Passed in late March 2020, the Coronavirus Aid, Relief, and Economic Security Act (CARES) was designed to address the economic fallout of the COVID-19 pandemic in the United States. Although this historic bill focuses on the extraordinary needs arising out of this crisis, it will undoubtedly have a lasting impact on the home health industry. Many of its provisions can pave the way for positive changes in patient care and operational efficiency.
Let’s discuss how the CARES Act is supporting the healthcare industry as a whole, temporary revisions to healthcare laws and regulations, and what this all means for home health providers—now and in the future.
The CARES Act includes substantial financial support for the U.S. healthcare industry through the Provider Relief Fund. The U.S. Department of Health and Human Services (HHS) will distribute $100 billion for healthcare-related expenses, lost revenue attributable to COVID-19, and uninsured patient care. Half of the funds will go to Medicare facilities and providers impacted by COVID-19. The remaining $50 billion will support targeted providers, such as those in highly impacted areas. In addition, after quickly realizing more funds were needed, the Paycheck Protection Program and Health Care Enhancement Act (PPPHCE) added $75 billion to the Fund in late April.
But the CARES Act provides more than just financial relief. It also includes an array of waivers and new rules to give healthcare providers maximum flexibility in responding to the pandemic safely and efficiently. We’ll discuss those in the next section.
To help home health providers navigate the changes implemented through the CARES Act, the Centers for Medicare and Medicaid Services (CMS) issued guidance specific to home health agencies. Their document is the most detailed source for understanding the CARES Act. But we’ve highlighted a few of the temporary amendments with the biggest potential impact on your daily operations.
Non-Physician Eligibility Certification Nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) can now certify eligibility for home health and establish a care plan. This change is one that the home health industry has long advocated, and Home Health Care News reports there’s a high likelihood it could become permanent.
Rehabilitation Assessments Similar to the changes described above, the CARES Act expands the category of therapists (OT, PT, or SLP) who may perform rehabilitation assessments for patients receiving therapy services as part of their care plan (subject to state laws). This is regardless of whether the service establishes home care eligibility for the patient.
Relaxed Paperwork Requirements The CARES Act gives home health providers more flexibility when it comes to paperwork, audits, and reporting requirements, so they can focus on patient care. For example, CMS has outlined extensions for processes such as OASIS transmissions, Home Health Quality Reporting Program, Medicare appeals, and cost reporting. They are also waiving the requirement to provide detailed information regarding discharge planning to patients and their caregivers in selecting a post-acute care provider. And, they’re allowing ten business days for home health agencies to provide a patient with a copy of their medical record.
Training and Supervision Extensions Since on-site training and supervision are major challenges due to social distancing, the CARES Act has temporarily delayed or reduced some of the requirements, including:
Annual on-site assessments for home health aides – This is being postponed, but must be completed no later than 60 days after the expiration of the public health emergency.
On-site visits for aide supervision – CMS is waiving the requirement for a nurse to conduct an on-site visit every two weeks. However, virtual supervision is encouraged when possible.
12-hour annual in-service training requirement for home health aides – This is postponed until the first full quarter after the public health emergency concludes.
Reduced Scope for Quality Assurance Programs Home health agencies must develop, implement, evaluate, and maintain an effective, ongoing, data-driven quality assurance program. CMS is modifying this requirement to concentrate on infection control issues, allowing providers to focus on the aspects of care delivery most closely associated with COVID-19 as well as tracking adverse events.
Stark Law Waiver The Stark Law prohibits a physician from making referrals for certain healthcare services payable by Medicare if the physician (or an immediate family member) has a financial relationship with the entity performing the service. During the public health emergency, CMS will permit certain referrals and the submission of related claims that would otherwise violate the Stark Law.
Expanded Telehealth Home health agencies can deliver services using telecommunications technology as long as they’re part of the patient’s plan of care and don’t replace needed in-person visits. However, CMS won’t provide reimbursement (yet). More on that in the next section. Home health providers can also satisfy physician face-to-face requirements using telehealth.
In many ways, the coronavirus pandemic has accelerated much-needed changes in the home health industry. Three, in particular, stand out.
Access to Post Acute Care One of the primary goals of the CARES Act was to free up hospital capacity by easing restrictions around admissions requirements in various settings. They’ve done this by giving nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) the ability to certify home health. Given that the CARES Act used the Home Health Care Planning Improvement Act as a framework, this bodes well for its continuation after the public health emergency. Adopting these changes permanently will reduce patient wait times, and may ultimately improve outcomes, efficiency, and satisfaction.
Workforce Enhancement With more patients receiving home health services, the CARES Act also addresses the need for temporary financial relief and workforce support for many post-acute providers. The Act does this in a few different ways:
Suspends the 2% Medicare sequestration cuts through the end of this year, freeing up funds for providers.
Provides $3.5 billion in state grants to support child care for health care sector workers, emergency responders, and other essential personnel.
Increases grant funding for entry-level health professionals (such as CNAs and home health aides) through the Health Profession Opportunity Grant.
Re-authorizes the Geriatrics Workforce Enhancement Program, with $41 million in funding each year from fiscal year 2021 through 2025.
Expansion of Telehealth Despite encouraging telehealth in the CARES Act, CMS has not yet provided billing codes for payment. However, this could change soon for two reasons:
There is an emergency bill making its way through the U.S. Office of Management and Budget. Under this legislation, CMS could potentially compensate providers for telehealth services. It would also permit home health agencies to assess patients remotely.
The CARES Act requires the Secretary of HHS to consider telehealth applications for home health.
In addition, the CARES Act enhances telehealth access through the HHS Telehealth Resource Center. With $29 million allocated annually from fiscal year 2021 through 2025, this will help home health agencies adopt new technologies through telehealth networks.
Focus on Training Clearly, the home health industry is critical to bolstering the overall capacity of the U.S. healthcare system in light of the pandemic. Many providers have already experienced an influx of patients, some with more acute needs than usual. To meet this challenge, home health agencies should take advantage of the financial resources now available to boost their workforce numbers and capabilities. Acting quickly will ensure your organization captures both the funds and qualified professionals necessary.
Plan for the New Normal With a COVID-19 vaccine still far off and the potential for future airborne viruses quite possible, home health providers who lead the way in terms of infection control and prevention will earn the trust and business of individuals, referring hospitals, and partners. Documenting and maintaining CDC-approved protocols will demonstrate your leadership in the home health space.
Embrace Technology Across the healthcare landscape, there’s a push toward leveraging technology to its fullest extent. Not only to reduce face-to-face interactions, but to improve transparency and efficiency. Implementing a homecare technology platform like HHAeXchange will allow home health agencies to quickly adapt in this unpredictable environment. Providers will be ready to implement telehealth, manage staff training, and quickly submit error-free claims — even as requirements change.
Although the pandemic was certainly not an ideal mechanism for spotlighting the importance of the home health industry, there is definitely cause for optimism once the crisis subsides. If providers are able to work more effectively during the crisis, home health agencies will have a strong argument for making these changes permanent.
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