Coronavirus Daily Update: CMS Granting Extensions for Providers in Quality Reporting Programs

During this critical time, Home Health Care News remains committed to bringing you all the essential news related to home-based care operations. At the same time, we also recognize the seriousness of the COVID-19 pandemic. In addition to our regular content, we’ll continue to highlight industry-related developments and mitigation strategies in this rolling bulletin.

What you need to know from Friday through Sunday (March 20-22)

CMS announced Sunday it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs.

CMS officials spoke to thousands of home health providers during a Friday morning phone conference, offering clarity on telehealth rules and face-to-face requirements.

— Various state governors have voiced concerns about health care workers’ access to PPE, at times clashing with the Trump administration.

— Doctors in Italy — the country hit hardest by the spread of coronavirus — are urging their peers around the world to care for patients in the home setting.

— Congressional leaders on Sunday afternoon failed to reach agreement on another major economic stimulus bill that includes additional funds for public health needs.

Doctors in Italy: Treat more patients at home

The death toll in Italy jumped by 793 to 4,825 on Saturday, with some ICUs in the country reportedly on the “brink of collapse.” Prior to Saturday, Italy had already surpassed China as the country with the most COVID-19-related fatalities.

A new paper suggests hospitals may be the main source of spreading the virus, as was the case with SARS years ago. Additionally, doctors in Italy are urging their peers around the world to avoid centralized care and shift the delivery of health care into the home.

The message underscores what home health providers have been saying for weeks.

“Managing patients at home is a brilliant thing,” Maurizio Cereda, co-director of the surgical ICU at Penn Medicine and a co-author of the paper, told STAT. “Bring them nutrition, measure their oxygen levels, even bring them oxygen, and you can probably keep many of them at home. This is what we mean by moving from patient-centered medicine: Of course you still care for and care about the patient, but you also think about the population as a whole. That change would decrease transmission and protect other patients as well as health care workers.”

What you need to know from Thursday (March 20)

— CMS approved the state of Washington’s request for an 1135 Medicaid waiver.

— Supply shortages appear to be worsening.

— At a White House Task Force press briefing, CMS asked that all elective surgeries, non-essential medical, surgical and dental procedures be delayed during the novel coronavirus outbreak.

— Millions of people in California have been ordered to stay at home except for when it is absolutely necessary for at least one month to slow the spread of COVID-19.

— As hospital capacity tightens, some patients may be diverted to skilled nursing facilities — not home.

Cutting elective surgeries could strain home health providers

To save supplies and human resources, CMS recommended on Thursday that all elective surgeries be halted.

“The reality is clear and the stakes are high: We need to preserve personal protective equipment for those on the front lines of this fight,” CMS Administrator Seema Verma said in a statement.

That could lead to uncertainty for some home health providers, especially those who specialize in post-surgical rehab.

“Knee replacement surgeries are likely to go down in frequency,” VNA Health Group President and CEO Dr. Steven Landers recently told HHCN. “Providing a high-value, post-acute service for joint replacement recipients is a big part of what home health agencies do.”

What you need to know from Wednesday (March 18)

The Senate voted 90-8 in support of a COVID-18 relief package that includes federally mandated paid sick leave; President Trump then approved the package Wednesday evening.

In a letter sent to Ohio Governor Mike DeWine, the Ohio Home Care & Hospice Association warned that hundreds of home care and hospice providers in the state are immediately in need of “additional assistance.”

Stocks again tumbled on Wednesday, triggering another 15-minute trading halt and erasing the Dow’s gains since January 2017.

— Nonprofit newsroom ProPublica released an in-depth report showing how hospitals can be quickly overwhelmed by COVID-19, information that reinforces the efforts of home-based providers and hospital-at-home programs.

— President Trump invoked the Defense Production Act, a move that lets the federal government order American companies to produce necessary medical equipment.

Senate, Trump approve emergency measures

Voting 90-8, the Senate approved a relief package that includes paid sick leave, unemployment benefits, free coronavirus testing and other measures. The president then gave his signature to the package Wednesday evening.

Specifically, the package offers two weeks of paid sick and family leave to certain workers who are under quarantine, who are helping family or who have children home from closed schools. The package also includes an additional 12 weeks of paid leave due to prolonged circumstances.

Two-weeks paid sick leave will be compensated at 100% normal salary. The 12-week measure will be compensated at 67% normal salary.

Without added financial support under Medicaid and Medicare, the move could prove costly for many U.S. home-based care agencies. The package does include a tax credit, however.

New York home care advocates call for support

New York Governor Andrew Cuomo announced Wednesday that there were 1,008 new confirmed cases of COVID-19 in his state. New York’s case total is now more than 2,380, making it the most exposed state in the nation — by far.

Of the more than 2,380 confirmed cases, at least 549 have required hospitalization.

While the ongoing pandemic has placed extreme pressure on New York’s hospital system, home-based care providers are beginning to see disruption as well. New York’s home-based care providers serve more than 900,000 individuals annually.

To support providers, the Home Care Association of New York State (HCA-NYS) is asking health care officials for supply reinforcements and expanded flexibility when it comes to normal requirements.

“While hospital surge capacity concerns are, of course, extremely vital in this massive public health crisis, essential access to supplies, regulatory flexibility and emergency aid are needed for home care providers … ,” HCA-NYS President and CEO Al Cardillo said in a statement. “A great many of these individuals are at risk and require vital services to protect their health and safety.”

HCA-NYS is a statewide health organization of nearly 400 member providers and organizations.

HCA-NYS is calling on state officials to make available immediate financial aid for home care’s COVID-19 response, in addition to waivers of certain regulations to relieve workforce pressures.

“These waivers would provide immediate relief,” Cardillo said. “Certain services or procedures can be done remotely, using telehealth or other technologies. Other procedures, such as timeframes for completing in-home assessments, can be relaxed. This regulatory flexibility helps reduce the exposure of patients and staff, allowing for deployment of resources proportionate to risk and preventing further stresses on hospitals as cases continue to rise.”

Ohio providers face dire situation

In a letter to Ohio Governor Mike DeWine, the Ohio Council for Home Care & Hospice called for additional assistance to help manage their COVID-19 response. The Council represents about 600 home care and hospice providers in the state.

“These health care at home agencies are on the front lines fighting this pandemic and are at a critical place,” Joe Russell, executive director of the Ohio Council for Home Care & Hospice, said in the letter. “The COVID-19 pandemic is stressing home care and hospice agencies to a breaking point.”

Specifically, Russell called for more personal protective equipment, coronavirus testing, telemedicine flexibility, reimbursement support and other measures.

“Most agencies will struggle to stay in operation if three is not additional flexibility to assist them with resource management,” Russell said.

Established in 1965, the Ohio Council for Home Care & Hospice is a nonprofit association that represents the interests of health care at home providers in Ohio.

“Unfortunately, without additional resources to support health care at home agencies with [PPE] needs, additional flexibility to manage agency workforce and plans of care, and having additional reimbursement flexibility, we are afraid the Medicaid home care program will begin to collapse,” Russell wrote.

What you need to know from Tuesday (March 17)

— The Trump Administration announced another round of telehealth expansions aimed at reducing person-to-person interaction during the COVID-19 crisis.

— Florida landed an 1135 waiver from CMS, with other states likely to follow suit to support Medicaid-reimbursed home-based care providers.

— CMS issued new COVID-19 guidance for Programs of All-Inclusive Care for the Elderly (PACE) organizations.

— The Pentagon announced it will provide up to 5 million N95 masks to the Department of Health and Human Services to help protect health workers.

The first cases of coronavirus in senior living were reported in the state of Georgia.

Partnership outlines priorities

On Tuesday, the Partnership for Quality Home Healthcare (PQHH) released a list of strategic policy and regulatory relief suggestions aimed at improving access to home health, ensuring patient safety and eliminating barriers during the ongoing COVID-19 emergency.

Among its suggestions, PQHH called for dedicated and clear telehealth capabilities for home health providers, including the use of phone-based visits.

“This will go far in containing the virus, in assisting patients in quarantine, in monitoring existing Medicare home health patients to ensure they will continue to stay in their homes and not seek hospital or physician care,” PQHH stated. “In addition, the telehealth rules should be modified to allow home health clinicians to bill directly for services provided.”

PQHH also called for clarity around Medicare’s homebound requirements and asked that policymakers ensure home health providers’ access to personal protective equipment (PPE).

“PPE supplies are running low but are critical to preventing exposure during home health visits of COVID-19 positive or quarantined patients that could harm home health workers or spread the virus to other homebound patients,” PQHH noted.

What you need to know from Monday (March 16):

— New York Governor Andrew Cuomo called attention to the likely capacity challenges U.S. hospitals will face moving forward; hospital-at-home models could be key to boosting capacity.

Stocks plunged once again, With the Dow dropping 2,997 points and trading paused for 15 minutes after rapid selloffs.

— On Sunday, The U.S. Centers for Disease Control and Prevention (CDC) recommended that no gatherings of 50 or more people take place over the next several weeks.

— Also over the weekend, the U.S. Centers for Medicare & Medicaid Services (CMS) issued an 1135 waiver to relax certain rules and Conditions of Participation (CoPs) for certain Medicare health care providers.

— The cost of in-patient admissions for COVID-19 treatment could top $20,000, a price tag that places a premium on preventative home health and hospital-at-home treatment.

Read: “Hospital-at-Home Programs Ready to Play Critical Role as Coronavirus Cases Spike”

CMS provides home health relief

CMS provided relief to home health agencies, specifically creating flexibilities around timeframes related to OASIS transmission. CMS also announced that it is allowing Medicare administrative contractors (MACs) to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs) during emergencies.

“It remains vital that our health care system be equipped to respond effectively to the additional [COVID-19] cases that do arise, that federal requirements designed for periods of relative calm do not hinder measures needed in an emergency,” CMS Administrator Seema Verma said in a statement. “These temporary blanket waivers – offered to providers and clinicians across the country – are reserved for the rarest of situations. They represent a massive mobilization of our country’s resources to combat this terrible virus. In a time of emergency, the health system needs maximum flexibility to respond appropriately.”

House passes coronavirus relief package

On Saturday, the U.S. House of Representatives passed bipartisan legislation in response to the spread of coronavirus.

Among its provisions, the relief package would provide paid emergency leave with two weeks of paid sick leave, in addition to up to three months of paid family and medical leave, according to House Speaker Nancy Pelosi (D-Calif.).

The Senate is in the process of reviewing the legislation, with some hinting that substantive changes will be needed for it to pass.

Home health legal experts previously told HHCN that a federally mandated sick leave policy would be devastating for some in-home care agencies.

“We are already seeing market consolidation as a result of PDGM and certain regulatory burdens that make it challenging for a smaller provider to keep up, and I fear this would add more fuel to the fire,” Angelo Spinola, an attorney and shareholder at San Francisco-based Littler Mendelson, said. “If these agencies are over-regulated to the point of going out of business, our seniors and their families may be forced to the grey market of less qualified, unsupervised caregivers.”

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