In Comments to CMS, HCA Seeks Clarification and Broader Regulatory Revisions Amid Public Health Emergency

HCA Vice President for Finance and Management Patrick Conole submitted comments last week to the U.S. Centers for Medicare and Medicaid Service (CMS) on CMS’s interim rule regarding home care and hospice “regulatory revisions” that have been issued in response to the public health emergency.

In our comments, HCA recognized CMS’s efforts thus far on regulatory relief and waivers, including CMS’s responsive interpretation of the “homebound” status definition in light of COVID-19, new allowances for non-physician practitioners to order home health services, and the modest expansion of remote telecommunications services to help shield against exposure risk and to help augment care.

On this latter area, however, HCA made several recommendations. We noted the recently extended or expanded flexibilities, permissions and payments for telehealth by other practitioners that should be likewise provided broadly to home health and hospice providers whose patients and staff also face infection exposure risks.

HCA urged CMS to reimburse home health agencies for telecommunication encounters that are included in the home health plan of care; and “the rate schedule should be commensurate with either the various physician evaluation and management visits paid on the physician fee schedule (PFS) or at the current low utilization payment adjustment (LUPA) rates per discipline of service.”

Also, because physicians are enlisting home health agencies for virtual visits under contractual arrangements permitted by CMS, we also called upon CMS to allow home health visits and concurrent billing whenever the home health agency (HHA) and physician have a shared patient, given that the “services provided by the HHA and the physician are separate and distinct services specific to each provider type and, therefore, appropriate for separate Medicare payment.”

When telecommunications are used during the physician face-to-face (F2F) requirement for home health and hospice, CMS currently requires both an audio and visual component. HCA also recommends that audio-only physician F2F encounters be permitted as an alternative. “This flexibility permits practitioners to conduct audio-only visits when two-way audio/visual technology is not available or not practicable for patients,” we write.

We also seek clarification on the applicability of telehealth for services, billing, and cost-reporting by hospices as they seek to limit exposure to infection among patients, families and caregivers. Our comments point to an apparent limitation on the use of technology-based visits solely for routine home care (RHC) levels of hospice services at a time when “the exposure risks are by no means limited to the home setting, as if such risks didn’t also exist for Inpatient Respite Care (IRC) or General Inpatient (GIP) Care in contracted facilities,” HCA writes.

We also urge CMS to withdraw its waiver allowing Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to provide visiting nurse services regardless of whether an HHA shortage exists in the regions where they are located. “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,” we write.

Members can read our entire comments here.