The Blanket Waivers Aren't Forever. One Word From The Federal Government And You Have 60 Days To Comply. You Ready?

The COVID-19 public health emergency gave our industry a break from increased administrative burden and some increased flexibility in regards to home health aide supervision and initial assessments. Although the waivers are still in place as of this post, the time is coming for that to end. The question is whether you are prepared to comply if the switch is flipped tomorrow?

The Current PHE Waivers:

The full list of healthcare waivers can be found on the CMS website under COVID-19 emergency declaration waivers. For the purposes of this article, we won’t focus on the entire list, but certain bullet points and how your agency would be able to comply if the Federal Government changed it today. The bullet pointed items are directly pulled from the COVID-19 emergency declaration waivers pdf.

• Initial Assessments: CMS is waiving the requirements at 42 CFR §484.55(a) to allow HHAs to perform Medicare-covered initial assessments and determine patients’ homebound status remotely or by record review. This will allow patients to be cared for in the best environment for them while supporting infection control and reducing impact on acute care and long- term care facilities. This will allow for maximizing coverage by already scarce physician, and advanced practice clinicians, and allow those clinicians to focus on caring for patients with the greatest acuity.
• Waive Onsite Visits for HHA Aide Supervision: CMS is waiving the requirements at 42 CFR §484.80(h), which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time. This waiver is also temporarily suspending the 2-week aide supervision by a registered nurse for home health agencies requirement at §484.80(h)(1), but virtual supervision is encouraged during the period of the waiver.
• 12-hour Annual In-service Training Requirement for Home Health Aides: CMS is modifying the requirement at 42 CFR §484.80(d) that home health agencies must assure that each home health aide receives 12 hours of in-service training in a 12-month period. In accordance with section 1135(b)(5) of the Act, we are postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. This will allow aides and the registered nurses (RNs) who teach in-service training to spend more time delivering direct patient care and additional time for staff to complete this requirement.
• Detailed Information Sharing for Discharge Planning for Home Health Agencies: CMS is waiving the requirements of 42 CFR §484.58(a) to provide detailed information regarding discharge planning, to patients and their caregivers, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, (another) home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) quality measures and resource use measures. This temporary waiver provides facilities the ability to expedite discharge and movement of residents among care settings. CMS is maintaining all other discharge planning requirements.
• Training and Assessment of Aides: CMS is waiving the requirement at 42 CFR §418.76(h)(2) for Hospice and 42 CFR §484.80(h)(1)(iii) for HHAs, which require a registered nurse, or in the case of an HHA a registered nurse or other appropriate skilled professional (physical therapist/occupational therapist, speech language pathologist) to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. In accordance with section 1135(b)(5) of the Act, we are postponing completion of these visits. All postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the PHE.
• Quality Assurance and Performance Improvement (QAPI): CMS is modifying the requirement at 42 CFR §418.58 for Hospice and §484.65 for HHAs, which requires these providers to develop, implement, evaluate, and maintain an effective, ongoing, hospice/HHA-wide, data driven QAPI program. Specifically, CMS is modifying the requirements at §418.58(a)–(d) and §484.65(a)–(d) to narrow the scope of the QAPI program to concentrate on infection control issues, while retaining the requirement that remaining activities should continue to focus on adverse events. This modification decreases burden associated with the development and maintenance of a broad-based QAPI program, allowing the providers to focus efforts on aspects of care delivery most closely associated with COVID-19, and tracking adverse events during the PHE. The requirement that HHAs and hospices maintain an effective, ongoing, agency-wide, data-driven quality assessment and performance improvement program will remain.

Why Are We Talking About This?

Things can change any day. Some of the current waivers have already been removed for other health care facilities. Let’s consider the home health aides. Many agencies have not resumed the routine 2 week supervisions of aides. It is clear that CMS recognizes virtual supervisions may be necessary at times, but it was intended to be an exception and not normal business operation. If your agency has not resumed in person home health aide supervision, what does this do to scheduling tomorrow if you have to make it happen?

The same holds true for the annual onsite supervisory visit for direct observation. If the federal government removes this waiver tomorrow, you have 60 days to complete the onsite for all your aides. If you are a small agency, this may not be a problem. If you are well-staffed, then it may not be a problem. For a lot of agencies, it will be tough. The same rings true for the 12 hours of aide in-service. You will have through the first full quarter after the end of the public health emergency. You need to consider the time you will have to devote back to QAPI, discharge planning, and timing of initial assessments and Oasis submissions. It will change the availability of staff for other things and you may have push back and requests to add more employees. Implement these things back to your normal day-to day operations so staff is accustomed when the waivers are removed. Do it methodically and with certain pieces added one or two at a time.

If your agency needs assistance with a mock survey, operations management, ICD 10 coding, Oasis, or interim management, call Kenyon Homecare Consulting at 206-721-5091 or contact us online to see how we can help you today!