Two new CMS rules


Therapists may perform assessments for now; NPs and PAs may certify eligibility beyond pandemic

Home care providers are welcoming two new regulatory changes – one permanent and one temporary – which are expected to make it less burdensome to begin home health services for eligible patients. One rules change determines who can certify patients for home health services for the rest of the pandemic and beyond while the other change is temporary, affecting who can perform the initial or comprehensive assessment for the duration of the current COVID-19 public health emergency. A permanent change The permanent rules change allows nurse practitioners, clinical nurse specialists and physician assistants to certify patient eligibility for home health services. Previously, only physicians were allowed by the Centers for Medicare and Medicaid Services (CMS) to certify patients. “This change is a permanent one because of a change to Social Security law,” said J’non Griffin, owner and president of Home Health Solutions, a nationwide outsourcing and consulting firm for home health, hospice and long-term care. U.S. Congress amended sections 1814 (a) and 1835 (a) of the Social Security Act in late March when it passed Coronavirus Aid, Relief and Economic Security legislation known as the CARES Act. Legislation making this change was already under consideration by Congress prior to the declaration of the public health emergency. Even though federal legislation paved the way for CMS to allow non-physician practitioners to certify home health patients, agencies will need to make certain state regulations do not get in the way, J’non said. “Every state has its own scope-of-practice regulations which must be followed, and there is no continuity from state to state,” she said. “Many states have temporarily suspended state regulations right now to allow providers to practice at the top level of their license, waiving the usual supervision requirements. But not all states.” Even among states which have suspended usual requirements, J’non said there is little conformity. “Some states require practitioners to have a certain length of supervised experience to practice without physician supervision, and they have reduced the length-of-time requirement during the public health emergency. But that length of time varies from state to state. It may be 1.5 years in one state and 3 years in another. For compliance, agencies will need to determine what the rules are for their particular state. “ They will also need to be aware that the rules for their state will change again when the public health emergency ends, J’non said. A temporary change CMS has updated its FAQs on the blanket waivers issued for the duration of the public health emergency to allow occupational therapists, physical therapists and speech language pathologists to perform initial and comprehensive assessments on home health patients when both nursing and therapy are ordered. The change was made late last week. CMS is 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. Existing regulations at § 484.55(a) and (b)(2) are not affected, and therapists will not be permitted to perform assessments in nursing- only cases. “Unlike the change in who is allowed to certify home health eligibility, this is a temporary change,” J’non said. “It will apply only for the duration of the public health emergency. CMS would have to actually change the regulations in order for it to become permanent, so for right now this is still a temporary change.” As with the change in who can certify patients for home health, the change allowing therapists to perform initial and comprehensive assessments is subject to state scope-of-practice regulations. Therapists will need to have a registered nurse or other professional complete any sections of the assessment beyond their scope of practice. “CMS has said it expects home health agencies to match the appropriate discipline performing the assessment to the needs of the patient to the greatest extent possible,” J’non said. To read the updated FAQs, click here.

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