Bill changes home care rules

Congress enacts new regulations for home health and hospice as part of coronavirus relief package

A coronavirus relief package passed by Congress today re-writes some long-standing home health rules as home health braces for an influx of COVID-19 patients from overflowing hospitals. New rules included in the $2 trillion bill known as the Coronavirus Aid, Relief and Economic Security (CARES) Act will allow certain non-physician providers to certify all home care patients and relax some of the criteria used to determine homebound eligibility so that more patients can be seen. “These changes are expected to make it easier for home health agencies to see more patients and help mitigate the risks of contacting COVID-19,” said J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm for home health, hospice and long-term care. “Additionally, it will now allow hospice providers to use telehealth to secure the face-to-face encounter between physician and patient which is required for hospice re-certification,” J’non said. Home health providers already had permission from the Centers for Medicare and Medicaid Services (CMS) to rely on telehealth for the face-to-face encounter in an attempt to minimize the risk of infection for homebound patients whose underlying medical conditions often place them at increased risk for COVID-19. The CARES measure passed the U.S. House of Representatives on a voice vote this morning and was sent to President Trump, who signed it late this afternoon. The changes will not become effective until CMS announces an effective date, J'non said, and may not be permanent. Here’s a look at some of the important ways in which the CARES package will affect home health: 1. Certifying patients just got easier. A strict rule requiring only a physician to certify patients for home health services has been relaxed. Nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs) are now able to certify eligibility for home health. Legislation to allow these other non-physician practitioners to certify home health patients has been pending since April 2019 as part of the Home Health Care Planning Improvement Act of 2019. “This important change already had bi-partisan support in Congress, but had not yet passed,” J’non said. “The CARES bill just incorporated the proposal from the pending legislation to allow non-physicians to be able to certify patients. “ Expanding certification privileges to NPs and PAs is expected to be of particular benefit in rural areas lacking physicians and will be of even greater value in a health care system over burdened by COVID-19 cases, according to J'non. 2. Expect a slight pay increase. Agencies should see a 2 percent increase in Medicare reimbursement starting May 1 and continuing through Dec. 31 2020, as CMS pauses the sequestration process for all fee-for-service Medicare providers. Sequestration is a 2 percent penalty imposed upon Medicare under the Budget Control Act of 2011, which was passed by Congress to reduce federal spending by $1.2 trillion over a nine-year period. The Medicare penalty became effective two years later, in 2013, and was expected to continue through 2022. The stimulus bill which passed today suspends sequestration for eight months. 3. Use telehealth for the F2F.

The CARES Act allows hospice providers to perform face-to-face encounters via telehealth. Home health providers already had permission from CMS to do this, as of last week.

But CARES stopped short of allowing providers to use telehealth in place of regular visits and be paid for doing so.

“Right now, it’s just for the face-to-face,” J’non said. “There is an emergency rule which is still being reviewed by the Office of Management and Budget, and that rule would allow the use of telehealth for more than just the face-to-face. But that rule was not part of the CARES package which passed today.” J'non said CMS has not made it clear how much agencies would be reimbursed for using telehealth in place of regular visits.

CMS confirmed last week that home health providers are included in a telehealth policy waiver and will be allowed to use telehealth to meet Medicare’s face-to-face requirements for episodes of care beginning March 6 through the remainder of the COVID-19 health crisis. But CMS representatives also warned that telehealth should not be used by agencies in place of regular in-person visits.

“That’s the latest word until the emergency rule makes it out of the OMB,” J’non said.

The Office of Civil Rights followed the telehealth waiver with a fact sheet outlining the types of platforms which will and will not be acceptable for telehealth purposes. Approved platforms include Apple’s Facetime, Facebook Messenger video chat, Google Hangouts video, Whatsapp video chat, or Skype.

Even some common texting applications such as Signal, Jabber, Facebook Messenger, Google Hangouts, Whatsapp, or iMessage have the green light from the Office of Civil Rights.

However, agencies should refrain from usingTikTok, Facebook Live, Twitch, or a chat room like Slack.

“The difference is based on whether the platforms are designed to be open to the public or allow wide or indiscriminate access to the communication,” J’non said. “To be acceptable, the platform must allow only an individual and the person with whom the individual is communicating to see what is transmitted.”