NHPCO: Make Permanent Telehealth Flexibilities for Hospice

The National Hospice and Palliative Care Organization (NHPCO) has called upon the U.S. Department of Health and Human Services (HHS) to make permanent regulatory flexibilities that allowed hospices to expand telehealth services during the COVID-19 pandemic.

Declaration of a national disaster allows the 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 the outbreak a national emergency. Several of these waivers allow for expanded use of telehealth.

NHPCO’s request was included in the group’s comments on President Trump’s Executive Order 13924: Regulatory Relief to Jumpstart the Economy and Get Americans Back to Work. The order directed federal agencies to rescind, modify, waive or provide exemptions from regulations that “may inhibit economic recovery.” 

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“Our [hospice and palliative care] providers have proven during this time that health care and family support services can be successfully delivered via telehealth as an extension to in-person visits,” according to NHPCO’s comments on the order. 

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.

The recently enacted $2.2 trillion CARES Act, designed to help the economy and essential industries weather the impact of the pandemic, also contained provisions related to hospice telehealth, including permitting practitioners to recertify patients via telemedicine appointments rather than face-to-face encounters.

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.”

Many hospices during the early stages of the pandemic quickly ramped up their telehealth to ensure continuity of care while limiting spread of the virus, often using consumer communications platforms such as Skype or Zoom to engage with patients and families remotely. To help facilitate this, HHS’ Office of Civil Rights suspended some requirements related to protected health information under the Health Insurance Portability and Accountability Act (HIPAA). In the long term, however, hospices would need to invest in systems that were fully HIPAA compliant. 

“There are some platforms that are available out there that are HIPAA compliant. As we’re looking at the flexibilities during the pandemic, that should give providers enough time to get themselves set up for what could happen after,” Judi Lund Person, vice president for regulatory and compliance at NHPCO, told Hospice News. 

NHPCO recommended that CMS sustain some additional 1135 waivers that are unrelated to telehealth, such as flexibilities related to hospice aide competency testing, and asked CMS to consider establishing a dedicated Medicare benefit for community-based palliative care. 

“Certainly one of the things we are looking at is all of the patients that could be served by a community-based palliative care approach. They don’t have to go to the hospital and don’t have to take beds that are now being used for patients who need inpatient care,” Lund Person said. “This would allow employers to bring employees back to work, and we could make sure that patients and their families have some care at home. That would bring economic recovery to some of the health care providers who are struggling.”

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