New CMS Waivers: Incremental Telehealth Flexibility, Plus Latitude on Homebound Requirement

The U.S. Centers for Medicare and Medicaid Services (CMS) has issued some new regulatory waivers and flexibilities, including a very incremental allowance for home telehealth and important latitude on the “homebound” requirement. This information is here.

Congress, in the recently enacted CARES Act for coronavirus relief, called upon federal officials to “encourage” telehealth. CMS has responded in a limited fashion, based on our read of the latest CMS communication, determining that the law does not permit CMS to pay home health agencies for telehealth. (The state Medicaid program, meanwhile, has already provided much more flexibility in this regard for Medicaid services, as previously reported to the membership.)

The CMS change, circulated last night, ostensibly allows expanded telehealth as a means to reduce costs, but not as a service billable under Medicare. HCA is further analyzing the language, speaking with federal officials and partners, and preparing to redouble our efforts on more expansive telehealth permissions for service and billing.

HCA thanks the over 900 members who wrote to Congress using our Legislative Action Center in a campaign urging lawmakers to press CMS for broad use and payment of telehealth as an alternative to home visits. Attention now turns back to Congress for legislation that would strengthen the telehealth allowance commensurate with the needs of the system to respond to the COVID-19 crisis and reduce exposure.

Homebound change

On the matter of “homebound” status, CMS has determined that an individual meets the requirement if needing skilled services and if deemed by a physician at high risk of contracting COVID-19 due to a compromised health condition, an allowance sought by HCA and partners at the National Association for Home Care and Hospice (NAHC).

Other home health waivers and flexibilities

Additionally, CMS has waived home health Conditions of Participation (CoPs) related to onsite home health aide supervision and in-person initial patient assessments which can now be done remotely. CMS has also implemented language from the CARES Act, as previously summarized for the membership, permitting non-physician practitioners to order and refer for home health services.

Previously, CMS had also offered flexibility on transmission of the OASIS and delayed the filing date of certain cost report due dates. (For a summary of all principal state and regulatory waivers, please see HCA’s COVID-19 resources page which HCA will be updating shortly to reflect this latest information.)

Hospice waivers and flexibilities

Per the CARES Act, CMS is allowing use of telehealth for the physician face-to-face encounter requirement in hospice and permitting telehealth billing by hospice physicians. It is also waiving: the requirement for hospices to use volunteers; timeframes for updating comprehensive patient assessments; non-core services requirements; and the 14-day home health aide in-person supervisory requirements, consistent with home health waivers. It has also suspended all medical review audits other than in cases of fraud investigation.

HCA will report back to the membership with further updates, interpretations and advocacy instructions as we push for broader COVID-19 regulatory flexibilities at the state and federal levels.

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