Place strategy

HHS renews public health emergency, keeping key home health waivers in place

The US Department of Health and Human Services (HHS) on Wednesday elected to renew the COVID-19 Public Health Emergency (PHE), keeping in place several regulatory waivers that have been critical for healthcare operators to home and palliative care since the beginning of 2020.

While the extension itself is unsurprising, it provides additional stability as operators grapple with labor shortages and general inflation, among other challenges. On top of that, this decision gives hospital-at-home responders more time under the acute hospital-at-home care waiver as they work to gain support from relevant legislation to the House and the Senate.

The PHE has been renewed several times since it was implemented by the Trump administration more than 24 months ago.

Without action from HHS and the Biden administration, it was set to expire on April 16.

“With more than two years having passed since the onset of the COVID-19 pandemic in early 2020, questions arise about when to end public health emergency declarations made by the federal government as soon as beginning, with some advocating their extension and others calling for their expiration,” Kaiser Family Foundation experts wrote in a recently released briefing note. “There are many implications for ending these emergency declarations.”

Wednesday’s extension is an additional 90 days, bringing the PHE into July.

Under the PHE, federal regulators have removed or changed normal requirements for Medicare and Medicaid providers, as well as private health insurers. While some waivers have focused on reducing reporting and supervision requirements, others have focused on new telehealth allowances and financial support.

Medicare-certified home health agencies, in particular, have had access to a long list of waiver flexibilities.

On the reporting front, for example, the Centers for Medicare & Medicaid Services (CMS) waived the requirement for home health agencies to complete their OASIS submission within 30 days. Instead, deferred submission is allowed during the PHE.

Through the waiver process, CMS also changed the requirement that all home care aides receive 12 hours of continuing education over a 12-month period. In addition, the agency waived the normal rule requiring a nurse to make an on-site visit every two weeks to ensure that the care provided is in accordance with the care plan.

Palliative care and home health agencies were also allowed to suspend quality assurance and performance improvement (QAPI) programs during the PHE.

Although home health agencies have not been able to receive direct reimbursement for virtual home visits, the ability to deliver services through telehealth tools has also been a major boost during the pandemic.

“Home health agencies, palliative care providers and many other types of organizations have relied on PHE exemption flexibilities to expand clinical capacity and leverage virtual care,” said James Lydiard, director of US Medical Management (USMM) strategy, to Home Health Care News. in an email. “An extension allows more time to determine what happens when these flexibilities are potentially removed – while avoiding immediate disruption for patients.”

USMM includes the Visiting Physicians Association (VPA), Pinnacle Home Health, Grace Hospice, Comfort Hospice, TheHomeDME and Lab2U.

Recently acquired by Rubicon Founders in late 2021, Michigan-based USMM is one of the nation’s largest independent home management services organizations. Its current footprint spans 11 states and 35 unique service areas.

More time for hospital-at-home programs

The extension of the PHE does not only help home care and palliative care operators. It also gives hospital-at-home programs some leeway as their advocates seek support beyond the crisis.

As of April 11, there were 92 health systems and 206 hospitals in 34 states approved for the CMS waiver for acute hospital care at home. The initiative, unveiled in November 2020, gave licensed entities the ability to provide acute home care and created a payment pathway under Medicare.

As it stands, the waiver will end with the PHE. With that in mind, some feared hospital-at-home programs were headed for a regulatory cliff on April 16.

“A number of programs have been launched, and the risk is that all of these waivers are related to the public health emergency,” Dr. Stephen Parodi, associate executive director of Permanente Medical Group, previously told HHCN. “With the decline of COVID, … we anticipate that the public health emergency will likely expire this year. It is necessary, from a regulatory point of view, to prevent these programs from ending if the derogation disappears.

Introduced in the House and Senate in March, the bipartisan Hospital Patient Services Modernization Act aims to extend the waiver allowing hospital care at home beyond the PHE for two years.

The legislation would also require the CMS to establish uniform health and safety requirements for program participants within a year of its enactment.

“We’ve put the health systems that are actually providing inpatient home services through the waiver in front of Hill staff to build that support,” Jeremiah McCoy, director of policy and government relations at Moving Health Home, previously told HHCN. “There’s a lot of education to be done with the staff at Hill. We work to make sure they know about the waiver, where the benefits are, the impacts on cost, quality, patient satisfaction, and health equity.

The bill is sponsored by Sen. Thomas Carper (D-Del.) in the Senate, with the support of five co-sponsors, including three Republicans and two Democrats. It is sponsored by Rep. Brad Wenstrup (R-Ohio) in the House, with support from four Democrats and two Republicans.