BIRMINGHAM, Alabama (March 31, 2020)—Regulatory changes released in recent days by the Centers for Medicare & Medicaid Services (CMS) in response to COVID-19 are almost all “good news,” William Dombi, president of the National Association for Homecare and Hospice, said Wednesday. 

Dombi and NAHC staff called a webinar to discuss many of the changes, waivers and rule suspensions has announced since the public health emergency began. They said that there are still a number of questions to be answered and details to resolve, and that they are continuing to work with regulators and legislators to find additional assistance for home health care and hospice businesses. 

“This is not the end of what we expect to see as relief related to the pandemic,” Dombi said on the webinar, which had more than 3,000 attendees. “This is just the start.” 

Highlights include: 

Dombi said reimbursement for telehealth was probably advocates’ first priority. 

“Our goal was to get telehealth visits to be recognized as the payment equivalent to face-to-face visits,” he said. CMS didn’t go quite that far, expressing concern that the time and cost of a telehealth visit is not equivalent to an in-person visit. 

Instead, the organization determined that home health agencies (HHAs) may provide all necessary telehealth services during the declared public health emergency, but telehealth services must be ordered by the physician or professional ordering care. Once an agency crosses the LUPA threshold with in-person visits, it will still receive its 30-day payment, even if the use of telehealth reduces their costs.

In addition, because the government has relaxed HIPAA enforcement, commonly available platforms like Skype, Facetime and Zoom may be used for telehealth. As of now, two-way live video is required, but there is an effort to allow telephone calls as well. 

Homebound Patients 
CMS accepted NAHC’s recommendations on considering most seniors presumptively homebound due to the need to protect this vulnerable population from infection. Now automatically classified as homebound are: 

  • Anyone who has tested positive with COVID-19
  • Anyone suspected to be infected who is quarantined, even if they are physically capable of leaving their home
  • Anyone qualified by a physician as being at risk of an infection, whether that’s because they have COPD or asthma or are at increased risk due to age. 

Non-physician Practitioners
Now, non-physician practitioners may order home health, establish a plan of care (POC), and certify or re-certify qualification for the home health benefit. Those professionals could be nurse practitioners, physician assistants or clinical nurse specialists. 

However, Dombi warned that practitioners will still be limited by state licensing and law, so make sure you’re aware of what your state allows. He said NAHC and state associaitions will be working to get states to waive some provisions or ensure there aren’t undue restrictions. 

He also said that the CARES Act will make this rule permanent after the epidemic, although CMS will need to implement it. 

Medicare Payments 
This measure is designed to keep funds flowing to HHAs that may be overburdened by keeping up with COVID or slowed down getting physician approvals and accelerates advanced payment to all providers (including hospitals and nursing homes). It will allow HHAs to estimate revenue for up to three months and get expedited payment. 

Dombi urged providers to be sensible in their estimates so they don’t end up having to pay CMS back. Medicare Administrative Contractors should have sent out additional instructions. 

Plan of Care
CMS is waiving the initial valuation requirement that requires an in-person visit within 48 hours of treatment being assigned to establish care needs. That meeting may instead be conducted remotely or through medical review. This will help with HHAs experiencing a surge of new patients. 

However, please note that the start of care comprehensive assessment must still be done as usual, said Mary Carr, NAHC’s vice president for regulatory affairs. While many agencies conduct the two tasks together, they are actually two different standards. 

The physician face-to-face encounter may also be conducted via telehealth. 

Review Choice Demonstration (RCD)
The demonstration has been paused in Illinois, Ohio and Texas and will be on hold in North Carolina and Florida until after the crisis. Claims submitted before March 29 will be processed “as usual”—although Carr said they are unsure what exactly that means—but claims after that date are not subject to RCD. HHAs may continue with prepayment review if they choose, but it is not required.