Hospices are wading through uncertain regulatory waters when it comes to infection control and prevention measures tied to the end of the COVID-19 public health emergency (PHE) on May 11.
Some infection prevention requirements instituted during the pandemic are expiring, whereas others could have a lasting impact on hospices’ health and safety policy.
This is the second of a four-part series by Hospice News that examines what hospices need to know about the changing regulatory conditions.
As the PHE expires, it’s important for hospices to stay tuned into evolving shifts in health care policy to ensure compliance at their organizations, as well as patient and staff safety, according to Mollie Gurian, LeadingAge’s vice president of home-based and HCBS policy.
Regulatory questions about infection control are percolating among hospices and other senior care providers, particularly when it comes to masking and COVID testing and mandates. For the time being, hospices should remain diligent in following the guidelines from the U.S. Centers for Disease Control and Prevention (CDC) and other regulatory agencies, Gurian stated.
“Share this message with your staff: Things aren’t changing,” Gurian told Hospice News in an email. “Infection control expectations around COVID are not going away. While the interim final rule on COVID testing will end with the PHE, the expectation is that all health care providers will continue to follow nationally recognized standards set by CDC on COVID-19, including testing and mitigation measures like masking.”
Share this message with your staff: Things aren’t changing. Infection control expectations around COVID are not going away.
Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge
Mandates for hospice workers
Health care providers must comply with all applicable pre-PHE requirements after May 11, according to recent guidance from the U.S. Centers for Medicare & Medicaid Services (CMS).
Some of these policy requirements are fairly straightforward, while others, such as those related to COVID vaccine policies and masking mandates for staff, remain murky. These two areas are crucial to ensuring continued care for patients in any setting, Gurian indicated.
The Biden Administration recently announced a halt to vaccine mandates for federal employees and international travelers, and CMS indicated that it will “soon end” vaccine requirements for health care workers. This comes with the stipulation that health care providers establish policies and procedures for staff vaccinations.
The U.S. Department of Health and Human Services (HHS) pledged to release more details as the PHE’s last day approaches.
Regardless of what happens with vaccines nationally, hospice providers will likely have a related policy or system in place.
Health care providers can still set their own internal COVID vaccine requirements, as they do with those for other diseases, according to Dr. Cameron Muir, chief medical officer at the National Partnership for Healthcare and Hospice Innovation (NPHI).
This could include hospices’ referral partners. For instance, skilled nursing facilities, hospitals or health systems could require hospice clinicians to be vaccinated before they enter a facility, he said.
“We’re going to have COVID vaccinations fall in line with much of the other normative practices around vaccination for influenza,” Muir said during a recent Hospice News webinar. “Generally speaking, we see many more health systems over the past numbers of years making the decision that [staff] have vaccinations documented and submitted to be able to maintain their privileges at a particular health system. I’m certainly seeing it much more as a provider being, entity by entity or facility by facility.”
Some settings may have tighter policies than others, such as skilled nursing facilities and nursing homes, according to Gurian. Hospice staff entering these settings may still be required to mask in some circumstances, she noted.
Additional waivers are also going away.
CMS will no longer waive Life Safety Code requirements for the placement of alcohol-based hand rub dispensers in skilled nursing facilities.
Also, the federal government will no longer require hospice staff to undergo routine COVID-testing when entering long-term care facilities, though those organizations may have their own policies.
Cost of quality and infection prevention in post-pandemic landscape
During the PHE, CMS waived some of the Quality Assessment and Performance Improvement reporting requirements for hospices and home health agencies.
Specifically, CMS narrowed the scope of the QAPI program to concentrate on infection control and adverse events. This also ends with the conclusion of the PHE.
This could be a regulatory “risk area” for hospices, according to Katie Wehri, director of home care and hospice regulatory affairs at the National Association for Home Care & Hospice (NAHC).
“What I do think is somewhat of a risk area for hospices is related to the QAPI requirements,” Wehri told Hospice News. “During the PHE, there was a waiver that hospices could narrow the focus of their QAPI program, to more infection control and prevention. That is expiring with the PHE. So, as they look at infection prevention and control in their QAPI program, they need to move beyond COVID-19. If they’re not following those waivers closely, they may forget to do that.”
Hospices that maintain a strong infection control program will have a leg up post-PHE, according to Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization (NHPCO).
“I think one of the lasting effects is much more focused on infection control in general,” Lund Person said. “We may see parts of the emergency preparedness regulations that deal with COVID and other infections. Whatever else is going to be coming down the pipeline, we don’t know. If hospices continue to think about protecting patients and staff, then that’s the driver all along. For now, it’s wait and see based on what the guidance is on how COVID transforms any policies.”
Some costs could rise
Safety is essential. It also can be expensive.
Costs have soared for supplies such as personal protective equipment (PPE) and sanitizing products. Providers have also relied more heavily on travel nurses while staff amid high turnover and quarantines.
By 2024, Medicare might not reimburse for COVID tests, vaccines and treatments to the same degree, Gurian explained.
This means hospices could be facing higher costs ahead, she added.
“Make sure to start procuring sources and understand the costs of these products for staff now,” Gurian said. “There are still allocations for testing and PPE coming out of HHS and some states, but we don’t know how long those will last. Understand your supply burn rate to help forecast future needs to ensure compliance with CDC guidance.”
Companies featured in this article:
LeadingAge, National Association for Home Care & Hospice, National Hospice and Palliative Care Organization, National Partnership for Healthcare and Hospice Innovation
