1. Home health & Hospice Staff Exempt from Family First Coronavirus Act Labor Requirements:

Over the weekend the U.S. Department of Labor added a clarifying statement to exempt health care workers from FMLA.  The definition: “a health care provider is anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, employer, or entity. This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.”

2. CARES ACT Changes:

• NPs & PAs can now certify eligibility for the home health benefits and to establish and manage the Plan of Care provided such is allowable under state practice laws (this is not a temporary change, this is permanent)!!! 13 year effort, FINALLY passed!
• Eliminates the 2% sequestration  for Medicare Services
• 100 billion dollars to cover unreimbursed health care related expenses and lost revenue attributed to the public health emergency
  • 2 loans under SBA (Small Business Administration)
    • 1) the SBA disaster relief loan

Visit: https://www.sba.gov/funding-programs/disaster-assistance

• 2) the SBA payroll protection loan* (this is the loan that will support the 100 billion allotted in congress, this loan can turn into a grant based off of the number of employees you have kept/ not laid off for a certain period of time
  • *** The rules for this loan are still being written, in the meantime start working with a larger bank on an application, some banks are starting the process NOW

 

3. Home Health CMS changes:

• Telehealth: NO reimbursement for telehealth services; however, NAHC is working with CMS and Congress to address this issue
• CMS DOES allow for HHAs to record the cost of telehealth services in the cost report
• Limited option: HHAs contract with a physician or NPP to provide telehealth to patients and then the physician or NPP would bill for telehealth service and pay the contracted rate to the HHA
  • CMS cautions that such action would be a concern if it is done within a home health covered episode
• CMS encourages HHA to use telehealth to potentially reduce costs; however it MUST be physician ordered rather than the HHA choosing to substitute telehealth when in person visits are ordered

 

4. Additional changes:
   1. A definition of the home health “homebound” requirement that means that any individual determined by their physician to be at high risk of contracting Covid-19 virus due to a compromised health condition, meets the homebound requirement because it is “medically contraindicated” to leave the home.
   2. A waiver of numerous Conditions of Participation, including:
      1. Onsite visit for home health aide supervision
      2. In person initial patient assessments. Instead, HHAs can provide these assessments remotely or by record review
   3. Utilizing enforcement direction to permit non-physician practitioners (NP, PA, and CNS)  to certify eligibility for the home health benefits and to establish and manage the Plan of Care provided such is allowable under state practice laws.  This change was mandated at part of the CARES Act enacted into law last week. However, CMS has been able to accelerate its implementation through its enforcement discretion authority.
   4. Suspend all medical review audits other than in cases of fraud investigation
   5. Suspend the Review Choice Demonstration program. HHAs will have the choice to continue with pre-claim review if they wish. Other claims will be subject to possible post-payment review. RCD will not expand into Florida and North Carolina as originally planned for May.  No new date has been set for that expansion.

 

5. Hospice CMS changes:
   1. Allowance to use telehealth for the physician face-to-face encounter requirement. This was mandated as part of the CARES Act. However, CMS determined it had the authority to make that change under its own authority. Effectively, this action speeds up the implementation.
   2. Permit the billing of telehealth services by hospice physicians
   3. Waive the requirement for hospices to use volunteers
   4. Waive timeframes for updating comprehensive patient assessments extended the deadline from 15 to 21 days
   5. Waive the non-core services requirements that include physical therapy, occupational therapy, and speech-language pathology
   6. Waive the 14 day home health aide in-person supervisory requirements same as in home health
   7. Suspend all medical review audits other than in cases of fraud investigation

 

6. Medicare Accelerated and Advance Payment Program: CMS will provide accelerated payments to Medicare Part A and Part B providers impacted by COVID-19 pandemic to provide cash relief for up to three months. CMS will streamline the advance payment process to issue payment within 7 calendar days of request.

 

Please go to this website and submit a request: https://www.palmettogba.com/palmetto/providers.nsf/ls/JM%20Home%20Health%20and%20Hospice~BN4QDV1682?opendocument&utm_source=JMHHHL&utm_campaign=JMHHHLs&utm_medium=email

 

(information PER NAHC)

 

Helpful Links:

https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers

https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19

https://www.cms.gov/files/document/provider-burden-relief-faqs.pdf.