Important note: when examining the resource links below, please be mindful of dates wherever labelled to ensure the most recent guidance or update.
Current Regulatory Waivers, Changes (Updated 04/01/20)
Medicare Home Health Telehealth Services: On March 30, CMS issued a very incremental allowance for home telehealth. 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 reported below.) CMS is ostensibly allowing expanded telehealth as a means to reduce costs, but not as a service billable under Medicare.
Medicare “Homebound” Requirement: On March 30, CMS determined that an individual meets the requirement for “homebound” status if needing skilled services and if deemed by a physician at high risk of contracting COVID-19 due to a compromised health condition.
Medicare Home Health Conditions of Participation (CoPs) and NPP Certifications: CMS reported on March 30 that CoPs related to onsite home health aide supervision and in-person initial patient assessments 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.
Hospice Telehealth: CMS reported on March 30 that it is allowing use of telehealth for the physician face-to-face encounter requirement in hospice and permitting telehealth billing by hospice physicians.
Hospice Volunteers, Assessments, Non-Core Services, Supervision: Per the CARES Act, CMS announced on March 30 it is 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.
Federal Quality Reporting Requirements: On Sunday, March 22, CMS announced some additional quality reporting program relief for providers. Home health data from January 1, 2020 through June 30, 2020 does not need to be submitted to CMS for purposes of complying with quality reporting program requirements. In addition, Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from January 1, 2020 through September 30, 2020 does not need to be submitted to CMS.
Medicaid Transportation Services: According to a March 21 letter, transportation managers shall: waive the 72-hour rule for enrollees requesting urgent trips for COVID-19 related symptoms; prohibit multi-loading vehicles, including group rides. Multi-loading shall only be approved in situations where no single loading alternative exists and must be specially approved by the manager/broker.
Medicaid Telehealth Use, Billing: A special edition of the state’s Medicaid Update on March 21 and updated on March 23 (see here) includes a guidance broadly expanding the use of telehealth, telephonic services and other communications methods by Medicaid providers during the COVID-19 state of emergency. This guidance was followed up with an extensive frequently asked questions document issued on March 31 (see here). Effective for dates of service after March 1, and for the duration of the state of emergency, “New York State Medicaid will reimburse telephonic assessment, monitoring, and evaluation and management services provided to members in cases where face-to-face visits may not be recommended and it is appropriate for the member to be evaluated and managed by telephone.” HCA has confirmed with DOH officials that the guidance applies to Article 36 home care providers and the March 23 version of the guidance provides more specific home care service and billing codes. It adds: “All telephonic encounters documented as appropriate by the provider would be considered medically necessary for payment purposes in Medicaid fee for service or Medicaid Managed Care.”
Medicare OASIS/RAPs: The federal disaster declaration provides relief to Home Health Agencies on the timeframes related to OASIS Transmission. It allows Medicare Administrative Contractors to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs) during emergencies (see CMS fact sheet here).
RN Supervision Visits Under Medicaid Personal Care: Governor’s Executive Order No. 202 “permit(s) nursing supervision visits for personal care services provided to individuals affected by the disaster emergency be made as soon as practicable” (emphasis added) in place of requirements for such visits to be made “at least every 90 days.”
EISEP Program Relief on Assessments: Governor’s Executive Order No. 202.1 suspends regulations related to assessments, reassessments and duration of care plan for home delivered meals and/or Expanded In-Home Services for the Elderly Program (EISEP).
Medicaid Program Initial Service Visit, Home Care Registry, Supervision Visits, Fair Hearings: Governor’s Executive Order No. 202.5:
- To the extent necessary to permit certified home health agencies, long term home health care programs, AIDS home care programs, and licensed home care services agencies serving individuals affected by the disaster emergency to conduct in-home supervision of home health aides and personal care aides as soon as practicable after the initial service visit, or to permit in-person and in-home supervision to be conducted through indirect means, including by telephone or video communication;
- To the extent necessary to permit initial patient visits for certified home health agencies, long term home health care programs and AIDS home care programs serving individuals affected by the disaster emergency to be made within 48 hours of receipt and acceptance of a community referral or return home from institutional placement;
- To extend the time in which home care services entities must submit information to the Home Care Worker Registry;
- To the extent necessary to allow or require appearance by any parties to a fair hearing by written, telephonic, video or other electronic means.
Record-keeping: Executive Order No. 202.10 provides relief from record-keeping requirements. It mentions “relief to the extent necessary for health care providers” … “including, but not limited to, requirements to maintain medical records that accurately reflect the evaluation and treatment of patients, or requirements to assign diagnostic codes or to create or maintain other records for billing purposes,” granting “absolute immunity from liability for any failure to comply with any recordkeeping requirement” if done so in good faith except in certain circumstances.
HCA has confirmed the applicability of this provision with state Department of Health officials who state that the reference does cover home care providers; however, the licensed home care professional is only protected from liability if they are not maintaining accurate patient records due to their COVID-19 response (e.g., having a patient surge due to a COVID-19 outbreak). Licensed home care professionals could not use this waiver provision generally to avoid keeping accurate patient medical records, regardless of the COVID-19 connection.
RN Orders for COVID-19 Specimen Samples: Executive Order No. 202.10 “permits registered nurses to order the collection of throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing.”
Recording: HCA March 20 Provider Call on COVID-19
- On March 20, 2020, the Home Care Association of New York State held a call with over 250 providers and organizations on COVID-19 updates. The call summarized recent state and federal guidance documents, active and pending areas of regulatory relief for providers coping with the crisis, findings from our survey of providers and other needs/issues, and questions and answers. A recording of the call is available here.
Home Care- and Hospice-Specific Guidance or Resources
- DOH Medicaid Changes to Private Duty Nursing (PDN) Policy (March 28, 2020)
- DOH Protocols for Essential Personnel to Return to Work Following COVID-19 Exposure or Infection (UPDATED March 31, 2020)
- DOH COVID-19 Guidance for Home Health Care Agencies and Hospice Providers (March 22, 2020)
- DOH COVID-19 Guidance for the Authorization of Community-Based Long-Term Services and Supports Covered by Medicaid (March 18, 2020)
- DOH Interim Guidance for Home Care Services Regarding COVID-19 (March 16, 2020)
- DOH COVID-19 Guidance for Children’s Waiver Services Providers (March 14, 2020)
- CDC Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings
- COVID-19 Home Care and Hospice Checklist (Developed By Barbara Citarella, RBC Limited Healthcare & Management Consultants)
- National Association for Home Care and Hospice (NAHC) COVID-19 Resource Page
COVID-19 Specimen Collection and Testing
- DOH Guidance on COVID-19 specimen collection and handling, including the use of nasal and oropharyngeal swabs as an alternative when nasopharyngeal are not available (March 25, 2020).
Guidance on Face Masks
- New York City Department of Health Overview of Strategies for Reuse and Extended Use of Personal Protective Equipment (March 31, 2020)
- CMS Guidance for use of Certain Industrial Respirators by Health Care Personnel
State and City Departments of Health
- DOH Guidance on the Contacts of a Close or Proximate Contact of a Confirmed or Suspected Case of COVID-19
- NYC Department of Health 2019 Novel Coronavirus (COVID-19) — Information for Providers
- NYS Department of Health Novel Coronavirus Information for Providers
- NYS Department of Health What You Should Know about the Flu
- NYS Department of Health Interim Guidance for Procedures When Identifying an Employee with Concerns for COVID-19 Exposures
Other Government Agencies
- What do Older Adults and People with Disabilities Need to Know about Coronavirus Disease 2019 (COVID-19)? (The Administration for Community Living)
- OSHA Guidelines for Workers and Employers
- USDOL COVID-19 or Other Public Health Emergencies and the Fair Labor Standards Act Questions and Answers
Centers for Disease Control And Prevention (CDC)
- CDC Guide to Preparing Your Community
- CDC Printable Fact Sheets for the Public
- CDC Video Series, Coronavirus Prevention for Individuals
- CDC Page on Coronavirus Disease 2019
- CDC Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus