Homecare Groups to CMS: We Need Help With Coronavirus

BIRMINGHAM, Ala. (March 11, 2020)—The National Association for Home Care & Hospice (NAHC) and the American Association for Home Care (AAHomecare) have separately asked the Centers for Medicare & Medicaid Services (CMS) to act quickly on items that will help homecare providers handle the outbreak of the novel coronavirus.

With the Centers for Disease Control urging sick and at-risk people to self-quarantine to prevent the spread of the COVID-19 epidemic, NAHC is seeking more protective gear, help with moving patients home from the hospital and priority testing for homecare patients and caregivers; AAHomecare requested relaxing the rules on home oxygen and increasing access to telehealth.

CMS issued preliminary guidance on March 4 for health care providers to implement infection control protocols, followed up with more specific guidance for home health agencies and dialysis centers on March 10. The new guidance offers instruction for dealing with staff who have been exposed or are showing signs of illness and offers a list of FAQs to help safely treat patients in this setting.

On Wednesday, NAHC announced that it had written a letter to CMS Administrator Seema Verner.

“Providing quality health care in the home is one of the best ways to prevent transmission of the novel coronavirus COVID-19. Therefore, it makes sense for CMS to make a series of policy changes to make it easier for home care and hospice to fulfill its potential in battling this pandemic,” NAHC said in a statement.

The organization has also been in touch with Congress and the Department of Health and Human Services, NAHC President Bill Dombi said in a video statement. In the same statement, Dombi said that agencies were enacting their infection control and emergency management plans to protect the safety of staff and patients.

“These providers are preparing for a potential upsurge in patients as individuals who are considered high risk are contracting the virus, as well as individuals who are exhibiting symptoms seek care,” he said.

“The homecare community is stepping up to meet the challenges presented by this virus,” he added.

The supports NAHC asked for included:

1. Provide expedited access to protective gear along with financial support for the gear;
2. Establish direct link to HHAs for MDs and EDs at hospitals to transition patients home;
3. Expedite transitions of patients from inpatient and SNF settings to home health care through discharge planning instruction; and
4. Provide priority testing of suspected at home isolated patients and their caregivers.

Additionally, it asked for HHS or CMS to modify or add policies and statutes where possible to reduce risk to patients and clinicians and make more clinicians available by:

• Flexibly interpreting “homebound” benefit requirements and also allowing “intermittent” home health rules to permit short-term daily skilled care rather than inpatient or skilled nursing facilities
• Allowing phone or electronic encounters instead of face-to-face meetings with physicians
• Allowing telehealth visits to count towards LUPA thresholds
• Allow Medicare/Medicaid reimbursement for some remote monitoring to reduce exposure
• Suspend expansion of Review Choice Demonstration to free up clinical staff
• And change some Conditions of Participation to reduce paperwork, free up clinicians and allow telephone supervision of home health aides
• Allow home health personnel to collect, transport, conduct and report COVID-19 test results
• And more

Earlier in the week, AAHomecare announced it was working to secure additional guidance from CMS to address issues specific to home medical equipment (HME) related to the outbreak, including:

• Relaxing Medicare requirements for chronic lung disease for the provision of home oxygen short term.
• Potential use of telehealth to meet Medicare requirements for face-to-face documentation and ongoing medical necessity.

In an email, AAHomecare said it was seeking additional details on how major respiratory stakeholders in the industry are responding and was reaching out to state Medicaid authorities and the National Association of Medicaid Directors for information on how they plan to address these issues, including potentially relaxing/suspending requirements related to reauthorization for supplies and rentals.

“The HME community has a long track record of serving patients under adverse conditions,” the announcement read. “The COVID-19 outbreak poses a unique threat to the safety of individuals in our industry and additional significant challenges if individuals needing care at home grows rapidly. We urge you to take careful precautions to protect yourselves and your colleagues from exposure so our industry can continue to serve the patients who depend on us – perhaps now, more than ever.”