CDPHE Intends Soon To Update Rules To Match This Week's Relief from CMS

Posted: April 3, 2020

The Colorado Department of Public Health and Environment Is working to match "blanket waivers and additional guidance" issued this week by CMS that would allow Colorado licensed and certified agencies to move forward without fear of related deficiencies in mandated surveys later. 

"We want to align with CMS waivers," said Cheryl McMahon, CDPHE's Home & Community Facilities Branch Chief.  McMahon said she expected an amended waiver to be issued through CDPHE's portal either today or early next week. 

CMS earlier this week waived some significant provisions of the home health Conditions of Participation, including:

  • The initial evaluation under 484.55 (a) will not require an on-site visit and may be conducted remotely or through medical review. This does not apply to the comprehensive assessment requirement under 484.55(b). Allowing HHAs to conduct the initial evaluation in this manner will help agencies comply with 48-hour rule for the initial evaluation visit if agencies are required to conduct an on site visit to determine eligibility and immediate care.
  • The requirement to submit the comprehensive assessment within 30-day of the date of completion is waived, and CMS will allow HHAs complete the comprehensive assessment.
  • 14-day HCA supervisory visits are waived during the public health emergency (PHE). CMS encourages HHAs to use virtual technology.
  • Several coverage and payment requirements have also been waived that include extending the time frame for auto-cancellation of requests for advanced payments (RAPs), NPPs may certify and write orders for home health services; physician face-to-face encounters may be conducted using two-way audio/visual communication; homebound status based on a physician order indicating that leaving the home is medically contraindicated; extended time frame for request for advanced payment auto cancel.
  • Agencies may provide visits through telehealth or any two audio/visual technology and not be subject to HIPAA compliance enforcement. The visits must be ordered by the physician and on the Plan of Care. Telehealth may substitute for an ordered on-site visit. Unfortunately, agencies may not receive reimbursement for telehealth visits.
  • Flexibilities under Medical review include halting targeted probe and educate reviews. Any additional documentation request (ADR) that has been requested will be withdrawn and the claim will process and be paid. CMS is pausing review choice demonstration (RCD) in Illinois, Ohio, and Texas . North Carolina and Florida will not begin on May 4, as previously scheduled. All claims submitted will be processed and paid and not be subject to a 25 percent reduction. Agencies wanting to continue with pre-payment review under RCD may do so.

McMahon spoke Thursday afternoon on a CDPHE call for trade associations representing home care, hospice, assisted living centers, nursing homes, skilled nursing facilities, EMS and paramedics, and other health-care providers and first responders. 

On the same call, CDPHE officials addressed testing of health-care workers by noting that CDC guidance remains that -- owing to a scarcity of tests -- workers must be symptomatic prior to receiving testing. Some hospice and home-care agencies already report they are treating COVID-19 positive patients, and the state has identified nursing homes and other senior living centers with COVID-19 -positive residents.