Issue: Quality Reporting
Question: Can home health agencies stop submitting the OASIS/HHCAHPS
Answer: Home health agencies are not required to submit the OASIS or the HHCAHPS for quality reporting purposes for the time period outlined below. However, the OASIS must still be on file in order for the claim to be paid. The Centers for Medicare & Medicaid Services (CMS) is granting the quality reporting submission exception as follows:
- Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey data from January 1, 2020 through June 30, 2020 (Q1-Q2)
- OASIS Q1-Q2 (Jan-Jun 2020) does not need to be submitted to CMS for quality reporting program purposes. The OASIS still needs to be submitted before the final claim for payment purposes.
*Agencies may voluntarily submit data during this time. NAHC has reached out to CMS to clarify if agencies voluntarily submitting during this time will have their voluntary submissions counted in the timeliness compliance calculation used for the 2% Annual Payment Update (APU) penalty.
Please see additional information here.
Question: Can hospice agencies stop submitting the HIS/CAHPS Hospice Survey?
Answer: Hospices are not required to submit the HIS or the CAHPS Hospice Survey for quality reporting purposes for the time period outlined below.
- Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS Hospice Survey) survey data from January 1, 2020 through June 30, 2020 (Q1-Q2) does not need to be submitted to CMS.
- HIS Q1-Q2 (Jan-Jun 2020) does not need to be submitted to CMS for quality reporting program purposes.
*Agencies may voluntarily submit data during this time. NAHC has reached out to CMS to clarify if agencies voluntarily submitting during this time will have their voluntary submissions counted in the timeliness compliance calculation used for the 2% Annual Payment Update (APU) penalty.
Please see additional information here.
Issue: PPE
Question: Supplies of facemasks are depleted/will soon be depleted. Can we use cloth/homemade facemasks?
Answer: (Summarized from information provided by Mary McGoldrick, MS, RN, CRNI®, home care infection control expert.) The CDC’s website does include cloth face masks/scarfs as examples of what to use when no face masks are available, but please consider the information below:
- On January 29, 2020, the World Health Organization released a publication called Advice on The Use of Masks in the Community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak. In the document, in the last line it states, “Cloth (e.g. cotton or gauze) masks are not recommended under any circumstance.”
- Face masks reduce aerosol exposure by a combination of the filtering action of the fabric and the seal it makes between the face and the mask. Although any material may provide a physical barrier, if as a mask it does not fit well around the nose and mouth, or the cloth allows infectious aerosols to pass through it, it will be of no benefit and only offer a false sense of security.
Question: Can we re-use PPE/how can we conserve PPE?
Answer: Please reference the CDC’s guidance on optimization of PPE
Issue: Home Health Abbreviated Comprehensive Assessment
Question: NAHC has received several questions regarding whether CMS has waived the comprehensive assessment requirement to permit an abbreviated assessment using only the items necessary for care planning and payment.
Answer: CMS has not issued any other blanket waivers other than the following:
- The timeframes related to OASIS Transmission. Allows Medicare Administrative Contractors to extend the auto-cancellation date of requests
There is confusion because CMS has posted this document. The waivers in this document are examples of blanket waivers that were issued during Katrina but have not been issued, thus far, for the COVID-19 pandemic. Individual providers or groups, such as, state associations or state representatives may request additional waivers by submitting a request to 1135waiver@CMS.HHS.gov. CMS could decide to apply any requested waiver more broadly.
Issue: Telehealth
Question: Can clinicians conduct visits via telehealth and these covered by Medicare?
Answer: Both home health and hospice providers are able to communicate with patients via telehealth; HOWEVER, CMS has not indicated these communications will qualify as visits and be considered covered under Medicare. There are two recent waivers which are applicable – one regarding expanded Medicare telehealth coverage and one regarding HIPAA. Please see below for these additional details.
The Trump Administration announced expanded Medicare telehealth coverage. Beginning on March 6, 2020, Medicare will temporarily pay practitioners to provide telehealth services for beneficiaries residing across the entire country. There are a lot of questions from home health and hospice providers about this announcement. Below is a summary of the key points as well as a link to a Fact Sheet and an FAQ document:
- Still, only practitioners can bill for telehealth services.
- Home health agencies, while not being able to bill for telehealth services, may find relief in that the physicians can utilize telehealth technology for a home health F2F encounter.
- Hospices – We have been in touch with CMS and understand that they are still thinking the issue through, but we have encouraged them (and some of our advocates in Congress) to permit this same flexibility for hospice providers.
- Telehealth technology has been expanded. The FAQ below describes the various technology that will be allowed during this state of emergency (emphasis added).
Question: Is any specialized equipment needed to furnish Medicare telehealth services under the new law?
Answer:
Currently, CMS allows for use of telecommunications technology that have audio and video capabilities that are used for two-way, real-time interactive communication. For example, to the extent that many mobile computing devices have audio and video capabilities that may be used for two-way, real-time interactive communication they qualify as acceptable technology. The new waiver in Section 1135(b) of the Social Security Act explicitly allows the Secretary to authorize use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE. In addition, effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.htm
To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
NAHC is seeking an expansion of this waiver to accommodate those situations where two-way audio and video are not available. We will provide any new information as soon as it is available.
The office of the HHS Secretary also released the following two documents concerning HIPAA. The first document includes reminders about how to handle HIPAA during emergency situations. The second document includes the waiver explaining that providers are able to communicate with patients during this emergency using alternative technologies. Specifically, the notice states:
During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies. Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.
OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification is effective immediately.
Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.
Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.
Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.
https://www.hhs.gov/sites/default/files/hipaa-and-covid-19-limited-hipaa-waiver-bulletin-508.pdf
Issue: Testing
Question: Can home health or hospice provider perform testing of patients? Is a CLIA waiver required?
Answer:Providers would not be performing the testing, but they could collect specimens if requested by local/state officials to do so. Because providers would not be performing the test and instead simply collecting the specimens, CLIA waived testing is not applicable. We would recommend a training and competency test for all clinicians who would be collecting the specimens.
Issue: Home Health Care in Nursing Homes, Assisted Living Facilities (ALFs) and Similar Facilities
Question: ALFs and similar facilities are denying us access to care for our patients. What can we do?
Answer: The federal government does not regulate ALFs, personal care homes and the like. States may have issued guidance to these facilities to restrict all visitors. In such cases, we recommend working with the facility to explain that hospice staff are not visitors but are health care providers. Hospice staff should utilize PPE properly and pass any facility screenings before entering these facilities. It may be helpful to share the CMS guidance to nursing homes which can be found in the link below. Even though these facilities are not nursing homes, they may consider CMS guidance to nursing homes in a memo dated March 13, 2020 and guidance published in another recently released memo.
If hospice providers are not successful in getting facility access granted, it may be helpful to speak with the local and state officials regarding the prohibition.
Hospice agencies may also be able to revise the hospice plan of care for fewer visits, if appropriate.
For questions about telehealth visits, please see guidance here.
Issue: Hospice Care in Nursing Homes, Assisted Living Facilities (ALFs) and Similar Facilities
Question: Should hospice workers (including volunteers) be allowed access to nursing homes?
Answer: Hospice workers (including volunteers) have experienced challenges gaining entry to care for patients residing in nursing homes. Despite early CMS guidance to nursing homes indicating that hospice staff should be granted access (if passing a screening and using PPE properly), access continues to be denied. We are hearing of wholesale denial as well as access only being granted when the hospice patient is actively dying and/or when symptom management is needed. It may be helpful for hospices to share the guidance cited in the paragraphs below with the nursing homes as they clearly indicate that hospice staff should be allowed access to the nursing home if passing a screening and utilizing proper PPE. If there is a local or state order that is more restrictive than what is included in CMS guidance below, it supersedes this guidance. NAHC is working towards a more direct statement on the issue from CMS.
CMS guidance states “hospice workers can enter a facility when using PPE properly,” and separate CMS guidance issued to hospice providers indicating the “If hospice care is provided in a nursing home, we have advised nursing homes that hospice workers should be allowed entry provided that hospice staff is following the appropriate CDC guidelines for Transmission-Based Precautions, and using PPE properly,” there were continuing issues with patient access.
CMS issued revised guidance to nursing homes on March 13 restricting all visitors to the facility, but specifying that hospice workers are among those excepted from the ban.
And, CMS stated in recent QSO memo on survey priorities: “CMS is aware that some providers (nursing homes, assisted living facilities, etc.) have significantly restricted entry for staff from other Medicare/Medicaid certified providers who are providing direct care to patients. In general, if the staff is appropriately wearing PPE, and do not meet criteria for restricted access, they should be allowed to enter and provide services to the patient (interdisciplinary hospice care, dialysis, organ procurement, home health, etc.).”
If hospice providers are not successful in getting facility access granted, it may be helpful to speak with the local and state officials regarding the prohibition.
Hospice agencies may also be able to revise the hospice plan of care for fewer visits, if appropriate.
For questions about telehealth visits, please see guidance here.
Question: ALFs and similar facilities are denying us access to care for our patients. What can we do?
Answer
Issue: Death in the Home of COVID-19 Patient/Person Under Investigation
Question: In the case of death in the home of a patient with a positive diagnosis of COVID-19, what precautions should we take relative to care of the body to ensure protection of family members/caregivers and our staff?
Answer: Providers should be in contact with their state department of health, and the department will direct them accordingly, in this type of situation. For preparation purposes, we would suggest that the provider simply indicate in the plan that they will communicate with their state department of health at the time of death to obtain further instructions. There are several reasons for this, and the first and most significant is that this situation is ever evolving and it is the state departments of health that are getting the information first – from the CDC, CMS and other sources. Then within their state’s emergency response structure there will be further communication. It is important for all providers to remember that the CDC is only able to provide guidance in general and not specific to a state or local area’s guidance, which is likely more current and accurate. Providers should be following their EP programs and communicating with their coalitions. If that is not possible, they should get linked in to the most appropriate source by contacting their state department of health.
Issue: Homebound
Question: Is a patient who is voluntarily self quarantined due to the pandemic considered homebound? It seems they would be since leaving the home is contraindicated at this time.
Answer:
NAHC has reached out to CMS regarding possible flexibility regarding the homebound requirement in light of COVID-19. However, nothing has changed as of yet, and a patient quarantined to the home due to COVID-19 must still meet the existing homebound requirements (copied below from Chapter 7 of the Medicare Benefit Policy Manual for convenience) for payment from Medicare. Each case needs to be evaluated against these criterion, of course, but in general, COVID-19 or a person under investigation for COVID-19, alone may not result in qualifying a patient as homebound. We’ll let you know if anything changes in regards to homebound criterion.
- Criterion One: The patient must either: – Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence OR – Have a condition such that leaving his or her home is medically contraindicated.
If the patient meets one of the criterion one conditions, then the patient must ALSO meet two additional requirements defined in criterion two below.
- Criterion Two: There must exist a normal inability to leave home; AND – Leaving home must require a considerable and taxing effort.
Issue: Treatment of Employee Returning from Self-Quarantine
Question: What do I do with an employee who was self-quarantined for 14 days after being out of the country? Can I really have that person come back to work?
Answer: Relative to safety concerns, we recommend that you review CDC guidelines related to potential risk and consult with your local public health officials. We also suggest that you seek guidance from your employment law attorney and/or risk management staff to assess level of risk/liability to your agency.