Hospice Advocates: Make COVID-19 Telehealth Flexibilities Permanent

The National Association for Home Care & Hospice (NAHC) has called on the U.S. Centers for Medicare & Medicare Services (CMS) to permanently extend flexibilities for telehealth that the agency has introduced on a temporary basis during the COVID-19 national emergency.

CMS has announced a series of regulatory flexibilities that allow hospices to perform more functions via telehealth than were previously allowed. The recent $2.2 trillion CARES Act stimulus package, designed to help the economy and essential industries weather the impact of the pandemic, also contains provisions related to hospice telehealth, including permitting practitioners to recertify patients via telemedicine appointments rather than face-to-face encounters.

During the pandemic, hospices may provide interdisciplinary services via telemedicine or audio as long as the patient is receiving routine home care level of care and those telemedicine services which are audio-only services are capable of meeting the patient and caregiver needs.

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“CMS has has indicated that they’re going to extend this authority to use telecommunications for the duration of the public health emergency, but we’d really like to see them clarify that what they’ve permitted during the public health emergency will also be permissible during normal times,” Theresa Forster, vice president for hospice policy and programs for NAHC, told Hospice News. “Certainly we don’t want to see telecommunications-based visits replace in person visits across the board. The goal instead is to ensure hospices understand that they have the flexibility to use telecommunications technology for visits where appropriate.”

Declaration of a national disaster allows the U.S. Secretary of Health and Human Services (HHS) to waive certain regulatory requirements under section 1135 of the Social Security Act. CMS issued 1135 waivers to relax conditions of participation (CoPs) for hospices and other health care providers after the White House declared a national emergency in response to the COVID-19 pandemic. Several of these waivers allow for expanded use of telehealth.

Hospices may have some preparation to do if they are going to continue these services in the long term. Some requirements related to protected health information under the Health Insurance Portability and Accountability Act (HIPAA) have been relaxed to allow health care providers to use non-compliant commercial communication platforms. In the long term, however, they would need systems that were fully HIPAA compliant.

“Hospices would need to ensure that they’re using the right platforms that do provide appropriate protection. That’s going to be an important step moving forward. It’s going to be very important for them to understand that while they may be using Zoom or Skype now, in the long term there is definitely going to be a standard they will need to meet.”

It seems likely that at least some of the emergency telehealth provisions will continue in the long term. While CMS has not made any formal announcement of a policy change, the agency’s leaders have indicated that such a move may be inevitable.

“I think the genie’s out of the bottle on this one,” CMS Administrator Seema Verma recently said. “I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

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