HHS Renews Public Health Emergency, Keeping Key Home Health Waivers in Place

The U.S. Department of Health and Human Services (HHS) on Wednesday opted to renew the COVID-19 public health emergency (PHE), keeping in place several regulatory waivers that have been critical lifelines for home health and hospice operators since the start of 2020.

While the extension itself is not surprising, it offers further stability as operators struggle with workforce shortages and general inflation, among other challenges. On top of that, the move gives hospital-at-home stakeholders extra time under the Acute Hospital Care at Home waiver, as they work on gaining support for corresponding legislation in both the House and Senate.

The PHE has been repeatedly renewed since implemented by the Trump administration over 24 months ago.


Without action from HHS and the Biden administration, it was set to expire on April 16.

“With more than two years having passed since the COVID-19 pandemic began in early 2020, questions are being raised about when to end the public health emergency declarations made by the federal government early on, with some advocating for their extension and others calling for their expiration,” Kaiser Family Foundation experts wrote in a recently released issues brief. “There are numerous implications to ending these emergency declarations.”

Wednesday’s extension is for another 90 days, which will carry the PHE into July.


Under the PHE, federal regulators have waived or modified normal requirements for Medicare and Medicaid providers, plus private health insurers. While some waivers have focused on reducing reporting and supervision requirements, others have revolved around new telehealth allowances and funding support.

Medicare-certified home health agencies, in particular, have had access to a long list of waiver flexibilities.

On the reporting front, for example, the Centers for Medicare & Medicaid Services (CMS) has waived the requirement that home health agencies complete their OASIS submission within 30 days. Instead, delayed submission is permitted during the PHE.

Through the waiver process, CMS has also modified the requirement that all home health aides receive 12 hours of in-service training in a 12-month period. Additionally, the agency has waived the normal rule requiring a nurse to conduct an on-site visit every two weeks to ensure delivered care is consistent with the care plan.

Hospice and home health agencies alike have also been allowed to pause Quality Assurance and Performance Improvement (QAPI) programs during the PHE.

Although home health agencies haven’t been able to receive direct reimbursement for in-home virtual visits, the ability to furnish services via telehealth tools has likewise been a major boost during the pandemic.

“Home health agencies, hospice providers and so many other types of organizations have leaned on the PHE waiver flexibilities to stretch clinical capacity and leverage virtual care,” James Lydiard, chief strategy officer of U.S. Medical Management (USMM), told Home Health Care News in an email. “An extension provides additional time to determine what happens when these flexibilities potentially phase out – all while avoiding immediate disruptions to patients.”

USMM is comprised of Visiting Physicians Association (VPA), Pinnacle Home Health, Grace Hospice, Comfort Hospice, TheHomeDME and Lab2U.

Recently acquired by Rubicon Founders at the end of 2021, the Michigan-based USMM is one of the country’s largest independently owned home-based management services organizations. Its current footprint extends into 11 states and 35 unique service areas.

More time for hospital-at-home programs

The extension of the PHE doesn’t just help home health and hospice operators. It also gives hospital-at-home programs some leeway as their advocates look to secure support beyond the crisis.

As of April 11, there were 92 health systems and 206 hospitals in 34 states approved for the CMS Acute Hospital Care at Home waiver. The initiative, unveiled in November 2020, gave approved entities the ability to deliver acute care in the home setting and created a payment pathway under Medicare.

As it stands, the waiver will end with the PHE. With that in mind, some were concerned hospital-at-home programs were heading toward an April 16 regulatory cliff.

“There are a number of programs that have been launched, and the risk is that all of these waivers are tied to the public health emergency,” Dr. Stephen Parodi, associate executive director for The Permanente Medical Group, previously told HHCN. “With COVID waning, … we expect that the public health emergency will likely expire sometime this year. There is a need, from a regulatory standpoint, to avoid these programs ending if the waiver goes away.”

Introduced in the House and Senate in March, the bipartisan Hospital Inpatient Services Modernization Act looks to extend the waiver enabling hospital-level care at home by two years beyond the PHE.

The legislation would also require the CMS to establish uniform health and safety requirements for program participants within a year of its enactment.

“We’ve been putting health systems that are actually providing hospital-at-home services through the waiver in front of Hill staff to build that support,” Jeremiah McCoy, director of policy and government relations at Moving Health Home, previously told HHCN. “There’s a lot of education that needs to happen with Hill staff. We are working to make sure they know about the waiver, where the benefits are, the impacts on cost, quality, patient satisfaction and health equity.”

The legislation is sponsored by Sen. Thomas Carper (D-Del.) in the Senate, with support from five co-sponsors, including three Republicans and two Democrats. It’s sponsored by Rep. Brad Wenstrup (R-Ohio) in the House, with support from four Democrats and two Republicans.

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