Courtesy of the National Association for Home Care & Hospice

The COVID-19 Public Health Emergency (PHE) began in early 2020 and will end on May 11, 2023. Throughout the PHE, various waivers, regulations, enforcement discretion, and sub-regulatory guidance were utilized to ensure access to care and give health care providers the flexibility needed to respond to the PHE. Some of these flexibilities became permanent over the years, some have been extended, and some will end after May 11.

The Centers for Medicare & Medicaid Services (CMS) has developed a roadmap for stakeholders to transition as the PHE comes to an end and recently released a memorandum with additional details to help guide providers toward returning to previous health and safety standards and billing practices. In addition, the memo provided additional information about staff vaccinations and emergency preparedness requirements and updates to areas where CMS will use its discretion in determining compliance.

The National Association for Home Care & Hospice (NAHC) has developed a table (attached) that incorporates the waivers and flexibilities applicable to home health and hospice providers with the current status of the waiver/flexibility, an indication of the current level (which ends when the PHE ends, has been made permanent, or has been extended), and the date on which providers need to be in full compliance with the applicable requirement. NAHC will update this resource as more information becomes available.

The most frequently asked questions NAHC receives regarding the end of the PHE are related to telehealth/telecommunications and whether home health and hospice staff need to be vaccinated against COVID-19 or have an acceptable exemption. These FAQs are addressed below and in the accompanying resource.

Q: Can face-to-face encounters be conducted via telehealth after the end of the PHE?

A: Omnibus budget appropriations bills for Fiscal Year (FY) 2023 extended the originating site waiver through December 31, 2024, allowing the face-to-face to be completed utilizing two-way audio and video telehealth for home health and hospice.

Q: Can providers continue to provide telecommunications visits after the end of the PHE?

A: Telecommunications technology can include, for example, remote patient monitoring; telephone calls (audio only and TTY); and two-way audio-video technology that allows for real-time interaction between the clinician and patient.

Telehealth visits:

• Must be included in the plan of care;
• Cannot replace an on-site visit; and
• Are not billable.

Home health services furnished using telecommunication systems must be included on the home health claim beginning July 1, 2023, with the following G-codes.

• G0320 – Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system.
• G0321 – Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system.
• G0322 – The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring).

Throughout the PHE, providers were permitted to conduct telehealth visits using various systems, including those not in compliance with HIPAA. However, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced on April 11, 2023, that a 90-day transition period would be provided for covered health care providers to comply with HIPAA rules for telehealth services. The transition period will begin on May 12, 2023, and expire on August 9, 2023, at 11:59 PM ET. During the 90-day transition period, OCR will still exercise its enforcement discretion and not impose penalties on covered health care providers for noncompliance with the HIPAA rules. Click here for more information.

Q: Do staff still need to be vaccinated against COVID-19 or have an acceptable exemption?

A: Per the QSO 23-23-ALL memo, CMS states it will soon end the requirement that covered providers and suppliers establish policies and procedures for staff vaccination. CMS will share more details regarding ending this requirement at the anticipated end of the PHE. In addition, CMS added a reminder that the strongest protection from COVID-19 is the vaccine. Therefore, CMS urges everyone to stay current with their COVID-19 vaccine.

As part of the roadmap (above), CMS issued provider-specific guidance that details plans for the phase-out of various waivers and flexibilities with the following documents applicable to home health. These resources are listed below:

• COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (Updated 10/13/2022)
• Home Health Fact Sheet (Updated 2/2023)

UPDATE: OASIS Completion and Submission Dates (5/10/23)

CMS has clarified the following applicable dates for the OASIS completion and submission for compliance when the PHE ends. The temporary guidance waivers are effective through the end of the COVID-19 PHE declaration. As the end of the PHE has been determined as 11:59 PM ET on May 11, 2023, these waivers expire with that date.

The extension of the five-day completion requirement for the comprehensive assessment waiver at the start of care would be based on the M0030 – Start of Care (SOC) date. For example, if the M0030 – SOC date is on or before May 11, 2023, the five-day extension waiver is in effect.  However, If the M0030 – SOC date is on or after May 12, 2023, the five-day extension waiver has expired.

Regarding the waiving of the 30-day OASIS submission requirement, this would be based on the M0090 – Date Assessment Completed. For example, if an assessment's M0090 date is on or before 5/11/23, the 30-day submission requirement for that assessment would be waived. If an assessment's M0090 date is on or after May 12, 2023, the 30-day submission requirement is in effect.

UPDATE: Therapist Performing the Comprehensive Assessment (5/10/23)

NAHC has requested an extension of the §484.55 waiver, which permits therapists to perform the comprehensive assessment. CMS has assured NAHC that the request is before department officials. Presently, the waiver is set to end on May 11, 2023, with the end of the PHE. Stay tuned for updates.