{"id":27235,"date":"2020-05-13T10:42:57","date_gmt":"2020-05-13T10:42:57","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=27235"},"modified":"2020-05-13T10:42:57","modified_gmt":"2020-05-13T10:42:57","slug":"cms-flexibilities-to-fight-covid-19-medicare-1135-waivers-two-interim-final-rules-enabling-health-system-expansion","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/cms-flexibilities-to-fight-covid-19-medicare-1135-waivers-two-interim-final-rules-enabling-health-system-expansion\/","title":{"rendered":"CMS Flexibilities to Fight COVID-19 – Medicare 1135 Waivers & Two Interim Final Rules Enabling Health System Expansion"},"content":{"rendered":"\n

<\/a>Download PDF<\/a><\/div>\n\n\n\n


Medicare 1135 Waivers & Two Interim Final Rules Enabling Health System Expansion<\/strong><\/p>\n\n\n\n

Medicare 1135 Waivers & Two Interim Final Rules<\/strong><\/p>\n\n\n\n

\u2022CMS has two critical roles:<\/p>\n\n\n\n

\u2022Ensure Medicare beneficiaries receive safeand effectivecare during the COVID-19 Public Health Emergency (PHE).<\/p>\n\n\n\n

\u2022Ensure Medicare payment\/coverage policies during the COVID-19 PHE do not impedeproviders working to expand capacity to treat patients.<\/p>\n\n\n\n

\u2022In light of the PHE, CMS can waive certain pre-approval requirements, federal licensing requirements, EMTALA, Stark Law, and \u201ccertain deadlines and timetables for performance of required activities.\u201d<\/p>\n\n\n\n

\u2022CMS is enabling significant health system flexibility during the PHE through waivers and regulatory flexibility.<\/p>\n\n\n\n

2<\/p>\n\n\n\n

Medicare 1135 Waivers & Interim Final RulesEnabling Health System Expansion<\/strong><\/p>\n\n\n\n

\u2022Waivers \u2013<\/strong>CMS issued national (\u201cblanket\u201d) \u00a71135 waivers for certainhospital CoPs, provider-based rules, and the physician self-referral law (\u201cStark law\u201d)<\/p>\n\n\n\n

\u2022Enables rapid expansion of hospital services in on-\/off-campus clinical\/non-clinical space, including in partnership with other entities<\/p>\n\n\n\n

\u2022Allows other facility types (e.g., ASCs) to become hospitals, subject to meeting more flexible CoPs in place during the PHE as well as streamlined enrollment and cost-reporting requirements<\/p>\n\n\n\n

\u2022Allows hospitals and other providers to offer things like free meals, childcare or laundry to healthcare workers by waiving sanctions under the Stark law<\/p>\n\n\n\n

\u2022Regulatory Flexibility \u2013<\/strong>CMS published two interim final rules, with comment periods<\/p>\n\n\n\n

\u2022Clarifies rules for hospitals to furnish inpatient services under-arrangement with other providers<\/p>\n\n\n\n

\u2022Clarifies when hospitals can furnish outpatient services in the patient\u2019s homeor other expansion site<\/p>\n\n\n\n

\u2022Establishes process for hospital outpatient departments to seek exception from lower payments when temporarily relocating due to the PHE<\/p>\n\n\n\n

\u2022Expands physician supervision flexibilitiesfor inpatient\/outpatient hospitals services<\/p>\n\n\n\n

\u2022Expands services that can be furnished through telehealth<\/p>\n\n\n\n

\u2022Expands types of practitioners that can furnish telehealth<\/p>\n\n\n\n

\u2022Expands coverage of ambulance transport to additional sites<\/p>\n\n\n\n

3<\/p>\n\n\n\n

Other Support \u2013CARES Act Provisions for Acute Care Hospitals<\/strong><\/p>\n\n\n\n

\u2022New $100b fund for providers responding to the COVID-19 PHE (grants \u2013HHS is administering)<\/p>\n\n\n\n

\u2022Initial $30b allocated in early April, as of 4\/28\/20 HHS had begun distribution of an additional $20b1<\/p>\n\n\n\n

\u2022Eliminates sequestration (2% reduction) to Medicare payments 5\/1\/20-12\/31\/20<\/p>\n\n\n\n

\u2022CMS took action to ensure provision is effective for claims starting 5\/1\/202<\/p>\n\n\n\n

\u202220% increase to IPPS DRG weight for patients diagnosed with COVID-19 during the PHE<\/p>\n\n\n\n

\u2022CMS took action to implement this provision for discharges on or after 1\/27\/203<\/p>\n\n\n\n

\u2022Expands CMS accelerated payment program<\/p>\n\n\n\n

\u2022CMS successfully allocated over $100b under this program and as of 4\/26\/20, CMS was revaluating the amounts that would be paid4<\/p>\n\n\n\n

\u2022Legislation includes other non-hospital related health provisions<\/p>\n\n\n\n

1:<\/strong>https:\/\/www.hhs.gov\/about\/news\/2020\/04\/28\/eligible-providers-can-submit-information-to-receive-additional-provider-relief-fund-payments.html<\/strong><\/p>\n\n\n\n

2<\/strong>https:\/\/www.cms.gov\/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive\/2020-04-10-mlnc-se#_Toc37418832<\/strong><\/p>\n\n\n\n

3 <\/strong>https:\/\/www.cms.gov\/files\/document\/se20015.pdf<\/strong><\/p>\n\n\n\n

4 <\/strong>https:\/\/www.cms.gov\/newsroom\/press-releases\/cms-reevaluates-accelerated-payment-program-and-suspends-advance-payment-program<\/strong><\/p>\n\n\n\n

4<\/p>\n\n\n\n

Expanding Capacity: Local Private vs. Public (Federal Emergency Management Agency, Department of Defense, State and Local Gov.) Approaches<\/strong><\/p>\n\n\n\n

Military hospital ships docked in a United States port and temporary military field hospitals erected in the United States in response to a mission assignment from the Federal Emergency Management Agency (FEMA) do not bill civilians or the Medicare program for any services rendered.<\/p>\n\n\n\n

Local Private Hospital<\/strong><\/p>\n\n\n\n

\u2022Hospital expands by repurposing clinical or non-clinical spaces<\/p>\n\n\n\n

\u2022Has existing CCN and uses their resources for operations (e.g., capital, equipment, labor)<\/p>\n\n\n\n

\u2022Hospital obtains appropriate licensing and other state approvals as needed<\/p>\n\n\n\n

\u2022Medicare pays hospital for care furnished in new sites under applicable payment system<\/p>\n\n\n\n

\u2022Professionals bill under MPFS<\/p>\n\n\n\n

Federally-Developed, Locally-Staffed<\/strong><\/p>\n\n\n\n

\u2022FEMA\/DOD\/State establishes new hospital-level care site, such as convention center, hotel, tent, etc.<\/p>\n\n\n\n

\u2022Facility operations and staffing handed off to existing Medicare-enrolled hospital(s)<\/p>\n\n\n\n

\u2022Hospital (in partnership with state or local gov) obtains appropriate licensing, other approvals<\/p>\n\n\n\n

\u2022Medicare largely pays hospital for care furnished in new sites under applicable payment system<\/p>\n\n\n\n

\u2022Professionals bill under MPFS<\/p>\n\n\n\n

5<\/p>\n\n\n\n

CMS Example Scenarios: Provider Flexibilities<\/strong><\/p>\n\n\n\n

Ambulatory Surgical Center (ASC)<\/strong><\/p>\n\n\n\n

ASCs can become hospitals under new streamlined process. They can also work under arrangement with existing hospital to create a temporary expansion site. <\/p>\n\n\n\n

Long-Term Care Hospital (LTCH)<\/strong><\/p>\n\n\n\n

LTCHs meet Medicare hospital requirements and can provide inpatient acute care to Medicare beneficiaries. Medicare\u2019s 50% rule will be dropped during the PHE (CARES Act).<\/p>\n\n\n\n

Hospitals & Practitioners<\/strong><\/p>\n\n\n\n

\u2022Hospitals can treat patients in existing clinical space, new temporary expansion sites, or triage patients to other care sites based on resources and COVID-19 status.<\/p>\n\n\n\n

\u2022Medicare-enrolled physicians and practitioners can furnish covered services in all of these care settings and bill for those services under the Medicare physician fee schedule<\/p>\n\n\n\n

Inpatient Rehab Facility (IRF)<\/strong><\/p>\n\n\n\n

IRFs meet Medicare hospital requirements and can provide inpatient acute care to Medicare beneficiaries. Medicare\u2019s 3-hour rule will be dropped during the PHE (CARES Act).<\/p>\n\n\n\n

Skilled Nursing and\/or Nursing Facility (SNF\/NF)<\/strong><\/p>\n\n\n\n

SNF\/NFs can work with hospitals under arrangements to be able to provide inpatient acute care to Medicare beneficiaries.<\/p>\n\n\n\n

FEMA\/DOD\/State Facility<\/strong><\/p>\n\n\n\n

Newly established care locations run by the state or federal government will furnish care to patients during the PHE.6<\/p>\n\n\n\n

CMS Example Scenarios: Hospital Expansion of Inpatient Beds<\/strong><\/p>\n\n\n\n

Medicare-enrolled Hospital<\/strong><\/p>\n\n\n\n

\u2022Has existing CCN<\/strong><\/p>\n\n\n\n

\u2022IPPS (~3,300), LTCH PPS (~380), Critical Access Hospital (~1300)<\/strong><\/p>\n\n\n\n

\u2022Wants to expand inpatient capacity during PHE<\/strong><\/p>\n\n\n\n

Example: Parking Lot Hospital Tent<\/strong><\/p>\n\n\n\n

\u2022Hospital erects a tent in their parking lot to provide covered services<\/p>\n\n\n\n

\u2022Care provided in tent must meet refined CoPs.<\/p>\n\n\n\n

\u2022Hospital can bill under existing CCN following standard billing practices for inpatient and outpatient services.<\/p>\n\n\n\n

\u2022Hospital should add \u201cDR\u201d condition code for patients in all new locations, including tents.<\/p>\n\n\n\n

Example: Repurposes Distinct Part Unit Beds<\/strong><\/p>\n\n\n\n

\u2022Hospital repurposes distinct part unit beds for use as short stay acute inpatient beds.<\/p>\n\n\n\n

\u2022Care furnished in new inpatient beds must meet refined CoPs; noting new flexibilities and waivers<\/p>\n\n\n\n

\u2022Hospital can bill under existing CCN following standard billing practices for inpatient services.<\/p>\n\n\n\n

\u2022Hospital should add \u201cDR\u201d condition code for patients in all new locations, including repurposed beds.<\/p>\n\n\n\n

Example: Rents Available Space (closed hospitals, empty building)<\/strong><\/p>\n\n\n\n

\u2022Hospital transforms a new empty building to inpatient space<\/p>\n\n\n\n

\u2022Care furnished in new inpatient space must meet refined CoPs.<\/p>\n\n\n\n

\u2022Hospital can bill under existing CCN following standard billing practices for inpatient services.<\/p>\n\n\n\n

\u2022Hospitals should add \u201cDR\u201d condition code for patients in all new locations, including the convention center.<\/p>\n\n\n\n

Policies Applying to All Scenarios<\/strong><\/p>\n\n\n\n

\u2022CMS will not require submission of amended 855A enrollment form during PHE.<\/p>\n\n\n\n

\u2022CMS, states and accreditors have stopped compliance survey activities.<\/p>\n\n\n\n

\u2022State licensure of new spaces\/bed may be required depending on state rules.<\/p>\n\n\n\n

\u2022Payments to professionals would also need to be considered \u2013below is specific to facility payments<\/p>\n\n\n\n

7<\/p>\n\n\n\n

CMS Example Scenarios: Shared Operations in Temporary Expansion Site<\/strong><\/p>\n\n\n\n

Convention Center<\/strong><\/p>\n\n\n\n

Hospital A<\/strong>(Capacity = 14 Beds)<\/p>\n\n\n\n

Hospital B <\/strong>(Capacity = 14 Beds)<\/p>\n\n\n\n

Hospital C <\/strong>(Capacity = 28 Beds)<\/p>\n\n\n\n

Key Attributes<\/strong><\/p>\n\n\n\n

\u2022This example temporary expansion site is jointly managed by 3 different hospitals.<\/p>\n\n\n\n

\u2022Each hospital manages its own \u201csection\u201d like a separate hospital \u2013they provide the staff and resources necessary for site operations, including the clinical staff and other necessary services (pharmacy, lab, radiologic, dining) required to furnish inpatient\/outpatient care.<\/p>\n\n\n\n

\u2022Certain resources are jointly purchased where it makes sense for economies of scale and operations (e.g., building power, oxygen and other DME)<\/p>\n\n\n\n

\u2022Each hospital bills separately for care furnished to their patients. Patients moving from one hospital\u2019s section to another hospital\u2019s section are considered inpatient transfers and billed as such.<\/p>\n\n\n\n

8<\/p>\n\n\n\n

CMS Example Scenarios: ASC to Hospital Conversion<\/strong><\/p>\n\n\n\n

Example: Ambulatory Surgical Center<\/strong><\/p>\n\n\n\n

Enrolls as a Hospital<\/strong><\/p>\n\n\n\n

\u2022Medicare-certified ASC enrolls as a \u201ctemporary expansion site\u201d hospital using new streamlined attestation process<\/p>\n\n\n\n

\u2022Newly-enrolled hospital must meet refined hospital Conditions of Participation in effect during PHE<\/p>\n\n\n\n

\u2022Medicare would provide a CCN for the newly-enrolled hospital<\/p>\n\n\n\n

\u2022Newly-enrolled hospital can bill using new CCN following standard billing practices for inpatient and outpatient services.<\/p>\n\n\n\n

\u2022The newly-enrolled hospital should add \u201cDR\u201d condition code for patients in all new locations<\/p>\n\n\n\n

Ambulatory Surgical Center<\/strong><\/p>\n\n\n\n

Medicare-enrolled Hospital<\/strong>9<\/p>\n\n\n\n

CMS Example Scenarios: Care Furnished in Patients\u2019 Homes<\/strong><\/p>\n\n\n\n

Patients Home<\/strong><\/p>\n\n\n\n

Hospital Inpatient<\/strong><\/p>\n\n\n\n

Under 1135 waivers and new under arrangements policy hospitals can consider the patient\u2019s home a temporary expansion site during the PHE. Hospitals would need ensure that the applicable expansion site meets all of the remaining conditions of participation, including the ability to provide laboratory and pharmacy services, 24-hour nursing care, and food services, among others. Any arrangement to furnish inpatient care in the beneficiary\u2019s home must be consistent with any state licensing or other regulatory requirements active under the state\u2019s emergency preparedness or pandemic plan.  +<\/p>\n\n\n\n

HHAs<\/strong><\/p>\n\n\n\n

HHAs can furnish care in the beneficiaries home during the PHE. In-person care can be supplemented by virtual care.<\/p>\n\n\n\n

Practitioners<\/strong><\/p>\n\n\n\n

Practitioners can care for patients in their homes with face-to-face visits by performing house calls or via telehealth<\/p>\n\n\n\n

Physician Practices Auxiliary Personnel<\/strong><\/p>\n\n\n\n

Physician practices can work with auxiliary personnel to furnish care incident to the physician\u2019s service in the patient\u2019s home. This could include, for example, infusions, wound care and other services. Under these approaches, the physician practice would bill for these services under the Physician Fee Schedule and pay the auxiliary personnel (e.g., home health agency or home infusion provider) directly.<\/p>\n\n\n\n

Hospital Outpatient Department<\/strong><\/p>\n\n\n\n

Under 1135 waivers hospitals can treat patients<\/p>\n\n\n\n

homes as provider-based departments (PBDs) during the PHE while the patient is enrolled as an outpatient. The PBDs can bill for medically necessary outpatient therapeutic services furnished in the home, assuming all other applicable requirements are met (including, to the extent not waived, the hospital conditions of participation). Hospital must be aware if patient is under a home health plan and not furnish services that are being furnished by home health agency. 10<\/p>\n\n\n\n

CMS Example Scenarios: Practitioners<\/strong><\/p>\n\n\n\n

Practitioners<\/strong><\/p>\n\n\n\n

Practitioners can treat patients with or without COVID in a variety of settings, including temporary expansion sites, and bill for services under the Medicare Physician Fee Schedule.<\/p>\n\n\n\n

Patient\u2019s Home<\/strong><\/p>\n\n\n\n

Practitioners can care for patients in their<\/p>\n\n\n\n

homes with face-to-face visits by performing house calls or via telehealth<\/p>\n\n\n\n

Skilled Nursing Facility and\/or Nursing Facility (SNF\/NF),<\/strong><\/p>\n\n\n\n

Inpatient Rehab Facility (IRF),<\/strong><\/p>\n\n\n\n

Long-Term Care Hospital (LTCH), Ambulatory Surgical Center (ASC)<\/strong><\/p>\n\n\n\n

Practitioners care for patients with face-to-face visits or via telehealth in these settings that provide inpatient acute care beds and meet Medicare hospital requirements.<\/p>\n\n\n\n

Hospital Inpatient\/Outpatient<\/strong><\/p>\n\n\n\n

Practitioners can care for hospital inpatients and outpatients with face-to-face visits or via telehealth as part of a medical practice or as an independent practice. Hospitals include the temporary expansion sites where inpatient and outpatient care is being furnished.<\/p>\n\n\n\n

Ambulatory Practices<\/strong><\/p>\n\n\n\n

Practitioners can care for patients via telehealth or with face-to-face visits using measures to avoid potential COVID transmission between patients (space scheduling and rooms, patients avoid waiting rooms, etc.).+ 11<\/p>\n\n\n\n

Key Links<\/strong><\/p>\n\n\n\n

CMS Waiver and Flexibilities Website: <\/strong>https:\/\/www.cms.gov\/about-cms\/emergency-preparedness-response-operations\/current-emergencies\/coronavirus-waivers<\/p>\n\n\n\n

Regulatory Flexibilities Press Release: <\/strong>https:\/\/www.cms.gov\/newsroom\/press-releases\/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19<\/p>\n\n\n\n

Regulatory Flexibilities Fact Sheet: <\/strong>https:\/\/www.cms.gov\/newsroom\/fact-sheets\/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient<\/p>\n\n\n\n

12<\/p>\n\n\n\n

Appendix A: Additional PHE Flexibilities for Post-Acute Providers<\/strong><\/p>\n\n\n\n

13<\/p>\n\n\n\n

CMS Example Scenarios:SNFs<\/strong><\/p>\n\n\n\n

Two or more CertifiedSNF\/NFs transfer patients between facilities to create a COVID and Non-COVID Facility.  Allowed under Blanket Transfer Waiver without additional approval. Each certified SNF bills Medicare for the residents in their facility.<\/strong><\/p>\n\n\n\n

Non-COVID<\/p>\n\n\n\n

COVID<\/p>\n\n\n\n

\u2022CMS is waiving requirements in 42 CFR 483.10(c)(5); 483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), (c)(9), and (d); and \u00a7483.21(a)(1)(i), (a)(2)(i), and (b) (2)(i) (with some exceptions) to allow a long term care (LTC) facility to transfer or discharge residents to another LTC facility solely for the following cohortingpurposes: Transferring residents with symptoms of a respiratory infection or confirmed diagnosis of COVID-19 to another facilitythat agrees to accept each specific resident, and is dedicated to the care of such residents;<\/p>\n\n\n\n

\u2022Transferring residents without symptoms of a respiratory infection or confirmed to not have COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents to prevent them from acquiring COVID-19; or<\/p>\n\n\n\n

\u2022Transferring residents without symptoms of a respiratory infection to another facility that agrees to accept each specific resident to observe for any signs or symptoms of a respiratory infection over 14 days.<\/p>\n\n\n\n

14<\/p>\n\n\n\n

Transfer residents from one or more Certified SNFs to a Non-Certified Location that is state approved and where residents must be cared for by SNF staff: Medicare reimbursement remains with the SNF caring for patients in the new location.  This location could be utilized by multiple SNFs, providing care with their own staff.<\/strong><\/p>\n\n\n\n

State Approved non-SNF Location staffed \/operated by Certified SNF<\/p>\n\n\n\n

\u2022CMS is waiving requirements related at 42 CFR 483.90, specifically the following: Provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements under \u00a7 483.90 to allow for a non-SNF building to be temporarily certified and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID-19 are available while protecting other vulnerable adults.<\/p>\n\n\n\n

\u2022These requirements are also waived when transferring residents to another facility, such as a COVID-19 isolation and treatment location, with the provision of services \u201cunder arrangements,\u201d as long as it is not inconsistent with a state\u2019s emergency preparedness or pandemic plan, or as directed by the local or state health department. In these cases, the transferring LTC facility need not issue a formal discharge, as it is still considered the provider and should bill Medicare normally for each day of care. The transferring LTC facility is then responsible for reimbursing theother provider that accepted its resident(s) during the emergency period.<\/p>\n\n\n\n

15<\/p>\n\n\n\n

Transfer of COVID residents to Federal\/State Run Facility staffed with Federal or State Personnel: Transfers by Order of Governmental Authority (e.g., FEMA) and no reimbursement to SNF.<\/strong><\/p>\n\n\n\n

No waiver necessary as long as transfer is not inconsistent with a state\u2019s emergency preparedness or pandemic plan, or as directed by the local or state health department<\/p>\n\n\n\n

16<\/p>\n\n\n\n

Flexibility for <\/strong>Inpatient Rehabilitation Facilities (IRFs) <\/strong>& <\/strong>Long-Term Care Hospitals (LTCHs)<\/strong><\/p>\n\n\n\n

Freestanding IRFs and \u201cdistinct part unit\u201d (rehab units part of an acute care facility) IRFs, and LTCHs are considered hospitalsfor Medicare enrollment and oversight purposes. They can furnish and bill Medicare for covered inpatient services, and, similar to other hospitals, they can take use waivers of CoPwaivers and other flexibilities to expand capacity during the PHE. Below are additional flexibilities specific to IRFs and LTCHs that enable them to treat more acute beneficiaries during the PHE.<\/p>\n\n\n\n

IRFs<\/strong><\/p>\n\n\n\n

\u2022Rehabilitation physicians can conduct the required 3 face-to-face visits per week by telehealth during the PHE. [IFC 1]<\/p>\n\n\n\n

\u2022During the PHE, rehabilitation physicians do not need do conduct the post-admission evaluation. [IFC 1]<\/p>\n\n\n\n

\u2022IRFs admitting patients in response to the PHE can exclude those patients for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF (commonly referred to as the \u201c60 percent rule\u201d). [Waiver]<\/p>\n\n\n\n

\u2022Acute care hospitals with inpatient rehabilitation units can relocate inpatients from rehabilitation unit to an acute care unit as a result of this PHE. [Waiver]<\/p>\n\n\n\n

\u2022Acute care hospitals can house acute care inpatients in excluded distinct part units, such as excluded distinct part unit IRFs or IPFs, where the distinct part unit\u2019s beds are appropriate for acute care inpatients. [Waiver]<\/p>\n\n\n\n

\u2022CMS is implementing Section 3711(a) of the Cares Act (PL 116-136), which requires CMS to waive the requirement that IRF patientsgenerally receive at least 15 hours of therapy per week.<\/p>\n\n\n\n

LTCHs<\/strong><\/p>\n\n\n\n

\u2022LTCHs can exclude patients admitted or discharged in order to meet the demands of the emergency from the 25-day average length of stay requirement, which allows these facilities to be paid as LTCHs. [WAIVER]<\/p>\n\n\n\n

\u2022CMS is implementing Section 3711(b) of the Cares Act, which requires CMS to waive the LTCH 50% rule (at least 50% of patientsmeet LTCH criteria), as well as the site-neutral payment rate (lower rate applied when LTCH criteria not met).<\/p>\n\n\n\n

17<\/p>\n\n\n\n

Flexibility for <\/strong>Home Health Agencies (HHAs)<\/strong><\/p>\n\n\n\n

Home health is critical to helping Medicare beneficiaries stay at home and stopping community spread of COVID-19. In addition tothe below, home health agencies can partner with physician practices (under \u201cauxiliary personnel\u201d arrangements) and with hospital outpatient departments to furnish care in the home (additional information is available on the next slide).<\/p>\n\n\n\n

HHAs<\/strong><\/p>\n\n\n\n

\u2022CMS clarified the applicability of the \u201chome bound\u201d requirement given the PHE and many public (e.g., state government determined) stay-at-home orders. [IFC 1]<\/p>\n\n\n\n

\u2022CMS clarified that during the PHE HHAs can use technology to supplement in-person care when documented in the plan of care. While virtual visits can\u2019t replace certain in-person visits, they can be used to supplement them. [IFC 1]<\/p>\n\n\n\n

\u2022NPs, PAs, and other licensed health care practitioners can order Medicaid<\/em>home health services (previously, only physicians could order) [IFC 1]<\/p>\n\n\n\n

\u2022HHAs can take up to 30 days to complete the comprehensive assessment, and do not need to submit OASIS data within 30 days \u2013delayed submissions are permitted during the PHE. [WAIVER]<\/p>\n\n\n\n

\u2022HHAs can perform Medicare-covered initial assessments and determine patients\u2019 homebound status remotely or by record review. [WAIVER]<\/p>\n\n\n\n

\u2022HHA nurses do not need to conduct on-site visit every two weeks. [WAIVER]<\/p>\n\n\n\n

\u2022Occupational Therapists can perform initial and comprehensive assessment for all patients, regardless of whether occupationaltherapy is the service that establishes eligibility, [WAIVER]<\/p>\n\n\n\n

\u2022HHAs can request accelerated payments for home health episodes that have not completed yet. MACs can auto-cancel these requests after a brief period of time, but CMS is allowing them to extend these cancellations in light of the PHE since it may take the HHAs longer to submit their claims. [WAIVER]<\/p>\n\n\n\n

\u2022CMS is working to implement Section 3708 of the Cares Act which will allow NP, PAs, Certified Nurse Midwives, and Clinical NurseSpecialists as practitioners who can certify home bound status and order home health in Medicare.<\/p>\n\n\n\n

\u2022CMS is also evaluating whether additional rulemaking is needed to implement Section 3707 of the Cares Act which allows additional use of technology for home health during the PHE (policy at least partially addressed in IFC 1).<\/p>\n\n\n\n

18<\/p>\n\n\n\n

CMS Example Scenarios: Patient\u2019s Home & Home Health Agencies (HHAs)<\/strong><\/p>\n\n\n\n

HHAs<\/strong><\/p>\n\n\n\n

HHAs can furnish care in the beneficiaries home during the PHE. In-person care can be supplemented by virtual care. Under the CARES Act, implemented via CMS\u2019 second IFC, NPs, clinical nurse specialists, PAs, and certified nurse midwives can now certify homebound status and order home health services.<\/p>\n\n\n\n

HHAs + Physician Practice<\/strong><\/p>\n\n\n\n

HHAs can work under auxiliary personnel arrangements with physician practices. For example, HHAs could work with a physician to infuse chemotherapy in the patient\u2019s home. Under this scenario, a physician would be required to supervise the home health nurse (can use audio\/video technology) and would bill for covered professional services under the physician fee schedule. The physician practice would pay the HHA directly.<\/p>\n\n\n\n

HHAs + Hospital Outpatient (OPDs)<\/strong><\/p>\n\n\n\n

HHAs can partner with hospital outpatient departments to furnish covered hospital items and services in the home. The hospital\u2019s clinical staff would need to supervise the home health nurse (can use audio\/video technology) and would bill for the services under the outpatient prospective payment system. The hospital would pay the HHA directly.<\/p>\n\n\n\n

Patients Home<\/strong>+<\/p>\n\n\n\n

+<\/p>\n\n\n\n

19 20<\/p>\n\n\n\n

<\/p>\n\n\n","protected":false},"excerpt":{"rendered":"

Medicare 1135 Waivers & Two Interim Final Rules Enabling Health System Expansion Medicare 1135 Waivers […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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