COVID-19 Updates for the Week Ending March 29

What follows are the most salient COVID-19 updates for HCA members as of the week ending March 29.

CARES Act, NPP Authorization, and HCA’s Call for Permissive Implementation of Telehealth Provisions 

Congress passed, and the President signed, a $2 trillion coronavirus aid package. It includes a long-time priority of HCA and national organizations: allowing non-physician practitioners to order and refer for home care services. (HCA awaits further implementation information from federal administrators.)

The package also includes a small business loan program as well as language directing federal administrators to “encourage” telehealth — but without explicitly allowing Medicare authorization or billing for telehealth or telephonic alternatives to home visits.

On the telehealth issue, HCA sent members a grassroots advocacy message to speak out. It tells Congress to “now demand that federal Medicare administrators implement key home health flexibility as they interpret and act on the new relief provisions” for telehealth. So far almost 900 people have acted on this campaign. If you haven’t done so, act now here.

We are also calling for other federal flexibilities in the applicability of the homebound requirement for COVID-19 cases that otherwise wouldn’t meet the eligibility test, relief from the face-to-face requirement, an abbreviated OASIS, and others.

Medicaid Telehealth Permissions Confirmed and Clarified

The state Department of Health (DOH) released a telehealth guidance with broad permissions for Medicaid services and billing. At HCA’s request, state officials reissued the guidance with specific mention of home care and specific “billing lanes” for “assessment and patient management” and “other services” in home care. See here.

Other Regulatory Relief Developments

As we reported in an alert last week, state officials submitted an expansive 1135 waiver request to the federal government, embracing many recommendations made by HCA for possible regulatory waivers. An ensuing response from the U.S. Centers for Medicare and Medicaid Services (CMS), however, referenced only a small number of the state’s requests, offering few new allowances — and, of these, most are applicable to non-home care settings.

“CMS continues to work on the additional waiver or modification requests that are not currently reflected in the attached approval,” CMS stated in its letter to New York State Health Commissioner Dr. Howard Zucker. “For those waiver or modification requests that require approval under authority other than section 1135 … [CMS] staff will continue to work with your team to review and make determinations regarding approval as quickly as possible.”

New Guidance on Workers Released from Isolation

Just yesterday, DOH released a set of guidance documents pertaining to the release from home isolation of health care workers or direct care personnel. It defines under what conditions these individuals are permitted to return to work following exposure or infection. See here.

Private Duty Nursing

DOH has released guidance for private duty nursing providers. The guidance is here.

Accelerated Medicare Payments

CMS announced an expansion of its Accelerated and Advance Payment Program for Medicare-participating health care providers and suppliers to ensure they have the resources needed to combat COVID-19 (see separate story).

DOH Survey

DOH has begun surveying Certified Home Health Agency (CHHA) and Long Term Home Health Care Program (LTHHCP) providers on a daily basis, through the Health Electronic Response Data System (HERDS), to collect data that intends to inform the state’s policy responses. HCA has expressed concerns about the practicality of several survey questions, and we continue to work with the Department to ensure that the survey questions are appropriately tailored.

HCA Conducts Phase II Survey

HCA released the results of our own survey of providers’ COVID-19 experiences on March 17. The results have helped HCA gain key areas of regulatory relief at the state level. It has also brought about press coverage in Reuters, the New York Times, USA Today, Home Health Care News, the Albany Times Union, City and State, Buzzfeed, Crain’s New York Business, the Syracuse Post-Standard and other news sources describing home care’s response work while also helping leverage our ask for priority access to supplies — another major and consuming area of activity this past week addressed to all levels of government.

HCA is asking members to complete a phase II version of our survey that will be used for similar purposes. Please complete this survey here by March 31 at noon.

HCA continues to advocate for further regulatory relief and personal protective equipment (PPE) at both the state and federal levels. We have conducted many calls with DOH officials to pursue measures that would help home care and hospice providers and managed long term care plans.

In addition, HCA has directly communicated with the New York City Department of Health and Mental Hygiene for home care providers to be given priority status in obtaining PPE.

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