As previously promised, Secretary Becerra gave more than 60-days’ notice prior to the end of the Public Health Emergency on May 11, 2023. CMS is encouraging health care providers to prepare now for the end of these flexibilities and to begin moving forward to reestablishing previous health and safety standards and billing practices.

CMS also released updated fact sheets summarizing the current status of Medicare Blanket waivers and flexibilities by provider type: Home Health: Flexibilities to Fight COVID-19.

We took a deeper look at the home health fact sheets and found several items to highlight. We’ve previously reported on the workforce related timelines which members can review in detail here.

Telehealth

• Telehealth Originating Site: CMS clarifies the required face-to-face encounter for home health can be conducted via telehealth (i.e., 2-way audio-video telecommunications technology that allows for real-time interaction between the physician/allowed practitioner and the patient) when the patient is at home. The face-to-face encounter can be conducted via telehealth irrespective of the COVID-19 PHE; however, the waiver only extends the “originating site” to the patient’s home during the duration of the COVID-19 PHE unless changed by Congress. In December, Congress extended the originating site waiver until December 31, 2024.
  • LeadingAge has reached out to CMS to correct this issue in the new waiver fact sheet. LeadingAge will be working with Congress on any future extensions of this flexibility or the permanent inclusion of this flexibility in statute.

• NEW Reporting Home Address: During the PHE, CMS allowed practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location. When the PHE ends, practitioners will be required to resume reporting their home address on the Medicare enrollment.
  • LeadingAge is following up with CMS on clarification of how this impacts clinicians who work on behalf of Part A settings like Home Health and are not billing for Part B services.

Patient Information Sharing

• Detailed Information Sharing for Discharge Planning for Home Health Agencies: CMS has been waiving the requirements of 42 CFR §484.58(a) to provide detailed information regarding discharge planning, to patients and their caregivers, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, (another) home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) quality measures and resource use measures. This temporary waiver provides facilities the ability to expedite discharge and movement of residents among care settings. CMS is maintaining all other discharge planning requirements. CMS will end this waiver at the conclusion of the COVID-19 PHE.
  • On May 11^th, 2023 HHAs will need to share detailed information regarding discharge planning to patients and caregivers regarding the selection of post-acute care providers. HHAs are advised to review their current processes and procedures to ensure this is part of the discharge planning process.

• Clinical Records: CMS extended the deadline for completion of the requirement at 42 CFR §484.110(e), which requires HHAs to provide a patient a copy of their medical record at no cost during the next visit or within four business days (when requested by the patient). Specifically, CMS has allowed HHAs ten business days to provide a patient’s clinical record, instead of four. CMS will end this waiver at the conclusion of the COVID-19 PHE.
  • On May 11^th, 2023 HHAs will have four business days to provide patients a free copy of their medical records. HHAs are advised to review their current processes and procedures to ensure they can meet the four business day timeline.

Quality

• Quality Assurance and Performance Improvement (QAPI): CMS has modified the requirements at §484.65 for HHAs, which require these providers to develop, implement, evaluate, and maintain an effective, ongoing, HHA-wide, data-driven QAPI program. Specifically, CMS modified the requirements at §484.65(a)–(d) to narrow the scope of the QAPI program to concentrate on infection control issues, while retaining the requirement that remaining activities should continue to focus on adverse events. The requirement that HHAs maintain an effective, ongoing, agency-wide, data driven QAPI programs will remain. CMS will end this waiver at the conclusion of the COVID-19 PHE.
  • Before May 11^th, 2023 HHAs that utilized this waiver will have to reevaluate their QAPI programs to ensure have to ensure the programs capture all elements of 484.65(a)–(d) beyond infection control and adverse events.
• OASIS Reproting Reporting: CMS provided relief to HHAs on the timeframes related to OASIS transmission by 1) extending the five-day completion requirement for the comprehensive assessment to 30 days; and 2) waiving the 30-day OASIS submission requirement. Delayed submission is permitted during the PHE. CMS also allows 30 days for the completion of the comprehensive assessment. HHAs must submit OASIS data prior to submitting their final claim in order to receive Medicare payment. CMS will end this waiver at the conclusion of the COVID-19 PHE.
  • On May 11^th, 2023 HHAs will have five calendar days to complete the comprehensive OASIS assessment and submit the OASIS within 30 days of completing the assessment of the beneficiary. HHAs are advised to review their current processes and procedures to ensure completion of the comprehensive assessment within five calendar days and submission within 30-days. For some agencies, this may require looking at current staffing models to ensure coverage and assessment of new admissions in a timely manner.
• Home Health Quality Reporting Program: HHAs are exempted from the Home Health Quality Reporting Program reporting requirements. The time period covered by this exemption was October 1, 2019 through June 30, 2020. HHAs that did not submit data for those quarters will not have their annual market basket percentage increase reduced by two percentage points. CMS delayed the compliance dates for collecting and reporting the Transfer of Health Information quality measures and certain standardized patient assessment data elements (SPADEs) adopted for the HH Quality Reporting Program. HHAs were required to begin collecting the Transfer of Health Information quality measures and certain SPADEs on January 1, 2023 with the implementation of OASIS-E.

Workforce

• Allow Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessment for all Patients: CMS has been 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 allowed 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 Consolidated Appropriations Act of 201 and subsequent CY 2022 Home Health Prospective Payment System Final Rule (CMS 1747-F), permanently allow occupational therapists to complete the initial and comprehensive assessments for patients when rehabilitation therapy service is the only service ordered. CMS will end this waiver at the conclusion of the COVID-19 PHE.
  • On May 11^th, 2023 HHAs will no longer be able to use OTs/PTs/SPLs to complete the initial or comprehensive assessment when the home health is ordered for nursing services only, even if therapy is part of the plan of care. HHAs are advised to review their current processes and procedures to ensure nurse staffing is available for the completion of nursing service only admissions. For some agencies, this may require looking at current staffing models to ensure coverage and assessment of new admissions in a timely manner. LeadingAge will be working with Congress on future extensions of this flexibility or the permanent inclusion of this flexibility in statute.

• NEW State Licensure: During the PHE, CMS allowed licensed physicians and other practitioners to bill Medicare for services provided outside of their state of enrollment. CMS has determined that, when the PHE ends, CMS regulations will continue to allow for a total deferral to state law. Thus, there is no CMS-based requirement that a provider must be licensed in its state of enrollment.
  • On May 11^th, 2023, HHAs and their employed clinicans will need to defer to individual state laws on whether or not a clinican can practice outside their state of enrollment.

• Workforce Training Updates: CMS made a number of clarifications regarding when home health and hospice agencies must come into compliance with waivers regarding workforce. LeadingAge urges its members to start preparing to do the necessary trainings and assessments in order to be back in compliance in a timely manner. LeadingAge previously reported on these changes here.