CMS’ rules regarding the delivery of telehealth continue to evolve. This blog discusses the following:

  • Home Health updates including loosened Medicare Homebound Requirements, suspension of the Review Choice Demonstration (RCD), and on-site visit requirement changes
  • Hospice updates including on site visit requirement changes, volunteer requirement changes, and expansion of time frame for the comprehensive assessment
  • Expansion of telehealth services covered by Medicare

Home Health Updates

Courtesy of the National Association for Home Care and Hospice (NAHC)

On Monday March 30th, CMS announced rule changes,  waivers of certain Conditions of Participation (COPs), as well as a series of interpretations of home health requirements designed to increase flexibility during the COVID-19 pandemic crisis. These include:

  • Loosened Medicare Homebound Requirements – under normal circumstances, patients are only eligible for home health services if they are confined to their home due to illness or injury, or because leaving home requires “a considerable and taxing effort.” CMS loosened this rule, stating in their announcement: “If a physician determines that a Medicare beneficiary should not leave home because of a medical contraindication or due to suspected or confirmed COVID-19, and the beneficiary needs skilled services, he or she will be considered homebound and qualify for the Medicare Home Health Benefit. As a result, the beneficiary can receive services at home.”
  • Suspension of the Review Choice Demonstration (RCD) – CMS is giving home health agencies the option to pause their participation for the duration of the pandemic. Home health agencies do not have to take any action for this pause to go into effect. RCD states include Illinois, Ohio, Texas, North Carolina, and Florida.
  • On Site Visits – CMS is loosening the requirement for a nurse to conduct an onsite visit every two weeks for home health and hospice

As the COVID-19 pandemic continues to develop, home health advocated have been lobbying to CMS in hopes of being paid for telehealth series. As of April 1st, there appears to be no mechanisms for home health providers to get paid for visits delivered via telehealth technology.

CMS announced that home health agencies can provide more services to beneficiaries through telehealth as long as it is part of the patients’ plan of care and does not replace essential in-person visits as ordered in the care plan. If an agency wants to replace any in-person visits that are ordered by the physician with telehealth, they must get new orders from the physician for those telehealth visits. The payment for the 30-day episode would include payment for telehealth visits. Outside of the visits that are ordered by the physician, CMS does encourage telehealth to be used with patients as a cost-saving measure. At this point in time, there is no additional reimbursement for home health providers.

  • For agencies looking for reimbursement in the short term, CMS does allow for Home health agencies to contract with a physician or non-physician practitioner (NPP) to provide telehealth services to patients. This should be done outside of a covered Home Health episode.
  • The physician or NPP would then bill for the telehealth service and pay the contracted rate to the home health agency
  • HRS has seen many agencies take advantage of this option by contracting for reimbursement with physician groups, hospitals and even commercial carriers.

Hospice Updates

CMS has waived several hospice regulations, including:

  • Requirement that a hospice nurse visit a patients’ location at least once every two weeks
  • Requirement that nurse conducts an onsite visit to evaluate whether aids are providing care consistent with the patients care plan
  • Requirement that volunteers provide 5% of patient care hours
  • Extension of the time frame for updating a patients’ comprehensive assessment to 21 days

CMS will allow hospice clinicians to provide services via telehealth if the services are consistent with the patient’s plan of care.

Still unclear, is whether physicians can certify patients for hospice via telehealth. CMS is still exploring this question and the HRS team is following closely.

Expansion of Covered Services

CMS announced that they will be adding more than 80 new telehealth services to the list of services covered by Medicare during the COVID-19 pandemic. All connected health services are now reimbursed at the same rate as in-person services.

CMS stated in their announcement: “Providers can bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth. New as well as established patients now may stay at home and have a telehealth visit with their provider.”

If a physician determines that a Medicare beneficiary should not leave home, and the beneficiary needs skilled services, he or she will be considered homebound and qualify for the Medicare Home Health Benefit. The beneficiary can receive telehealth services at home in that instance.

CMS has eliminated the requirement that virtual check-in services can only be used after the doctor and patient have met in person.

Clinicians able to receive reimbursement for telehealth services include MDs and NPs. HRS clients who have qualified health care professionals who can bill for E&M codes under Part B can now provide telehealth services. There are not restrictions on the geographic location of the patient or the patients location.