Preparing for Home Healthcare in a Post-COVID World: What Will Stay and What Will Go

As the COVID-19 Public Health Emergency (“PHE”) approaches the three-year mark, what initially seemed like the “new” normal seems closer to just plain normal for many healthcare providers. As a result, while the Department of Health and Human Services (“HHS”) has committed to giving healthcare providers and patients 60 days’ notice before ending the PHE, the Centers for Medicare & Medicaid Services (“CMS”) has wisely urged stakeholders to prepare for the end of the various waivers and flexibilities. While many of these flexibilities were concessions to facilitate patient access to care based on the extraordinary circumstances under the PHE, other waivers appear to have triggered actual shifts in HHS policy.

On September 1, 2022, CMS issued several provider-specific fact sheets, which will be helpful to providers seeking to re-visit their policies and practices to ensure compliance with Medicare billing and quality requirements post-PHE. Highlights from the Home Health Agencies fact sheet include the following reminders:

  • While face-to-face encounter visits may continue to be conducted via telehealth “irrespective of the COVID-19 PHE,” the 1135 waivers largely responsible for expanding telehealth during the PHE by easing the Medicare “originating site” restrictions to allow patients to receive telehealth services in their homes will expire the first day after the 151st day following the end of the PHE.
  • CMS guidance that a patient may be considered “homebound” based on their physician’s determination that they cannot leave the home because of a COVID-19 diagnosis (confirmed or suspected) or the patient’s increased susceptibility for contracting COVID-19 is not a change in the homebound definition and will apply “irrespective of the COVID-19 PHE.”
  • Regulations at 42 C.F.R. § 409.43 have been codified to permanently allow certain non-physician practitioners, including nurse practitioners, clinical nurse specialists, or physician assistants, to certify/re-certify patient eligibility and order and establish a home health plan of care.
  • All postponed onsite visits for the annual training and assessment of home health aides must be completed by the registered nurse or other appropriate skilled professional no later than 60 days after the expiration of the PHE, and the waiver of this requirement will end at the conclusion of the PHE.
  • The waiver of nurse (or other professional) onsite visits for home health aide supervision every two weeks will end at the conclusion of the PHE, but the Calendar Year Home Health Prospective Payment System Final Rule allows for one virtual supervisory visit per 60-day episode for patients receiving skilled care under rare circumstances. For patients receiving non-skilled care, the nurse must make onsite (in-person) visits every 60 days to ensure the home health aide services are meeting the patient’s needs and provide a semi-annual supervisory direct observation visit for each patient receiving home health aide services.

Providers may review the September 1, 2022, fact sheet in its entirety here.

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