look for different end dates on specific activities.
  • Some waivers and flexibilities will be integrated into ongoing regular practice.
  • A few reporting requirement dates have been shortened back to their pre-PHE status, and these need particular attention to ensure timely reimbursement.
  • Exceptional payment for COVID vaccines and monoclonal antibodies will revert to regular Medicare Part B vaccine and biologics reimbursement schedules.

Some Waivers and Flexibilities Changes are Permanent 

The value of some changes have resulted in permanent improvements to operations and procedures for home health and hospice agencies. Substantive changes include:

  • Plans of Care and Certifying/Recertifying Patient Eligibility for a Medicare eligible home health patient may continue to be performed by a nurse practitioner, clinical nurse specialist, or a physician assistant who is working in accordance with state law. Physicians are no longer required for POC/eligibility certification. Now, physicians and practitioners can: 1) order home health services; 2) establish and periodically review a plan of care for home health services (e.g., sign the plan of care); 3) certify and re-certify that the patient is eligible for Medicare home health services.
  • Medicare Telehealth and Telecommunications Technology is permitted within the 30-day period of care, as long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care. Telecommunications technology includes remote patient monitoring; audio and TTY telephone calls, and two-way audio-video technology that allows for real-time interaction between the clinician and patient. Only in-person visits can be reported on the home health claim. The required face-to-face encounter can be replaced by a real-time audio/visual visit between the physician and patient. This waiver is extended to 151 days after May 11.
  • Allow Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessment for all Patients so that any rehabilitation professional (OT, PT, or SLP) can perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law.

Highlights of Home Health Waivers Ending for Some Activities 

Waivers and flexibilities are ending for many important services and operational requirements. The return to normal functioning will affect activities, including but not limited to:

  • Requests for Anticipated Payment (RAPs) auto-cancellation dates by Medicare Administrative Contractors are not extended.
  • Reporting deadlines are re-established for the 5-day completion of the comprehensive assessment and the 30-day OASIS submission requirement.
  • Remote initial assessments or those performed by record review will end. In-person initial assessments are required to resume.
  • Onsite visits for HHA aide supervision require a nurse to conduct an onsite visit every two weeks, and a registered nurse to provide 2-week aide supervision.
  • 12 hours of annual in-service training in a 12-month period for home health aides must be completed by the end of the first full quarter after the end of the PHE.
  • Detailed information sharing for discharge planning for HHAs is required to be provided to patients and their caregivers, or the patient’s representative regarding the selection of a post-acute care provider.
  • Copies of clinical records should be provided to a patient at no cost during the next visit or within 4 business days of the patient’s request.
  • An onsite supervisory visit for training and assessment of aides by a registered nurse (hospice) or a registered nurse , physical therapist, occupational therapist or speech language pathologist (HHA) is required All onsite assessments postponed due to the PHE must be completed by these professionals no later than 60 days after the expiration of the PHE.
  • Quality Assurance and Performance Improvement (QAPI) programs must be developed, implemented, evaluated and maintained by hospice and home health agencies. Providers must maintain an agency-wide, data-driven quality assessment and performance program to remain compliant with CMS operating requirements for hospice and home health agencies.

The Challenge of Implementing Change

Change is not easy. The rapid changes required to adjust to the threats of the pandemic required new procedures and operations, and that same sort of effort is required to move beyond the public health emergency. Faced with meeting these federal deadlines on an accelerated timeline demands focus and organizational skills – all while continuing to manage day-to-day emergent needs of patients and maintaining compliance with reams of new regulations each year.

For your convenience, the CMS document detailing the effect of the end of the PHE on home health and hospice is here. If you want some help interpreting the ways that these changes will affect your agency, Corridor has experience in operational and back office efficiencies to smooth the transition to a post-PHE world.

About Corridor

For over 30 years, Corridor has partnered with home health and hospice providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operations executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.

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