How The Public Health Emergency Helped Cut Regulatory Red Tape For Home Health Agencies

With the public health emergency (PHE) set to finally end on May 11, home health stakeholders are finding that the impact won’t be as disruptive as once feared.

This is because most of the biggest issues have already been addressed by Congress and the Centers for Medicare & Medicaid Services (CMS).

“Congress addressed the face-to-face encounter side of it, so we’re not going to be losing as much as we might have, if that hadn’t happened,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News. “For example, CMS early on in the pandemic made permanent the ability of home health agencies to use virtual visits, if authorized by the treating physician or treating practitioner.”

This means that the required face-to-face encounter for home health services can take place through telehealth.

Another factor that will potentially lessen the negative impact of the PHE ending is the Acute Hospital Care at Home waiver — which was originally tied to the PHE — getting an extension through the omnibus spending bill, Moving Health Home Founder Krista Drobac told HHCN.

“We were successful in decoupling the waiver related to acute care in the home from the PHE at the end of last year when we secured the two-year extension,” she said. “Now we’re focused on educating Congress about the other barriers that didn’t get waived during the PHE but are necessary for providing patients more options in the home.”

Drobac noted that Moving Health Home is pushing for a bill that will potentially be introduced in the House.

“It will give patients the options for care in the home,” she said. “There’s a lot of pieces that are still missing related to home infusion, home dialysis, home-based primary care, home-based imaging, home-based labs and even Medicare personal care services. We’ve taken a look across the full spectrum of all the things that need to change in order for a patient to truly be able to stay home in a variety of different cases, so we’ll be introducing legislation there.”

Still, there are some concerns providers should keep their eye on with the PHE coming to an end in the spring.

“We’ve heard from several of our mission-driven home health members that they are concerned with the end of the waiver that allows for therapists to perform the initial and comprehensive assessments for all patients,” Mollie Gurian, vice president of home health and HCBS policy at LeadingAge, told HHCN in an email. “Given the nursing shortage, home health agencies have appreciated the critical flexibility to utilize therapists to do the initial assessments on home health patients in order to initiate care, even when they are nursing based. We encourage CMS to consider ways to extend this flexibility in places with extreme nursing shortages.”

There are also some administrative flexibilities, regarding training and supervision activities, that Dombi believes CMS should consider maintaining on a permanent basis.

Ultimately, Dombi pointed out that the PHE was an opportunity for CMS and providers to learn what was truly administratively necessary and what wasn’t.

“In some respects, the home health agencies might have an increased appreciation for some of the structures that are there for assuring quality of care, but even more importantly, we think CMS has gained knowledge about overdoing it with regards to administrative structure,” he said. “Maybe that process isn’t something to keep layering on top of, in order to achieve an end that you can sometimes get to in more efficient ways.”