06 Feb The Public Health Emergency Extension and Home Health Care

What you should know about how the PHE Extension Affects Homecare

The Acting Secretary of the United States’ Department of Health and Human Services (HHS) sent letters to state governors on Friday, January 22, 2021. In the letter, DHHS officials warn that the current public health emergency (PHE) could last through the entire calendar year. What does this mean for home care agencies?

1135 Waivers

To begin, this extends the Section 1135 National Blanket Waiver that allows flexibility with the face-to-face requirements for home health Start of Care. Under the waiver, home health agencies may use notes from a physician or physician’s agent’s telehealth encounter as long as it was performed via a two-way communication platform with audio and video capabilities. 

The Health Insurance Portability and Privacy Act (HIPAA) requirements have relaxed. They now allow for these encounters to occur via telephones so long as there is a visual component, and platforms such as Skype are allowable.  

Furthermore, since Congress passed the Coronavirus Aid, Relief, and Economic Stability (CARES) Act, nurse practitioners, physician assistants, and clinical nurse specialists can certify patients for home health. Read more about non-physician certifications here. Hospice agencies can use notes from physicians or nurse practitioners that are employed by the hospice company. These allowances are in effect for the duration of the PHE. 

Homebound Status Considerations

Secondly, COVID-19 considerations continue to affect homebound status. Those individuals at an increased risk of contracting COVID-19 due to chronic health conditions qualify as homebound. Furthermore, the Centers for Medicare and Medicaid Services (CMS) says, patients are considered homebound and qualify for the Medicare Home Health benefit if their provider determines that they should not leave their place of residence due to known or suspected COVID-19 infection. 

Compliance Flexibilities

Thirdly, on-site aide supervision requirements are waived for both home health and hospice agencies during the PHE. CMS is encouraging the use of virtual supervision for the duration of the waiver. 

Fourthly, CMS modified the requirement at 42 CFR §484.65 for Quality Assurance and Performance Improvement (QAPI) programs. The programs may focus on infection control and focus on adverse events. 

OASIS-E Postponed

Finally, the extension of the PHE pushes the release of OASIS-E farther away. CMS reports that they are delaying the release of the next version of OASIS until January 1 of the year that is at least one full calendar year after the end of the COVID-19 PHE. The OASIS-E data set will support the Transfer of Health (TOH) Information quality measures and the new or revised Standardized Patient Assessment Data Elements (SPADES).

Summary

In summary, although the HHS extended the PHE on January 8, 2021, through April 20, 2021, there is concern that the current COVID-19 pandemic could continue to affect operations through the rest of 2021. While this announcement could give agencies some comfort, remember that the department may modify or terminate the declaration at any time. The letter states that if a decision is made to end the PHE or allow it to expire, the department will provide states with at least a 60-day notice to allow agencies time to prepare.

In response, agencies must maintain operations while preparing for the eventual end of the PHE. Providers will have to brace for enforcement of the CMS Conditions of Participation (CoPs), HIPPA rules, and other regulatory guidelines to resume. At some point, stakeholders must decide which flexibilities to maintain, scale back on, or drop as they strategize for the future.

Helpful Links:

Info about the PHE.

DHHS letters to state governors

Section 1135 National Blanket Waiver

Homebound status Information 

Patients considered homebound and qualifying for the Medicare Home Health

OASIS-E information

Request information on Home Health Software

The Alora Homecare Software Blog

Read the Alora blog for industry news, including recent news, articles and commentaries, as well as other issues that pertain to Homecare in the U.S and beyond. For more information on the Public Health Emergency Extension, Home Health Software, other blog topics, questions and feedback, please send us an email to HomeHealthSoftware@Alorahealth.com