CMS Interim Final Rules
There have been two Interim Final Rules, the most recent on May 1, that have been issued by CMS during this historic pandemic of the century. This Public Health Emergency (PHE) has taken the full focus of national officials and in the process, there have been sweeping concessions for healthcare, some permanent and others temporary.
One of the most game-changing updates has been 13 years in the making and is now a PERMANENT change.
Non-physician practitioners (nurse practitioners, physician assistants and certified nurse specialists) will now be termed “allowed practitioners” in being able to certify and order home health services for Medicare beneficiaries. As with all things Medicare, agencies must abide by state law which may vary from state to state. If the state law does NOT allow for practitioners other than physicians to certify and order home health this will not help you.
Many states have already lifted their bans on other allowed practitioners and all states are expected to shortly. The original language was that CMS would not enforce the requirement for a MD, DO or DPM to certify and order home health during the PHE, but have now codified into regulation that this is permanent. CMS goes on to ensure that the face-to-face encounter is addressed by amending the regulations to state that an allowed practitioner would also perform the face-to-face encounter for the patient for whom they are certifying eligibility.
In addition, if a face-to-face encounter is performed by an allowed NPP, in an acute or post-acute facility, from which the patient was directly admitted to home health, the certifying practitioner may be different from the provider performing the face-to-face encounter. Also, see the COVID-19 Waivers Update regarding the allowance of face-to-face encounters being conducted via telehealth during the PHE.
CMS is granting exceptions to the HHVBP New Measures data reporting requirements.
CMS is implementing policy, via the Interim Final Rule in May, to align the Home Health Value-Based Purchasing (HHVBP) Model data submission requirements with any exceptions or extensions granted for purposes of the Home Health Quality Reporting Program (HHQRP) during the PHE. This includes implementing a policy for granting exceptions to the New Measures data reporting requirements under the HHVBP Model during the PHE. HHAs in the nine HHVBP Model states are not required to separately report measure data for the Q4 2019, Q1 2020 & Q2 2020, for purposes of the HHVBP Model, as a result of the PHE. CMS is granting an exception to all HHAs participating in the HHVBP Model for the following New Measure reporting requirements:
- April 2020 New Measures submission period (data collection period October 1, 2019 –March 31, 2020)
- July 2020 New Measures submission period (data collection period April 1, 2020 –June 30, 2020)
Although the data collection period for the April 2020 New Measures submission period began in 2019, the data collected during this period are used for the calculation of the Total Performance Scores for 2020 performance and therefore non-submission of this quarter will not impact 2019 data or calculations. Home health agencies may optionally submit part or all of these data by the applicable submission deadlines.
If CMS makes the determination to grant an exception to New Measure data reporting for periods beyond the April and July 2020 submission periods, CMS will communicate this decision to the home health agencies participating in the HHVBP Model. CMS is considering the possibility of significant changes regarding the calculation of 2020 outcomes under HHVBP.
OASIS-E Implementation Extended
Another significant update that came from this Interim Final Rule was to extend the date for OASIS-E implementation. OASIS-E is to carry a significant amount of change in OASIS documentation and CMS recognizes this to be the case. As a result, OASIS-E will not be implemented until January 1 of the year following at least 1 full year after the end of the PHE.
Updated 1135 Waivers
Lastly, a huge update for home health in the form of updated 1135 waivers, is now allowing Physical, Speech and Occupational Therapists to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care. This is, of course, subject to what is permitted under state law. This is also regardless of whether the service establishes eligibility for the patient to receive home care.
The existing regulations at §5/8/2020191484.55(a) and (b)(2) would continue to apply; rehabilitation skilled professionals would not be permitted to perform assessments in nursing only cases. Therapists must continue to act within their state scope of practice laws when performing initial and comprehensive assessments. Registered nurses or other professionals should be called upon to complete sections of the assessment that are beyond the scope of practice of the therapist. The flexibility this affords home health agencies is tremendous during this PHE.
As stated many times before, HPS is very honored to be involved in the home care and hospice industries and again want to reiterate how thankful we are for all of you who are on the frontlines keeping everyone as safe and healthy as you possibly can. Please let us know if there is anything that we can assist you with during this PHE or in the future.