HHS Extends COVID Public Emergency, Future Uncertain for Hospice Telehealth

The U.S. Department of Health & Human Services (HHS) has extended the COVID-19 public health emergency (PHE) for an additional 90 days, to expire in July rather than the previous date of April 16.

The extension means that most of the pandemic-related regulatory will remain in place for now, but hospice providers remain in the dark about potential long-term policy changes, particularly around telehealth.

“Many of the telehealth flexibilities that have helped dramatically improve patient access to care are temporary and limited to the duration of the COVID-19 PHE,” the groups indicted in the letter. “As it stands today, providers must weigh the costs of investing in the technological and clinical infrastructure required to maintain telehealth programs at scale against the possibility that Congress may ultimately decide not to support permanently expanded telehealth coverage.”

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The telehealth waivers have helped home-based care providers maintain continuity of services while limiting in-person contact that could spread the COVID-19 virus.

Expanded utilization of virtual care also allowed providers to deploy staff more judiciously amid worsening workforce shortages. 

Hospices have been able to connect with patients via telehealth and assess a situation before sending a clinician to the home, which could save hours of travel time in rural areas where patients are geographically dispersed. 

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Of particular value is the waiver allowing hospice physicians to use telehealth to recertify patients for the benefit.

HHS has indicated that the telehealth flexibilities would remain in place for at least five months after the PHE expires, but even with that additional time providers will be hard pressed to put that genie back in the bottle.

Clinician focus groups convened by the Medicare Payment Advisory Commission (MedPAC) echoed this assertion.

“Clinicians in our focus groups believed that telehealth will remain a permanent part of the health care landscape, and most of them planned to continue offering audio and video telehealth visits after the PHE,” MedPAC reported to Congress. “Clinicians thought a combination of in-person and telehealth care would be ideal in the future.”

Beyond telehealth, hospices have been exempt during the PHE from requiring a registered nurse or other skilled professional to make an annual, onsite supervisory visit for each aide.

HHS also waived the requirement mandating that hospice annually assess the skills and competence of all individuals furnishing care, and to provide in-service training and education programs where required.

The department also permitted providers to narrow the scope of their required Quality Assurance and Performance Improvement (QAPI) programs to focus on infection control and adverse events, extended time frames for patient assessments and waived some volunteer-related requirements.

The pandemic has been anything but predictable. Nevertheless, the possibility exists that this action by HHS will be the last PHE extension.

At the state and local levels, many of the pandemic-related safety measures and restrictions have come down in recent months, such as mask mandates, and continued funding for COVID-19 testing and response have become a point of contention among lawmakers.

But the White House and federal health agencies remain concerned about the potential threat posed by the emergent BA.2 subvariant. The subvariant now represents 85% of U.S. cases and has caused infection rates to start ticking back upward, according to the U.S. Centers for Disease Control & Prevention (CDC).

“We’ve made tremendous progress in our fight against the virus. We have 217 million Americans fully vaccinated, two out of three eligible adults boosted, a medicine cabinet full of highly-effective treatments, and convenient tests,” White House COVID-19 response Coordinator Jeff Zients, said in a press briefing. “But, as we’ve made clear for months, there’s more work to do. The country urgently needs additional funding from Congress to continue our fight against COVID.”