In The News

Elizabeth Hogue: Hospital Discharge Planners Risk Disciplinary Action by State Licensure Boards

Posted: April 8, 2020
A key manager at a home health agency recently related an instance that seems like a clear failure to comply with applicable standards for discharge planning from hospitals. The manager said that the Agency received a referral from a hospital and subsequently admitted the patient. Two days after the patient was admitted to the Agency, the hospital notified the Agency that the patient was positive for COVID-19!
So, the staff members who visited this patient were then quarantined. The Agency notified the state health department whose staff contacted all of the patients seen by staff members who also visited the patient who tested positive for COVID-19. All of the patients were quarantined.
Apart from the significant facts that the Agency now has fewer staff members to care for patients, patients are inconvenienced, and patients and caregivers may contract the virus with possibly dire results, this conduct is a clear violation of applicable standards of care for discharge planning for hospitals.
The Centers for Medicare and Medicaid Services (CMS) recently issued new Conditions of Participation (COPs) for hospitals. These new rules were effective on November 29, 2019. New COPs for hospitals are applicable to acute care hospitals, long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), inpatient psychiatric facilities, children's hospitals, cancer hospitals, and critical access hospitals (CAHs). COPs for hospitals now generally require the discharge planning process to include:
  • Transfer and referrals of patients along with necessary medical information at the time of discharge to appropriate post-acute (PAC) services providers and suppliers, facilities, and agencies and to other patient service providers and practitioners responsible for patients' follow-up or ancillary care
  • Provision of necessary medical information to receiving facilities or appropriate PAC providers and practitioners responsible for patients' follow up care after patients are discharged from hospitals or transferred to other PACs or, for HHAs, other HHAs
A diagnosis of COVID-19 surely qualifies as "necessary medical information" that must be provided by discharge planners/case managers to PAC providers when patients are discharged from hospitals. Anecdotally, PAC providers; including home health agencies, hospices, private duty agencies HME companies, skilled nursing facilities (SNFs) and assisted living facilities (ALFs); have complained for many years that hospital discharge planners/case managers do not provide essential information when patients are referred to them. This instance certainly seems to be an egregious example of these complaints!
Hospital discharge planners/case managers may be disciplined for their failure to meet applicable standards. Most hospital discharge planners/case managers are licensed nurses or social workers. They are subject to discipline by state licensure boards. Provided with the facts described above, it seems highly likely that state licensure boards will discipline hospital discharge planners/case managers for these types of lapses.
Hospital discharge planners/case managers must now be meticulous about providing essential information to PAC providers when patients are discharged. The stakes are high for patients, caregivers and for hospital discharge planners/case managers themselves! 
©2020 Elizabeth E. Hogue, Esq.  All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author.

Home Care Telehealth Waiver Now Open to Certified Agencies

Posted: April 6, 2020

The Colorado Department of Public Health & Environment on Friday sent the below communication through its portal making available to all Class A and Class B Home Care Agencies the waiver application for "observation, supervision, and evaluation requirements" through telehealth methods. It's republished here for those agencies who may not have timely received it. 

On March 31st, the Division made a waiver application available for licensed-only agencies to meet specified observation, supervision, and evaluation requirements through telehealth methods rather than in-person or on-site. The waiver also allowed certain therapy services to be provided via interactive audiovisual connections. At the time the application was distributed, CMS certified home health agencies were not eligible to apply due to limitations in CMS regulations. CMS has begun issuing waivers of some requirements, so the Division is now making the waiver application available to all Class A and Class B Home Care Agencies.  Please note that CMS certified agencies must continue to comply with certification requirements, and must only implement the waiver of state regulations to the extent allowable under current CMS regulations and waivers.

The waiver application can be found here:   Homecare Telehealth Waiver

Similar to the waiver distributed on March 31, 2020, due to the need to respond to the COVID-19 pandemic and protect both healthcare workers and homecare clients, the Division will expedite this waiver process.  Successful waiver applications will receive approval within 2 days after submission. Division staff will contact agencies with any questions.

Licensed-only facilities that have already applied for a waiver using the form distributed March 31, 2020, do NOT need to submit this waiver application.

CDPHE continues to explore additional options to ease the burden for providers during this public health emergency.  We will provide updates as they become available.

For questions or assistance with the application process, contact Cheryl McMahon ([email protected]). 

--- Cheryl McMahon, Branch Chief, Home and Community Facilities Branch Chief


HHAC's Appeal For Higher Medicaid Rates Published In 'Colorado Politics'

Posted: April 6, 2020

The Home Care & Hospice Association of Colorado's appeal for higher Medicaid reimbursement was published at, Colorado's leading news site dedicated to political news and analysis 

"Even before the coronavirus outbreak, home-based care providers faced big challenges," wrote Don Knox, HHAC's executive director. "Medicaid reimbursement rates have not kept pace with the cost of recruiting and retaining care providers, making it difficult for many home health and personal care agencies to continue to offer services to Medicaid patients. If these providers are no longer able to serve Colorado’s Medicaid population, the cost of health care goes up as people are forced to seek care in more expensive settings that are nearing a breaking point."

Knox added that to prevent the state’s vulnerable Medicaid population from being locked out of access to safe, cost-effective home health and personal care, reimbursement rates must be updated to keep pace with the rising costs that all health care sectors have experienced.

"More than ever, the time to act is now," he wrote. 

Full story



Members: Join the COVID-19 Discussion Circle TODAY

Posted: April 6, 2020

HHAC has launched a COVID-19 Discussion Circle. Click here to join the circle and to immediately start a discussion thread or reply to a discussion post. You must be signed in as a member to view. 

The COVID-19 is one of a number of discussion circles available at the Home Care & Hospice Association of Colorado website. Others are Background Checks, Electronic Visit Verification, Best Practices, Private Pay and West Slope Forum. See all the discussion circles here.

To find discussion circles in the future go to the HHAC website > Member Center > My Community > View All Circles




Business-Relief Programs Available Under The CARES Act

Posted April 3, 2020

The Coronavirus Aid, Relief, and Economic Security (CARES) Act provides assistance to small businesses impacted by COVID-19. Congress did not, however, provide a one-size-fits-all solution, according to the Denver law firm Brownstein Hyatt Farber Schreck. Instead, small businesses must determine their eligibility for various assistance programs. 

This guide from the law firm outlines the provisions in the Act to help small businesses determine whether to proceed with an application for a loan, how to claim an elective tax incentive, and how to comply with certain changes in the tax code.

Here are elements of the CARES Act that HHAC has culled from resources it believes to be reliable: 

  • The Paycheck Protection Program (“PPP”) authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. All loan terms will be the same for everyone. Fact sheet
  • The SBA offers Economic Injury Disaster Loans to help small businesses meet working capital needs caused by a natural disaster. The loans may be used to pay fixed debts, payroll, accounts payable, and other bills that could have been paid had the disaster not occurred.
  • The SBA's Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing.
  • For small businesses with current non-disaster SBA loans, under the CARES Act, the SBA will cover all loan payments on these loans, including principal, interest, and fees, for six months. This relief will also be available to new borrowers who take out loans within six months of March 27, 2020.
  • The CARES Act provides that employers and self-employed individuals may defer payment of the employer share of payroll taxes owed on wages paid for the period ending December 31, 2020.
  • The Federal Reserve also indicated it would be announcing a new Main Street Business Lending Program to support lending to eligible small and mid-sized businesses. For its part, the CARES Act clarifies that the mid-sized businesses facility that it has authorized does not limit the Federal Reserve’s discretion in establishing other programs and facilities within the Federal Reserve’s authority, including such Main Street Business Lending Program. As of March 29, 2020 the Main Street Business Lending Program has not been formally announced by the Federal Reserve.
  • The Employee Retention Credit is a fully refundable tax credit for employers equal to 50 percent of qualified wages (including allocable qualified health plan expenses) that Eligible Employers pay their employees. This Employee Retention Credit applies to qualified wages paid after March 12, 2020, and before January 1, 2021. The maximum amount of qualified wages taken into account with respect to each employee for all calendar quarters is $10,000, so that the maximum credit for an Eligible Employer for qualified wages paid to any employee is $5,000.
  • The CARES Act, in Section 2108, provides funding for those states with existing short-time compensation programs and says that the federal government will fully fund the amount of short-time compensation paid under a state's short-time compensation program.
  • The CARES Act has changed the treatment of Net Operating Losses (NOLs) that are generated in tax years 2018, 2019, and 2020 to permit them to be carried back up to five years. This will allow for an immediate claim for refund for taxpayers who had taxable income during the carryback time period
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