Latest Round of COVID-19 Medicare Waivers Changes Little for Struggling Home Health Agencies

The U.S. Centers for Medicare & Medicaid Services (CMS) and the White House announced a new round of regulatory flexibilities aimed at improving care for seniors during the coronavirus Thursday.

Home health agencies, however, were largely left out of the picture — again.

In its announcement, CMS outlined steps it is taking to increase access to COVID-19 testing for Medicare and Medicaid beneficiaries while creating more flexibility for hospitals to deliver services in non-traditional settings, including the home. CMS and the White House also touted new initiatives meant to increase access to telehealth services, which many see as a key resource for successfully mitigating the spread of coronavirus.


“We dramatically expanded access to telehealth … for Medicare beneficiaries,” President Donald Trump said during a White House coronavirus task-force briefing shortly after CMS’s announcement. “The number of Medicare patients using telehealth has increased from roughly 11,000 a week to more than 650,000 [people] a week.”

Under new waivers and rule changes, Medicare will no longer require an order from a treating physician or other practitioner for beneficiaries to get COVID-19 testing or related laboratory tests. As long as a national emergency is called, COVID-19 tests may be covered when ordered by any health care professional authorized to do so under state law, according to CMS.

“Testing is vital, and CMS’s changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries,” CMS Administrator Seema Verma said in a statement.


When it comes to telehealth, CMS announced it is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services.

Previously, only doctors, nurse practitioners, physician assistants and a handful of others were able to deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists (PTs), occupational therapists (OTs) and speech language pathologists (SLPs).

While CMS and President Trump touted telehealth on Thursday, home health providers are still unable to bill for telehealth-driven visits or count them toward low utilization payment adjustment (LUPA) thresholds.

Thursday’s announcement did not change anything in that regard, sources confirmed to HHCN.

“[It helps] only to a limited degree,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told HHCN in an email. “We sought to include home health agencies and hospices in the 1135 waiver expansion that is part of the CARES Act. We believe that it permits CMS to include ‘providers’ as parties eligible to bill under the Part B benefit.”

Still, it is possible home health agencies can indirectly benefit from Thursday’s rulemaking, Dombi noted. For example, a therapist employed by a home health provider may be able to bill for telehealth therapy when that service is furnished outside of the home health benefit.

Unable to bill for telehealth or count remote visits toward LUPAs, Medicare-certified home health providers have suffered a variety of setbacks.

Nationwide, 41.5% of home health agencies report serving actively infected COVID-19 patients, according to a recent NAHC survey. That figure is substantially higher in hotspots such as New York and New Jersey.

More than 30% of home health agencies have experienced revenue reductions in excess of 20%. Meanwhile, over 50% of agencies have seen revenue reductions in excess of 15%.

Roughly eight out of 10 agencies have seen declining admissions.

Across the country, home health patients and their families are commonly refusing care. That refusal, in turn, has led to fewer visits per episode and skyrocketing LUPA rates. Broadly, LUPAs are payment reductions compared to what a home health agency would normally receive for a 30-day episode of care.

According to the NAHC survey, 52% of home health agencies with below national average LUPAs in March 2019 reported at least a tripling of LUPAs in March 2020. Roughly two-thirds of agencies reported at least a doubling of LUPAs.

While CMS continues to restrict telehealth for home health providers, the agency is seemingly paving the way for hospitals to deliver home-based care to patients and receive payment for telehealth visits in the home.

“Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a [temporary provider-based-department] of the hospital,” CMS wrote in its announcement. “Examples of such services include counseling and educational service as well as therapy services.”

Also on Thursday, the White House and CMS announced the formation of a special nursing home task force — The Coronavirus Commission for Safety and Quality in Nursing Homes — that they say will better prepare long-term care facilities for future outbreaks.

“The commission will comprehensively assess the response,” Verma said during the White House briefing. “It will identify best practices, and also provide recommendations for how we go forward to protect our nursing home residents and make sure we are providing the best quality of life.”

The task force will also reportedly help long-term care facilities get necessary resources during the current crisis. During the White House briefing, Trump stated that the Federal Emergency Management Agency (FEMA) will soon begin distributing personal protective equipment (PPE) to the country’s 15,400 nursing homes.

“It’s a spot that we have to take care of,” he said. “I guess you could call it a little bit of a weak spot, because things are happening at the nursing homes that we’re not happy about. We don’t want that to happen.”

FEMA will base the quantities on each facility’s staffing and PPE usage rates.

Neither CMS nor Trump hinted at any PPE support for home health providers, which remain excluded from most priority lists.

To its credit, CMS has cut some red tape for home health providers and created leeway around the homebound requirement. CMS also has eased some reporting requirements and signed off on non-physician certification, ensuring health care professionals are working at the top of their licenses.

A full list of CMS home health regulatory changes related to the coronavirus can be found here.

Additional reporting by Alex Spanko

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