NAHC: Great Successes During Pandemic, More Work to Do

BIRMINGHAM, Ala. (October 19, 2020)—The COVID-19 pandemic changed the world for homecare—but also elevated the profession in the eyes of the public and lawmakers, William A. Dombi, president of the National Association for Home Care & Hospice, said Monday as he opened the group’s annual conference.

“What has emerged is energy and enthusiasm about our future,” Dombi said.

The 2020 Home Care and Hospice Conference and Expo, originally scheduled to be held in Tampa, Florida, was moved online due to coronavirus concerns. NAHC announced the event will return to Tampa in 2024.

Dombi said that the advocacy group has a new focus in Washington: pushing the Medicare program to create a new benefit to allow for care at home that’s equivalent to that provided in a skilled nursing facility (SNF). The effort, dubbed “Choose Home,” would give individuals the option of either going home or into a SNF, and would allow them to get some of the hands-on custodial care and protective supervision that’s more common to nursing homes at home.

Dombi also said there have already been several wins in Washington for the industry, most notably the culmination of an effort that began in 2007 to allow non-physician practitioners to provide Medicare authorization and oversee the creation of care plans. It was passed as part of the CARES Act.

“This was not just a public health emergency temporary measure, this was a permanent measure,” Dombi said. “After 13 years of blood sweat and tears to get it there, I think this was a great accomplishment.

Other victories include:

• The inclusion of homecare and hospice providers in the $175 billion pandemic provider relief fund established by the CARES act, which he said was recognition that care providers need to be there during and after COVID-19.
• Greater flexibility allowed for the use of telehealth, which he said needs more work, especially in allowing for reimbursement, and that NAHC hopes to have a bill on that this year.
• The fact that some states, including Massachusetts and Arkansas, have put federal Medicaid support funds toward homecare.
• The Centers for Medicare & Medicaid Services (CMS) has provided several waivers to conditions of participation, including putting aside requirements for in-person aide supervision.
• OASIS E has been placed on hold until at least Jan. 1, 2022 and possibly longer depending on when the public health emergency concludes.
• CMS has paused surveys, claim audits and expansion of the Review Choice Demonstration Program.

Another bright spot, he said, is that homecare providers were given 10 million of the 150 million rapid COVID-19 tests deployed by the federal government—a clear sign of the broader public recognition of the value of homecare and hospice.

“We have gained strength and stature within the public and the health care system overall,” he said. “There has been absolute exponential increase in respect for what we do in the home setting.”

Yet there are a number of items still on NAHC’s to-do list, including:

• The latest version of the coronavirus stimulus package, which Dombi said may come during a lame duck session
• Continued funding for provider relief
• A move to get revisions to the Medicare home health benefit to have palliative care recognized
• Countering a Medicare Advantage carve-in for hospice
• Finalizing the home health payment rule and rolling back the 3.46% behavioral adjustment
• Focuses on personal care, a consumer tax credit for the purchase of care in the home, and private duty nursing services

Dombi and NAHC Board Chair Mary Carr also said the organization has committed itself to having it and its members undertake “meaningful and rigorous self-examination” when it comes to combatting racism and prejudice in the industry. He said NAHC is working to establish an 11-member diversity task force.