Hospices Need More from Regulators During COVID-19 Crisis

Congress and the U.S. Centers for Medicare & Medicaid Services (CMS) have offered a number regulatory flexibilities to hospice providers during the novel coronavirus pandemic through legislation and through emergency waivers. While providers and other stakeholders embrace these changes as positive and necessary steps, hospices may need additional federal support that to date they haven’t seen.

CMS earlier this week suspended the requirement that a hospice nurse visit a patient’s location at least once every two weeks, including onsite visits to evaluate care provided by aides. The agency has also waived the rule that volunteers provide 5% of patient care hours and extended the timeframe for updating a patient’s comprehensive assessment to 21 days.

The agency will also allow hospice clinicians to conduct visits and provide services via telehealth as long as those activities are consistent with the patient’s plan of care, and hospice physicians will be allowed to recertify patients via telehealth rather than strictly conducting face-to-face encounters.

“The relief developed by CMS brings significant improvements that will help increase care access, reduce paperwork burdens, and provide greater options in delivery of care at home,” stated William A. Dombi, president of the National Association for Home Care & Hospice. “The most valuable actions are expanded opportunities to combine telehealth services with in-person visits to patients, the suspension of burdensome claim review activities, and the waiver of some operational requirements that did not affect direct delivery of care. These changes will improve efficiencies and put patient care over paperwork.”

CMS has also indicated that it would accelerate payment to hospices and other providers during the pandemic to help relieve some of the financial pressure hospices are facing and temporarily ended the practice of 2% sequestration of hospice payments.

Though these actions are beneficial, additional considerations may be needed to help hospices function effectively during the pandemic. One of the principal concerns is the availability of supplies, including personal protective equipment (PPE) for infection prevention and control. Hospices also need an avenue for billing for the new telehealth services many are providing as well as authorization from CMS to include those activities on their cost reports.

“Unless we have adequate protective equipment, we can’t make visits and we can’t safely provide care, which is why telehealth is even more important. CMS can’t create PPE. Congress can’t create PPE. But we’ve been clear with the administration that they have the authority to make sure that adequate PPE exists. That’s number one,” Edo Banach, president and CEO of the National Hospice & Palliative Care Organization (NHPCO), told Hospice News. “Number two is additional flexibilities when it comes to not only the ability to provide the telehealth services but to have the services count [in billing and cost reports], and additional funding for the technology and training that it really takes to provide telehealth services.”

The cost report issue could have long term implications for hospice payment, as the Medicare Payment Advisory Commission uses those data when making its recommendations to Congress for hospice payment amounts each Fiscal Year. 

“In addition to all the people in the health care system that have had to step up, CMS is certainly working 24/7 to meet the demand. They’ve worked tirelessly over the last few weeks to get some of these waivers, and we’re thankful that some of them were done,” Banach told Hospice News. “Hospices, certainly home health agencies and other community-based providers, do need additional support from CMS and from the government.”