HHS Renews Public Health Emergency, Keeping Key Home Health Waivers in Place

Home Health Care News / By Robert Holly
 
The U.S. Department of Health and Human Services (HHS) on Wednesday opted to renew the COVID-19 public health emergency (PHE), keeping in place several regulatory waivers that have been critical lifelines for home health and hospice operators since the start of 2020.
 
While the extension itself is not surprising, it offers further stability as operators struggle with workforce shortages and general inflation, among other challenges. On top of that, the move gives hospital-at-home stakeholders extra time under the Acute Hospital Care at Home waiver, as they work on gaining support for corresponding legislation in both the House and Senate.
 
The PHE has been repeatedly renewed since implemented by the Trump administration over 24 months ago.
 
Without action from HHS and the Biden administration, it was set to expire on April 16.
 
“With more than two years having passed since the COVID-19 pandemic began in early 2020, questions are being raised about when to end the public health emergency declarations made by the federal government early on, with some advocating for their extension and others calling for their expiration,” Kaiser Family Foundation experts wrote in a recently released issues brief. “There are numerous implications to ending these emergency declarations.”
 
Wednesday’s extension is for another 90 days, which will carry the PHE into July.
 
Under the PHE, federal regulators have waived or modified normal requirements for Medicare and Medicaid providers, plus private health insurers. While some waivers have focused on reducing reporting and supervision requirements, others have revolved around new telehealth allowances and funding support.
 
Medicare-certified home health agencies, in particular, have had access to a long list of waiver flexibilities…

Read Full Article

Public Health Emergency Renewed to July 15, 2022

Last Wednesday, U.S. Health and Human Services Secretary Xavier Becerra renewed the COVID-19 public health emergency declaration, effective April 16.

HHS will provide states and territories with no less than 60 days’ notice prior to the termination of the public health emergency declaration for COVID-19. In the meantime, certain waivers from the Centers for Medicare and Medicaid Services for certain requirements under section 1135 of the Social Security Act will continue to be in effect. Read the latest at COVID-19 public health emergency declaration renewal.

CMS Revises Manual Instructions for the NOA and Allowed Practitioners

From NAHC

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12615 that incorporates policies for the implementation of the  Notice of Admission (NOA) and the subsequent elimination of the Request for Anticipated Payment (RAP). The NOA became effective January 1, 2022.

The CR also provides corrections and clarifications regarding who may sign the certification and plan of care  for home health beneficiaries at section 30.2.1 of the Medicare Benefit Policy Manual.

CMS has not altered any of the policies around the contents, criteria for submission, and untimely submission policy of the NOA.

The revisions in the CR to section  30.2.1 – Definition of an Allowed Practitioner, incorporates the requirements for physician assistant, nurse practitioner, and certified nurse specialist at §410.74, §410.75 and §410.76 respectively. These same requirements are incorporated into the home health Conditions of Participation  at §484.2- Definitions.  CMS has not changed their policy around defining these non-physician practitioners but providing consistency in their policies on the requirements for PAs, NPs and CNSs.

CMS permits these NPPs to practice with in their scope of practice in accord with state laws. Several states do not require a collaborative agreement or other documentation of collaboration with a physician, while other states have specific collaborative arrangement requirements for which NPPs must   comply with when caring for home health patients.  However, where the state is silent on collaboration for an NP and CNS,  CMS, in accord with§ 410.75(c)(3)(ii) and §410 .76(c)(3)(ii),  requires  that the practitioner have  documentation  on her/his scope of practice and some information on how she/he deals with patients whose needs are outside the scope of practice for an NP or CNS as evidence of collaboration, but CMS does not require a collaborative agreement with a physician. 

• 410.75 (c)(3)(ii). In the absence of State law governing collaboration, collaboration is a process in which a nurse practitioner has a relationship with one or more physicians to deliver health care services. Such collaboration is to be evidenced by nurse practitioners documenting the nurse practitioners’ scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice. Nurse practitioners must document this collaborative process with physicians.

• 410.76(c)(3)(ii). In the absence of State law governing collaboration, collaboration is a process in which a clinical nurse specialist has a relationship with one or more physicians to deliver health care services. Such collaboration is to be evidenced by clinical nurse specialists documenting the clinical nurse specialists’ scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice. Clinical nurse specialists must document this collaborative process with physicians.

The National Association for Home Care & Hospice (NAHC) is somewhat puzzled why CMS chose the phrase  “….however, a CNS and NP must work in collaboration with a physician in accordance with §§ 410.76(c) and 410.75(c) even if state laws governing collaboration do not exist.”  to describe the requirements for collaboration where the state is silent.

NAHC will be requesting information from CMS on compliance expectations for the revised manual changes at section 30.2.1 , particularly what the Medicare contractors will be looking for during medical review.

Home Health Agencies Should Brace for PDGM Battle Later This Year

Home Health Care News / By Patrick Filbin
 
Home health providers should brace themselves for a potential Patient-Driven Groupings Model (PDGM) battle with the U.S. Centers for Medicare & Medicaid Services (CMS) later this year.
 
Implemented on Jan. 1, 2020, PDGM is the largest overhaul to how Medicare-certified home health agencies are paid in two decades. And normally when CMS implements something of this magnitude, there are ongoing tweaks and changes to make sure reimbursement is fair to both the government and providers.
 
That balancing act is even more important with PDGM, which must be budget neutral, as mandated by Congress.
 
Yet because of the COVID-19 pandemic, any major recalibrations or corrections to PDGM’s foundation have, so far, been delayed, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi. That could begin to change later in 2022, when CMS is gearing up to release its proposed payment rule for 2023.
 
“We’ve been having those conversations for three years,” Dombi told Home Health Care News during an interview at the Capital+Strategy conference. “We had those conversations before PDGM was put into the law because we knew, going down the pike, you’re going to be seeing what we’re facing from a Medicare home health priority perspective.”
 
Typically, CMS releases its proposed payment rule in late June or early July. With two years of PDGM observations and the public health emergency starting to wane, the agency may float big adjustments at that time.
 
“The concept [of budget neutrality] is a lot easier to state than it is to apply,” Dombi said. “The application of it, right now, has been … kicked down the road for a couple of years with the explanation being, ‘The data is not yet sufficient for us to make the judgment on it.’ The data will be sufficient for 2023.”
 
Now, Dombi said, CMS will be determining what the methodology is for determining whether the budget has been neutral or not.

Rad Full Article