[Updated] $2 Trillion Stimulus Bill Would Relax Home Health Certification Requirements, Encourage Telehealth Use

Political leaders agreed to one of the most expensive legislative packages in the history of Congress on Wednesday, finalizing the details of a roughly $2 trillion stimulus bill. While the record-breaking package has far-reaching implications for the overall economy, it also reportedly includes specific language that could trigger significant change throughout the home-based care landscape moving forward.

On Wednesday night, the Senate voted 96-0 to approve the package. Next up is the House, which will convene on Friday morning to consider the relief deal.

“[Our] response is providing direct assistance to the American people, injecting new resources where they are needed most, and moving our country a step closer to emerging from this crisis stronger than we were before,” Senate Appropriations Committee Vice Chairman Patrick Leahy (D-Vt.) said in a statement.

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Among the stimulus bill’s in-home care highlights is the ability for nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs) to certify eligibility for home health. This is a major change to former requirements, which only allowed physicians to certify home health eligibility for a patient.

If the bill is finalized as currently structured, the change would likely be permanent, William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News in an email.

It is unknown when the U.S. Centers for Medicare & Medicaid Services (CMS) would ultimately implement the change, but the agency could do so “immediately if they wish,” Dombi added. The change would likely not come later than six months.

“The Senate bill contains a number of pieces of relief for both home health agencies and hospices,” Dombi told NAHC members in an online update video released this week. “Our longstanding bill on nurse practitioners and physician assistants may actually become law.”

The home health industry previously pushed for non-physician certification in the Home Health Care Planning Improvement Act of 2019, introduced last April.

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“The ability for patients to gain access to home health services would be much more efficient,” LHC Group CEO Keith Myers previously told HHCN, describing non-physician certification as a “massive win” if ever made a reality.

Without certification flexibility, in-home care providers often experience communication challenges with patients’ doctors, which, in turn, creates delays that leave individuals without needed care for inappropriate periods of time. Chances of those communication challenges happening now are even more likely as doctors deal with waves of new COVID-19 cases.

Loosening homebound requirements

Apart from non-physician certification, the bill includes $955 million for the Administration for Community Living (ACL) to provide wide-ranging support for home- and community-based services caregivers.

It also features $200 million in funding for a federal push to bolster infection-control efforts in the nation’s nursing home, Skilled Nursing News reported.

CMS is probably on the brink of announcing other new flexibilities for home-based care providers as well, Dombi believes.

Through the bill, Congress is additionally urging CMS to encourage telehealth services, though no direct payment mechanism is created directly. That could change sometime soon, as there’s also an emergency rule making its way through the U.S. Office of Management and Budget (OMB).

Under the emergency rule, providers could potentially be compensated for telehealth and home health homebound requirements could be relaxed, but both possibilities are largely still up in the air.

Washington, D.C.-based long-term care association LeadingAge wrote to CMS Administrator Seema Verma on Tuesday, urging her to relax the above-mentioned in-home care restrictions.

As for the homebound requirement, the emergency rule would allow home health agencies to conduct initial assessments of patients either remotely or by record review. That way, LeadingAge argued in the letter, beneficiaries could be granted care without causing risk to themselves or health care workers.

Providers are eagerly awaiting word from OMB on the homebound and telehealth fronts, Aaron Tripp, the VP of reimbursement and financing at LeadingAge, told HHCN.

“It would be helpful, especially during the pandemic, to allow virtual visits to count as a regular visit as part of the Patient-Driven Groupings Model (PDGM), including the use of the telephone for those who do not have computer access,” Tripp said.

The big picture

The stimulus bill is meant to be a rapid infusion of cash into a badly hurting economy. Generally, the bill will send billions of dollars directly to American citizens, offer assistance and incentives to smaller companies, and bail out major industries.

Some in-home care agencies could benefit from the bill’s emphasis on aiding smaller businesses. For example, it provides federally guaranteed loans available at community banks for businesses that pledge to not lay off workers.

Under the emergency period, which ends on June 30, loans would be granted and forgiven if the employer paid its workers during the duration of the crisis.

Because caregivers are even more vital during the crisis, being rewarded for holding onto workers could be a major advantage for providers.

The home-based care industry is still awaiting clarity on a bill that was passed last week — the Families First Coronavirus Response Act (FFCRA). Broadly, that bill will give workers guaranteed paid sick leave and paid time off if they need to take care of children who are off school due to closures, among other scenarios. Health care workers, however, are exempt from that.

Industry advocates are now working to ensure that non-medical home care workers are included under the “health care workers” umbrella.

“We are hopeful that the flexibilities being granted to home health agencies … become the rule — not the exception — after the outbreak concludes,” Tripp said.

While the Senate overwhelmingly passed the bill, many still had reservations about it as recently as Wednesday afternoon, including New York Governor Andrew Cuomo, who felt it was not sufficient.

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