WASHIGTON, D.C. (May 13, 2020)—Late on Friday, May 8, 2020, the Centers for Medicare & Medicaid Services (CMS) updated its COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers document with welcome changes for home health agencies and hospices. CMS expanded the types of therapists able to perform the initial and comprehensive assessment for all home health patients to include PTs and SLPs in addition to OTs for the duration of the public health emergency, regardless of whether or not the service establishes eligibility for the patient to be receiving homecare. CMS also expanded the waivers of the Life Safety Code pertaining to hospice inpatient units, specifically alcohol-based hand-rub dispensers, fire drills and temporary construction sections of the LSC. NAHC has been advocating for the changes to the initial and comprehensive assessment. The updates are below.
Home Health Agencies
Allow Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs)to Perform Initial and Comprehensive Assessment for all Patients (Revised since 4/30Release)
CMS is waiving the requirements in 42 CFR §484.55(a)(2) and §484.55(b)(3) that rehabilitation skilled professionals may only perform the initial and comprehensive assessment when only therapy services are ordered. This temporary blanket modification allows any rehabilitation professional (OT, PT, or SLP) to 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, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. The existing regulations at §5/8/2020191484.55(a) and (b)(2) would continue to apply; rehabilitation skilled professionals would not be permitted to perform assessments in nursing only cases. We would continue to expect HHAs to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. Therapists must act within their state scope of practice laws when performing initial and comprehensive assessments, and access a registered nurse or other professional to complete sections of the assessment that are beyond their scope of practice. Expanding the category of therapists who may perform initial and comprehensive assessments provides HHAs with additional flexibility that may decrease patient wait times for the initiation of home health services.
Hospice Inpatient Units
Multiple Providers: Specific Life Safety Code (LSC) Waiver Information:
(New since 4/30 Release) CMS is waiving and modifying particular waivers under 42 CFR §482.41(b) for hospitals; §485.623(c) for CAHs; §418.110(d) for inpatient hospice; §483.470(j) for ICF/IIDs and §483.90(a) for SNF/NFs. Specifically, CMS is modifying these requirements as follows:
Alcohol-based Hand-Rub (ABHR) Dispensers: We are waiving the prescriptive requirements for the placement of alcohol based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control. However, ABHRs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers. This includes restricting access by certain patient/resident population to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area.
Refer to: 2012 LSC, sections 18/184.108.40.206. In addition, facilities should continue to protect ABHR dispensers against inappropriate use as required by 42 CFR §482.41(b)(7) for hospitals; §485.623(c)(5) for CAHs; §418.110(d)(4) for inpatient hospice; §483.470(j)(5)(ii) for ICF/IIDs and §483.90(a)(4) for SNF/NFs.
Fire Drills: Due to the inadvisability of quarterly fire drills that move and mass staff together, we will instead permit a documented orientation training program related to the current fireplan, which considers current facility conditions. The training will instruct employees, including existing, new or temporary employees, on their current duties, life safety procedures and the fire protection devices in their assigned area.
Refer to: 2012 LSC, sections 18/220.127.116.11.
Temporary Construction: CMS is waiving requirements that would otherwise not permit temporary walls and barriers between patients.
Refer to: 2012 LSC, sections 18/18.104.22.168.