CMS Permits Outpatient Services in the Home

WASHINGTON, D.C. (May 5, 2020)—The Centers for Medicare & Medicaid Services’ (CMS) most recent COVID-19 Interim Final Rule with Comment (IFC) provides flexibility for hospital outpatient departments (HOPD) to provide services to their patients to their home. During the COVID-19 public health emergency (PHE), a patient’s home may be considered an off-site location of a hospital department. Only registered outpatients may receive services in the home by the HOPD.

The HOPD may bill for services of registered outpatients provided in the patient’s home by the HOPD clinical staff. The services provided must require the staff be present in the home, such as wound care, drug administration etc., and cannot be provided via telecommunications. However, the services of the physician/practitioner providing care in the HOPD may conduct a visit with the patient via telehealth and bill it as an HOPD visit.

The HOPD services may not be provided to patients in the home that are under a home health plan of care. However, a home health agency may not open a patient to services if the HOPD is providing outpatient services in the home.

Although this might be helpful for HOPD patients receiving wound care and other recurring outpatient services, it could compete with potential home health admissions.

The National Association for Home Care & Hospice (NAHC) is interested in knowing the impact this will have on home health agencies. To provide the agency with your experiences, please contact NAHC at [email protected]

Below are excerpts from the rule:

Hospital In-Person Clinical Staff Services in a Temporary Expansion Location (which may be home) 

Clinical staff:

Hospitals also provide services that are furnished by clinical staff under a physician’s or qualified non-physician practitioner’s (NPP’s) order that do not require professional work by the physician or qualified NPP, and thus, are billed only under the OPPS when furnished by the hospital and are not separately billable under the PFS. Wound care, chemotherapy administration, and other drug administration are examples of these types of services.

This flexibility enables hospitals to furnish these clinical staff services in the patient’s home as an outpatient PBD and to bill and be paid for these services as HOPD services when the patient is registered as a hospital outpatient. Because these services have to be provided in person by clinical staff, these services cannot be furnished by telecommunication technology by the hospital. In these instances, hospital clinical staff must be physically present in the patient’s home or other temporary expansion location

Importantly, during the time period that the patient is receiving services from the hospital clinical staff as a registered outpatient, the patient’s place of residence cannot be considered a home for purposes of HHA services. This is because HHAs cannot bill for services furnished in PBDs of hospitals, and a patient’s home has provider-based status when the patient is a registered hospital outpatient and HOPD services are being furnished

The hospital should be aware if the patient is under a home health plan of care, and it must not furnish services to the patient that could be furnished by the HHA while the plan of care is active. That is, to the extent that there is some overlap between the types of services a HHA and a HOPD can provide, and the patient has a current home health plan of care, the hospital should only furnish services that cannot be furnished by the HHA.

Hospital Services Accompanying a Professional Service Furnished Via Telehealth

Professional services

For many professionals, the HOPD is the usual location where they furnish services.  For the duration of the COVID-19 PHE and effective March 1, 2020, when a practitioner who ordinarily practices in a HOPD furnishes a telehealth service to a patient who is located at home (or otherwise not in a telehealth originating site), they would submit a professional claim with the place of service code indicating the service was furnished in the HOPD.