Home Health Advocates to CMS: Stop Waiting to Cut ‘Meaningless Red Tape’

Officials from the U.S. Centers for Medicare & Medicaid Services (CMS) attempted to provide additional clarity to home health providers responding to the coronavirus pandemic Friday, speaking with stakeholders during a late morning conference call that quickly hit capacity.

Among topics discussed, CMS offered guidance on telehealth policies, face-to-face rules and Medicare’s homebound requirement. More than 7,000 people called in for the briefing, which lasted about 30 minutes in total.

Despite the clear appetite for information, CMS officials took minimal questions, Joanne Cunningham, executive director of the Washington, D.C.-based Partnership for Quality Home Healthcare (PQHH), told Home Health Care News.

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And most of the answers didn’t exactly sound urgent.

“I thought that they could have announced more [action] on things that were moving,” Cunningham said. “I was somewhat disappointed by the very ‘we’re still looking at things’ kind of messaging.”

PQHH, the National Association for Home Care & Hospice (NAHC), individual providers and countless others have been working diligently over the past week to sift through the rapidly evolving COVID-19 regulatory landscape, which seems to change on an hourly basis.

So far, those changes have included, for example, flexibilities created via 1135 waiver and certain semi-relevant telehealth announcements. They also include relief on OASIS-related requirements.

While certain practitioners have been given extremely flexible telehealth capabilities in response to COVID-19, home health providers can still not use telehealth in place of in-person visits, CMS confirmed during Friday’s call.

Face-to-face visits by a physician or approved practitioner qualifying a patient for home health care may be performed via telehealth, however.

When it comes to waiving Medicare’s “homebound” requirement, CMS stated that no changes have yet been made. Agency officials said they are still “looking at” that for the time being.

CMS’s priority should be “unleashing providers” by eliminating “meaningless red tape,” according to Cunningham.

“In the home health sector, we are at DEFCON 1. Full stop,” she said. “Agencies are trying to fulfill their mission to be frontline providers of health care services in the home to the Medicare population, which is frail and elderly, as well as be part of the COVID-19 response mechanism.”

More than anything, home health providers need more regulatory relief and flexibility to do that, Cunningham said, noting that “there are still too many barriers.”

Globally, ample coverage has been given to hospitals and acute settings that have become overwhelmed by COVID-19 patients. Nationally, the U.S. media has frequently highlighted coronavirus challenges facing nursing homes, too.

But home health providers are likewise feeling the strain.

In New York, where there’s more coronavirus cases than anywhere else in the country, providers are particularly stretched thin. A majority of organizations already face shortages of personal protective equipment and trained staff, with others reporting issues of patients refusing in-person care.

If home health providers were able to check in on patients via telehealth tools, that would, of course, help solve the latter pain point.

“One of the things CMS should be doing in a time period like this, to improve capacity in the system, is to seriously look at telehealth,” AccentCare CEO Steve Rodgers recently told HHCN. “Unfortunately, if we broadly expanded telehealth, we couldn’t get paid for it.”

Dallas-based AccentCare is a provider of home health, hospice and and personal care services, with more than 170 locations across the country. Its New York operations are based out of the AccentCare of New York brand.

In addition to home health care, CMS briefly addressed hospice providers’ role in the COVID-19 response.

So far, CMS has not made any updates to hospice-related telehealth. Similarly, at this time, the agency is not allowing for hospice face-to-face encounters completed through telehealth means.

CMS initially released home health guidance on March 10.

“We need nimbleness,” Cunningham said. “We need creativity. It’s about saving lives.”

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