The National Association or Home Care & Hospice submitted comments on the Centers for Medicare & Medicaid Services (CMS) Interim Final Rule with Comments (IFC) issued March 30, 2020 in response to the COVID-19 pandemic.
HCAF cosigned the comments along with more than two dozen state home care associations and organizations. Click here to read the full letter, which also includes NAHC's comments on behalf of hospice organizations. Below is a summary issues and recommendations related to home health agencies (HHAs).
Homebound Status Under the Medicare Home Health Benefit
The expanded homebound definition allows more Medicare beneficiaries to be eligible for the Medicare home health benefit. NAHC has learned of a state Medicaid managed care program that is directing home health agencies to change the payer from Medicaid to Medicare for dual eligible beneficiaries that meet the expanded Medicare homebound definition for COVID-19. As a result, the cost for many dual eligible beneficiaries will be shifted from Medicaid to Medicare. NAHC recommends CMS should evaluate the appropriateness of state Medicaid programs shifting the cost of care for dual eligible patients to the Medicare program.
The Use of Technology Under the Medicare Home Health Benefit During the Public Health Emergency (PHE) for the COVID–19 Pandemic
NAHC had several requests related to flexibilities for the use of telehealth including Two-way audio visual and audio only technologies.
Permit the HHA and the physician to each conduct and bill for concurrent visits with a shared patient of the HHA and the physician when the service is on the HHPOC. During this PHE, many physicians are conducting telehealth visits which may limit their ability to provide comprehensive evaluations for certain conditions. NAHC believes the services provided by the HHA and the physician are separate and distinct services that are specific to each provider type, and therefore, appropriate for separate payment.
CMS should reimburse HHAs for telecommunication encounters that are included in the Home Health Plan of Care. The rate scheduled should be commensurate with the various physician evaluation and management visits paid on the physician fee schedule.
Permit practitioners to conduct the face-to-face encounter for Medicare home health certification via audio only technology in addition to two-way audio/visual technology and in-person visits.
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
NAHC requested that CMS withdraw the PHE waiver and instruct RHCs and FQHCs to work with HHAs before the initiating visiting nurse services to center patients. The Medicare home health benefit offers more services to beneficiaries receiving care in the home than the RHCs or FQHCs can provide. Additionally, many HHAs are able to accept these patients during the PHE. CMS should restore the longstanding requirement that RHCs and FQHCs are permitted to provide visiting nurse services in the home only after it is determined that no HHA is available to provide the care.