COVID-19 developments are extremely fluid. In an effort to communicate updates in an efficient manner, HCA is providing the following concise bullets with the most essential information collected to date (as of March 23, 2020 at 8 a.m., HCA’s deadline for the Situation Report).
Please visit our COVID-19 page (http://homecareprepare.org/covid-19/) for copies of all state and federal guidance documents referenced here as well as a running summary of regulatory relief actions. We will alert you by e-mail for further updates.
New York on Pause; Only Essential Services Allowed
- Governor Cuomo has implemented ever stricter limitations on business operations throughout the past week. New York State is “on pause.” Non-essential employees and businesses must work remotely. HCA members have asked, and Administration guidance confirms, “home health care aides or workers”and professional staff are “essential” and, therefore, not subject to the limitation.
HCA’s Operations: How to Reach Us
- Per the emergency order, HCA staff are working remotely at home. HCA members can continue to reach us by e-mail and office phones which are being forwarded to our cell phones or offsite phone extensions. A directory is here: https://hca-nys.org/about/staff.
“Matilda’s Law” Limits Home Visitation to the Elderly, Vulnerable
- Governor Cuomo announced “Matilda’s Law,” named for the Governor’s mother, to protect vulnerable populations, including individuals age 70 and older, those with compromised immune systems, and those with underlying illnesses. The measure requires these individuals to stay home and limit home visitation to immediate family members or close friends in need of emergency assistance. “If it is necessary to visit such individuals, the visitor should get prescreened by taking temperature and seeing if person is exhibiting other flu-like symptoms. Both individuals should wear a mask for the duration of the visit.”
PPE Access
- HCA members continue to report alarming barriers in accessing personal protective equipment (PPE) for staff. Recent directives have not recognized home care and hospice as a priority in the supply chain, an issue that HCA has raised repeatedly to city, state and federal authorities, including in daily communications to the offices of Senators Charles Schumer and others. HCA on Sunday reached again to the Governor’s office, state Health Department and Congressional Delegation for direct assistance on PPE and other priority access provided with Essential Personnel status.
Expanded Telehealth Waivers For Medicaid but NOT for Medicare Home Health. Telehealth Visits Are Allowed for Medicare F2F, As Conducted by Practitioner (i.e. M.D., N.P.P.) Who Can Bill
- As HCA alerted members on Sunday, the state Department of Health (DOH) has allowed for broader use and billing of telehealth under Medicaid, but several questions remain. HCA has provided DOH with explicit language seeking to clarify and authorize the broadest possible scope for telehealth/telephonic means of patient services, visits, and standards of care compliance, including for use in aide supervision, aide orientation and other procedures or tasks, as well as full reimbursement for all such services. We will report back with an update on those questions regarding specific billing procedures and service discipline permissions.
- For Medicare, the federal 1135 waiver, however, is limited in what forms of telehealth are allowable/billable. The U.S. Centers for Medicare and Medicaid Services (CMS) says that the underlying statute does not permit use of telehealth in lieu of home health visits under Medicare, nor is billing allowed, as HCA and others vigorously request, including in the third Congressional aid bill now being negotiated. Telehealth can be used for the face-to-face requirement (F2F) for home health but not hospice at this time; however, physicians, not home health, are permitted to bill.
Other State and Federal Waivers on OASIS Transmittal (Medicare), Supervision and Visit Timeframes (Medicaid), Quality Reporting
- OASIS timeframes have been relaxed.
- Various state Executive Orders in the past week have allowed for in-home supervision visits “as soon as practicable” or through telephone or video communication, initial visits within 48 hours (for certified home health agencies), and extended time to submit information to the Home Care Worker Registry under Medicaid.
- HCA is continuing to work to have DOH clarify and improve the provisions of these guidance actions for our member sectors.
- On Sunday, CMS announced some additional quality reporting program relief for providers. Home health data from January 1, 2020 through June 30, 2020 does not need to be submitted to CMS for purposes of complying with quality reporting program requirements. In addition, Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from January 1, 2020 through September 30, 2020 does not need to be submitted to CMS.
- All regulatory relief actions for home care, hospice and ManagedLong Term Care (MLTC) are summarized in one go-to section of HCA’s COVID-19 webpage. See http://homecareprepare.org/covid-19/.
HCA Survey Findings, Press Statement, Statewide Call
- HCA held a March 20 statewide call to synthesize information about the crisis, organizations’ needs and regulatory changes. An archive recording is here: https://tinyurl.com/wndnfd7.
- HCA surveyed the membership, netting over 300 responses in a 40-hour period early last week. These responses were shared with the Department and the media. They accompanied HCA’s request for financial assistance, priority access to supplies and regulatory relief. The survey findings are in a memo to state officials (see here) and were also reported by Home Health Care News at https://tinyurl.com/vpgqelp and Crain’s Health Pulse at https://tinyurl.com/t3239oo. See the “press release” section of HCA’s website for a statement to the media about the survey findings and our requests of state officials.
HCA Requests, and DOH Revises, Screening “Guidance” for Home Care
- Throughout the past week, HCA has been working to explain to DOH officials the impracticality of a previously published DOH guidance on screening of home care workers. Originally, the guidance indicated that “staff must be screened for respiratory and fever symptoms upon arriving at work.” We explained this was impractical given that staff report to the home for patient care cases, not a centralized location for screening. Late on Sunday evening, DOH revised its guidance, per HCA’s request, acknowledging that: “Since ‘arrival at work’ often means arrival at the patient’s home, the Department is recommending that home care staff use the CDC guidance for health care personnel … and self-monitor for fever by taking their temperature twice a day and remain alert for respiratory symptoms.” HCA thanks the Department for using our language request in the updated Dear Administrator Letter, which should be read in full here.
DFS Guidance
The state Department of Financial Services (DFS) is suspending preauthorization requirements for home health care services following an inpatient hospital admission. Plans may review home health care services for medical necessity concurrently or retrospectively. DFS’s guidance is here.
Plans subject to the Insurance Law are also reminded that the plan of care for home health services must be established and approved in writing by a physician, and this requirement remains unchanged, except to the extent that the state has permitted telehealth and verbal orders to suffice for this requirement for the duration of the COVID-19 emergency.
Federal Aid Bill
The latest COVID-19 relief package, which includes a number of provisions to aid home care agencies, professionals and patients, failed in its first effort to reach the 60 vote threshold needed in the Senate. There are a number of areas that are still being negotiated, not related to home care. At the same time, the House, is drafting its own version of a third relief package. If the House and Senate end up with differing versions, the two chambers will need to work together to draft a final package to send to the President.
At this time, the Senate is scheduled to vote on a package on Monday. House Members returned to their districts last week and would either need to be called back to Washington to vote or the House would have to agree to pass a bill by unanimous consent. This would take complete agreement by the Majority and Minority.
Given the number of moving parts that still exist, we are not anticipating passage of a third coronavirus package until Tuesday at best but more likely towards the end of the week.
In Summary
HCA thanks the membership for your service and information flow with HCA. We also thank city, state and federal officials for working with us, and continuing to do so, toward resolution on a variety of matters. We will continue to keep you updated on the most relevant news.