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PHE Conclusion: What Does It Mean for Home Health?

    The Biden administration announced that the COVID-19 public health emergency (PHE) is set to conclude on May 11, 2023, after 3 years. While home health stakeholders initially feared the end of the PHE, it appears that it may not have as significant an impact on home health as expected, although there will be some ripple effects to contend with.

    Temporary flexibilities and waivers that were granted will expire when the PHE ends, but some may be modified or extended for varying periods to aid providers adjust. Some waivers will continue permanently while some have been extended through acts of Congress.

    Continuing Waivers

    Some waivers and flexibilities that were granted during the PHE have been extended or made permanent as it proves to be beneficial to patients and overall home health operations:

    • Telehealth and virtual visits can be used within the 30-day period of care, as long as it’s included in the patient’s plan of care and doesn’t replace necessary in-person visits as ordered by the treating physician or treating practitioner.  However, only in-person visits can be reported on the home health claim. This provision is permanent beyond the COVID-19 PHE. 
    • The face-to-face encounter can be conducted via telehealth irrespective of the COVID-19 PHE; however, the waiver will expire the first day after the 151st day following the end of the PHE.
    • Aside from physicians, nurse practitioners, clinical nurse specialists, or physician assistants can continue to order home health services; establish and periodically review a plan of care for home health services (e.g., sign the plan of care); and certify/recertify patient eligibility for Medicare home health services in accordance with state law.
    • COVID-19 vaccinations to home health patients will continue to be reimbursed. 

    Things to Look Out For

    The end of the PHE may lead to confusion among home health providers, as its regulations have been in effect for such an extended period. For one, home health workers who started their careers during the PHE may find it confusing to adapt to the changes since they are used to the flexibilities that were in place.

    Several important services and operational requirements will be impacted as many waivers and flexibilities come to an end. These include:

    • Medicare Administrative Contractors will not extend the Requests for Anticipated Payment (RAPs) auto-cancellation dates.
    • Reporting deadlines for the comprehensive assessment (5-day completion) and OASIS submission requirement (30-day) will be re-established.
    • In-person initial assessments will be required to resume as remote initial assessments or those performed by record review will end.
    • Onsite visits for HHA aide supervision will require a nurse to conduct an onsite visit every two weeks, with a registered nurse providing 2-week aide supervision.
    • Home health aides must complete 12 hours of annual in-service training within the first full quarter after the PHE ends.
    • Detailed information sharing for discharge planning for HHAs must be provided to patients, caregivers, or representatives regarding the selection of a post-acute care provider.
    • Patients should receive copies of clinical records at no cost during the next visit or within 4 business days of their request.
    • Onsite supervisory visits for training and assessment of aides by a registered nurse, physical therapist, occupational therapist, or speech-language pathologist (HHA) are required. All postponed onsite assessments must be completed no later than 60 days after the expiration of the PHE.
    • Home health agencies must develop, implement, evaluate, and maintain Quality Assurance and Performance Improvement (QAPI) programs to remain compliant with CMS operating requirements.

    Navigating Regulatory Changes for Success

    Transitioning away from the PHE will not be a walk in the park. The speedy alterations that were necessary to adapt to the pandemic’s challenges necessitate an equivalent level of dedication to advance beyond the emergency phase. It is a difficult task to meet these accelerated federal deadlines while juggling the immediate needs of patients and keeping up with the new regulatory requirements. 

    With the right strategy and support solutions, home health businesses can access the needed expertise and resources to seamlessly navigate ever-changing compliance demands and industry developments hence, allowing more focus on patient care and business growth.

    For further reference, the detailed CMS fact sheet discussing the implications of the PHE conclusion on home health and hospice is available here for your convenience.