The National Association for Home Care & Hospice has joined other health care stakeholders in writing a letter to leaders in both parties in the United States Senate, urging them to make permanent the current telehealth flexibilties created to deal with the COVID-19 public health emergency (PHE). Expanded access to telehealth durng the PHE has…
On August 18, 2022, the Centers for Medicare & Medicaid Services (CMS) issued extensive materials providing guidance related to the planned phase-out of various waivers, regulations, enforcement discretion, and sub-regulatory guidance that were utilized to ensure access to care and give health care providers the flexibilities needed to respond to COVID-19 Public Health Emergency (PHE).…
Don’t miss fact sheets for home health & hospice at end of this article On August 18, 2022, the Centers for Medicare & Medicaid Services (CMS) issued extensive materials providing guidance related to the planned phase-out of various waivers, regulations, enforcement discretion, and sub-regulatory guidance that were utilized to ensure access to care and give…
Legislation to extend telehealth waivers until the end of 2024 passed by the U.S. House of Representatives late last week, offering the hope that this pandemic-related flexibility could be made more permanent and outlive the public health emergency (PHE), which is set to expire in October.
The news is notable because it means that these pandemic-relief telehealth flexibilities could be untied from the public health emergency (PHE). Currently, the PHE is set to expire in October, but could receive another extension.
On Tuesday, the House Rules Committee moved the Advancing Telehealth Beyond COVID-19 Act forward in an almost unanimous vote.
“The bill gives Congress, Medicare, and stakeholders time to produce a permanent policy with any necessary program integrity measures and benefit qualifications on a complex set of issues,” said NAHC President William A. Dombi. “For home health and hospice, it preserves, at least temporarily, the very valuable option of telehealth visits to meet the face-to-face encounter requirements under the respective benefits.”
Dombi has previously said that both “in home health and in hospice, [agencies] delivered telehealth services quite robustly during the pandemic for free. And so now the next expectation is [they’ll] always do it for free.”
Understandably, providers want to be paid for the telehealth services they provide and Dombi believes this may now be possible. “The extension also provides an opportunity to get additional changes in telehealth policy in place such as payment to home health agencies,” added Dombi. “It essentially guarantees there will be a future legislative vehicle to do so, whereas Congress does not have the time to consider those changes now.”
Before the PHE created circumstances leading to the current flexibility, patients were required to have an in-person doctor’s appointment before they could receive home health services.
The legislation would maintain the increase in the geographic locations where Medicare beneficiaries can receive telehealth services.
“We saw telehealth services widely and successfully adopted during the COVID-19 pandemic, now we must ensure those services are here to stay,” Congresswoman Debbie Dingell (D-MI) said in a statement. “For seniors, traveling to a doctor’s office can be a prohibitive barrier to receiving the care they need, and we cannot allow people who have come to rely on telehealth throughout the pandemic to have that resource taken from them. This legislation brings us one step closer to permanently expanding telehealth services and allowing Americans to continue to access critical health care from the comfort of their home.”
Legislation to extend telehealth waivers until the end of 2024 passed by the U.S. House of Representatives late last week, offering the hope that this pandemic-related flexibility could be made more permanent and outlive the public health emergency (PHE), which is set to expire in October. The news is notable because it means that these…
On Monday, June 13, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), is issuing guidance on how covered health care providers and health plans can use remote communication technologies to provide audio-only telehealth services when such communications are conducted in a manner that is consistent with the applicable requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules, including when OCR’s Notification of Enforcement Discretion for Telehealth – PDF is no longer in effect.
This guidance will help individuals to continue to benefit from audio-only telehealth by clarifying how covered entities can provide these services in compliance with the HIPAA Rules and by improving public confidence that covered entities are protecting the privacy and security of their health information.
While telehealth can significantly expand access to health care, certain populations may have difficulty accessing or be unable to access technologies used for audio-video telehealth because of various factors, including financial resources, limited English proficiency, disability, internet access, availability of sufficient broadband, and cell coverage in the geographic area. Audio-only telehealth, especially using technologies that do not require broadband availability, can help address the needs of some of these individuals.
“Audio telehealth is an important tool to reach patients in rural communities, individuals with disabilities, and others seeking the convenience of remote options. This guidance explains how the HIPAA Rules permit health care providers and plans to offer audio telehealth while protecting the privacy and security of individuals’ health information,” said OCR Director Lisa J. Pino.
The Guidance on How the HIPAA Rules Permit Health Plans and Covered Health Care Providers to Use Remote Communication Technologies for Audio-Only Telehealth may be found at: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-audio-telehealth/index.html.
On Monday, June 13, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), is issuing guidance on how covered health care providers and health plans can use remote communication technologies to provide audio-only telehealth services when such communications are conducted in a manner that is consistent with the applicable requirements…
Late in the evening on Tuesday, March 8, the House of Representatives’ Appropriations Committee released the text of the FY2022 Omnibus government spending legislation. The situation is very fluid right now and the details of the bill could change. For example, after a dispute among lawmakers, $15 billion in Covid-19 relief funding was pulled out of the $1.5 trillion omnibus package leaving the federal government with only a few months’ supply of coronavirus therapeutics.
It is possible the text of the bill could change, but as of Wednesday afternoon, this is what is in the legislation that matters for hospice.
Importantly, the funding package does not include any relief from impending Medicare sequester payment cuts. As a reminder, a one percent across-the-board reduction in Medicare payments is set to take effect April 1, 2022, lasting through June 30, 2022. The full two percent cuts will begin July 2022, lasting through the end of the calendar year. NAHC continues to advocate strongly for a further delay of the sequester reductions. Even as the pandemic enters a more stable phase, the current labor crisis in health care has increased costs for providers of all kinds, and a Medicare rate cut will only exacerbate the already dire workforce situation.
“We are very pleased to see the extension of the telehealth waivers in the bill as they have proven extremely valuable during the pandemic,” said NAHC President William A. Dombi. “Our hope is to see these become permanent parts of Medicare in the future. Also, we anticipate further legislative opportunities this year to deal with sequestration as well as our Choose Home bill among other crucial matters.”
A summary of the Labor-Health and Human Services portion of the bill (where most of the health care provisions are included) is HERE.
Included in the massive bill are a number of provisions relevant to home-based care providers, including:
Telehealth (Sec. 301-309)
- An extension of the Medicare flexibility allowing hospices to perform the face-to-face (F2F) recertification visit via telehealth (Sec. 306). This flexibility will be extended for 5 months (151 days) after the end of the COVID-19 public health emergency (PHE). The current PHE declaration is in place until April 16, 2022, but it may be extended further till at least the middle of July 2022.
- The inclusion of this specific extension is an advocacy win for NAHC and the hospice community. In recent days, intel from Capitol Hill indicated that the F2F fix was not being considered for extension. NAHC, our members, and other hospice stakeholders ramped up our advocacy to Congress to press for the F2F’s inclusion, and we are pleased to see it in the omnibus. We will continue to fight for a permanent extension.
- Like the F2F telehealth extension, many other pandemic-era telehealth flexibilities are being extended for the same 5-months post-PHE timeframe. This includes the changes to the geographic and originating site requirements (Sec. 301), which are allowing patients to receive telehealth services in their own homes and in non-rural parts of the country. It also includes the flexibility to use audio-only telehealth (Sec. 305) It is through this provision that authorization for using telehealth to conduct the home health face-to-face results.
- There is also a provision that will require both a MedPAC and an HHS OIG report on the expansion of telehealth as a result of the PHE, to inform future payment and program integrity policy (Sec. 308)
- Additionally, beginning July 1, 2022, CMS will be required to publicly post, on a quarterly basis, data on Medicare claims for telemedicine services, including data on utilization and beneficiary characteristics (Sec. 308).
- It is important to note that this legislation does not cover extensions for every single Medicare service that has been allowed to be delivered via telehealth during the pandemic. For example, the current flexibility provided hospices to deliver routine home care (RHC) using telehealth and telephone technology would not be extended by this bill. Likewise, a number of specific interventions that have been added to the Medicare Telehealth Code List only for the duration of the PHE would also not be extended by the omnibus. This includes certain Medicare Part B services that have been used by palliative care providers during the pandemic, such as CPT codes 99341-99345, which are evaluation and management (E&M) codes for home visits to new patients. (The current list of Medicare Telehealth Codes can be found HERE). NAHC believes that it will be up to CMS to determine extension policy for those telehealth services not covered by these legislative expansions.
Hospice Cap Methodology Extension (Sec. 312)
- Included is an extension by one year, until 2031, of the current methodology used to update the Medicare hospice aggregate cap by the annual hospice payment update (APU), as opposed to the Consumer Price Index for Urban areas (CPI-U). This methodology of using the APU to update the cap has been in place since 2016 (as a result of the IMPACT Act of 2014) and was already set to remain effective until 2030 (as a result of the Consolidated Appropriations Act, 2021). The provision in this omnibus package simply extends this methodology to 2031. A one-year extension is expected to save the government ~$55-60 million dollars, so when applied across the nearly 5000 Medicare-certified hospices, this provision does not represent a major impact for providers.
CMS Report on Hospice Respite Care (Included in the Joint Explanatory Statement)
- A congressional request to CMS, in consultation with the Office of the Assistant Secretary for Planning and Evaluation (ASPE), to provide, within 180 days of the enactment of the omnibus bill, a report to the relevant congressional committees on the current capacity and best practices for the provision of hospice respite care, including in the home.
Other important elements of the bill include:
- Health workforce: $1.3 billion, an increase of $72 million above the FY 2021 enacted level, for the Health Resources and Services Administration’s (HRSA) Bureau of Health Professions programs to support health workforce development.
- Program integrity funding: Roughly $659 million for CMS’ program integrity efforts; $102 million for HHS OIG program integrity activity; and $112 million for Department of Justice program integrity work within the health care industry.
Additional summary and explanatory documents related to the bill can be found on the House Appropriation Committee’s press release page HERE.
In addition to the omnibus funding package, the House of Representatives also released a very short-term “continuing resolution” bill that will fund the government for four additional days beyond the current funding expiration date of Friday, March 11, 2022. These four extra days will give the Senate time to review and pass the funding package by the new deadline of Tuesday, March 15, 2022.
Text of the bill is HERE. A summary of the entire bill is HERE Late in the evening on Tuesday, March 8, the House of Representatives’ Appropriations Committee released the text of the FY2022 Omnibus government spending legislation. The situation is very fluid right now and the details of the bill could change. For example,…