April 22, 2020

Additional Flexibility is Needed to Allow the Home Health Community to Care for Patients During COVID-19

Last week, the Partnership sent a letter to the Center for Medicare & Medicaid Services (CMS) Administrator Seema Verma applauding the agency’s work in response to COVID-19 and requesting additional regulatory flexibility.

Recent waivers, flexibilities and guidance have gone far toward assisting providers in continuing to provide necessary care to patients during this national public health emergency. This has helped to mitigate the upheaval that the home health provider community and patients have experienced. Yet, challenges persist.

Home health providers are experiencing significant difficulties in providing critically needed care to existing Medicare patients, a severe reduction in referrals, and an increase in low utilization payments. In addition, staffing challenges are widespread, with personal protective equipment (PPE) in short supply and increased costs for training, screening and other activities related to COVID-19.

In order to tackle these challenges, the Partnership is asking CMS to extend additional flexibilities to provide the necessary tools to the home health provider community to effectively care for patients:

Payment for Telehealth. CMS has encouraged and expanded the use of telehealth by many provider groups and allowed payment for it but has indicated it will not allow home health telehealth encounters to count as in-person visits for purposes of payment. While telehealth visits certainly do not take the place of in-person visits, during the COVID-19 crisis, it would make policy and public health sense to facilitate telehealth for home health providers by instituting a temporary payment mechanism to count them as in-person visits. CMS could achieve this in multiple ways:

  1. CMS could grant enforcement discretion with respect to Section 1895(e) to allow visits using technology to replace in person visits under the home health payment system.
  2. CMS could use an Administrative Order to provide some level of payment for virtual home health visits.
  3. CMS could establish through an interim final regulation the ability for home health agencies to be paid directly for an episode of virtual visits provided in conjunction with an established care plan.

Flexibility on Signed Orders and Certifications. In order for home health providers to be paid for care, a physician or nurse practitioner must sign written orders and certify that patients are eligible for home healthcare. Obtaining timely orders has always been a challenging part of documentation requirements, but the current crisis has made this an untenable situation and one that requires a whole new level of administrative burden. CMS could fix this by:

  1. Waiving or suspending the requirement that home health providers secure signed and dated physician orders and eligibility certifications during the COVID-19 pandemic emergency.
  2. Providing clarification surrounding the new plan of care requirement that requires documented care plan changes (signed by physicians) to allow for the incorporation of telehealth visits.

The home health industry is committed to playing an even larger role in the health care system’s response to mitigating and combatting the COVID-19 crisis. We stand ready to work with CMS in every way possible to help solve existing and emerging problems in the health care delivery system.

To learn more about the community’s response to COVID-19, click here.