In The News

Colorado Is Creating Guidelines To Help Make Excruciating Coronavirus Care Decisions

Posted: April 2, 2020

What if four patients in respiratory distress need a ventilator to keep them alive, but a hospital has just one available? Who makes that call? And how?

Public health and community leaders are contemplating excruciating dilemmas just like that before demand for medical help in the coronavirus crisis peaks in coming weeks, The Colorado Sun reports.

They’re updating protocols, called “crisis standards of care,” for the most urgent medical decision-making possible, guidelines to determine, as resources get scarce, who gets care and at what level and who does not.

Full story

 

 

Home Health Provider Feeling COVID-19 Heat: ‘We Are Not the Fire, We Are the Fire Department’

Posted: April 2, 2020

On Friday, Feb. 28, just after 10 p.m. PT, Brent Korte — chief home care officer at EvergreenHealth — got a call that changed everything. It was from his boss.

“She asked me if I was sitting down,” Korte told HomeHealthCareNews.com. “She told me that EvergreenHealth not only had patients who had tested positive for COVID-19, … but that a patient passed away in our hospital. This was the first death from COVID-19 in the United States.”

Based just outside of Seattle, EvergreenHealth is one of the largest home health and hospice providers in the Pacific Northwest. The not-for-profit provides about 250,000 visits per year and is affiliated with a local small hospital system.

Full story

Evergreen's Korte on PPE

Korte recommends PPE conservation based around science. That means making tough choices and being prepared to defend them, while also communicating to staff that overprotecting now may mean no protection later.

But providers should also keep in mind that, as things change, so should their protocols.

“We started with N95 mask respirators for positive patients, and then we moved to droplet precautions, which are goggles, gloves, surgical masks and gowns,” Korte said. “Then we laid off the gowns for some patients; then we went to no masks for all visits; then to limiting visits; and then we chose to start limiting visits to [those] that are only clinically, essentially necessary in person.”

Those changes all happened over the course of 26 days. At the time of the webinar, Evergreen’s protocol was back to mandating surgical masks and droplet precautions for all patients because “infection rates have increased, and we’re trying to make sure that we’re not the vector,” Korte said.

 

CMS Coronavirus COVID-19 Stakeholder Calls: Access Transcripts Here

Posted: April 1, 2020

CMS this week made transcripts available for the following calls. 

This link has all CMS Partner Relations Group Podcasts, transcripts and audio recordings. CMS makes Open Door Forums and other presentations available as an audio podcasts. The Podcasts are available, free of charge.

 

Non-Physician Practitioners in Colorado Can Certify Eligibility for Medicare Home Health Benefit

Posted April 2, 2020

With passage of the CARES Act., non-physician practitioners (NPPs), nurse practitioners, physician assistants, and clinical nurse specialists, finally have gained the long-overdue authority to certify eligibility for the Medicare Home Health benefit. This authority extends through the current pandemic, although CMS is formulating rules, per the CARES Act, to make the change permanent. 

Some states' licensing rules conflict with the new authority, but not Colorado's. Our state licensing rules state that “physician or other intermediate health care provider,” which includes NPs and PAs, can authorize care. 

 

 

Colorado Hospital Association Receives CMS Waiver Relief For Home Health, Hospice

Posted: March 30, 2020

CMS continues to provide relief for Colorado home health and hospice providers, the latest courtesy of a Colorado Hospital Association 1135 waiver request, which won approval this morning. 

Details relating to home health and hospice are below. The entire waiver is attached here as a PDF.

Thanks, 

Don Knox, HHAC

 

The attached waiver portions took effect as of 6 p.m. Eastern Daylight Time on March 17, 2020, with a retroactive effective date of March 1, 2020. Once the national emergency terminates, including any extensions, section 1135 waivers will no longer be available. 

Home Health Agencies

  • Reporting: Provides relief to Home Health Agencies on the timeframes related to OASIS Transmission. (Approved on 3/13/2020- Clarified) This waiver includes:
    • Extension of the 5-day completion requirement for the comprehensive assessment
    • Waives the 30-day OASIS submission requirement 
  • Home Health 42 C.F.R. § 484.55(a). Home health agencies can perform initial assessments and determine patients’ homebound status remotely or by record review. This will allow patients to be cared for in the best environment while supporting infection control and reducing impact on acute care and long-term care facilities. This will allow for maximizing coverage by already scarce physician and advanced practice clinicians and allow those clinicians to focus on caring for patients with the greatest acuity. 

Hospice:

  • Waive requirement for hospices to use volunteers. CMS is waiving the requirement that hospices are required to use volunteers (including at least 5% of patient care hours). It is anticipated that hospice volunteer availability and use will be reduced related to COVID-19 surge and anticipated quarantine. (42 CFR §418.78(e))
  • Comprehensive Assessments: CMS is waiving certain requirements for Hospice (§418.54) related to update of the comprehensive assessments of patients. This waiver applies the timeframes for updates to the comprehensive assessment (§418.54(d)). Hospices must continue to complete the required assessments and updates, however, the timeframes for updating the assessment may be extended from 15 to 21 days. 
  • Waive Non-Core Services: CMS is waiving the requirement for hospices to provide certain non-core hospice services during the national emergency, including the requirements at §418.72 for physical therapy, occupational therapy, and speech-language pathology.

Home Health & Hospice:

  • Waived onsite visits for both HHA and Hospice & Aide Supervision: CMS is waiving the requirements at 42 CFR 418.76 (h) and 484.80(h), which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan as this may not be physically possible for a period of time. This waiver is also temporarily suspending 2-week aide supervision requirement at 42 CFR §484.80(h)(1) by a registered nurse for home health agencies, but virtual supervision is encouraged during the period of the waiver.
 
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