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CMS Waivers for Home Health and Hospice Agencies

Melissa McCall

March 27, 2020

This information below has been leveraged from CMS notifications to different state hospital associations, culminated into one place for your reference. CMS has provided waivers and modification to some states and they appear to be responding to hospital requests first, and then to future nationwide waivers and modifications. We have also provided content from the National Association of Home Care and Hospice (NAHC) in addition to the Hospital Association. The following pertains to home health agencies and hospices.

Home Health Agencies

Reporting: Provides relief to Home Health Agencies on the time-frames related to OASIS Transmission. (Approved on 3/13/2020- Clarified) This waiver includes:

  • Extension of the 5-day completion requirement for the comprehensive assessment
  • Waives the 30-day OASIS submission requirement

Home Health 42 C.F.R. § 484.55(a)

Home health agencies can perform initial assessments and determine patients’ homebound status remotely or by record review. This will allow patients to be cared for in the best environment while supporting infection control and reducing impact on acute care and long-term care facilities. This will allow for maximizing coverage by already scarce physician and advanced practice clinicians and allow those clinicians to focus on caring for patients with the greatest acuity.

Hospice

Waive requirement for hospices to use volunteers.  CMS is waiving the requirement that hospices are required to use volunteers (including at least 5% of patient care hours). It is anticipated that hospice volunteer availability and use will be reduced related to COVID-19 surge and anticipated quarantine. (42 CFR §418.78(e))

  • Comprehensive Assessments: CMS is waiving certain requirements for Hospice (§418.54) related to update of the comprehensive assessments of patients. This waiver applies the time-frames for updates to the comprehensive assessment (§418.54(d)). Hospices must continue to complete the required assessments and updates, however, the time-frames for updating the assessment may be extended from 15 to 21 days.
  • Waive Non-Core Services: CMS is waiving the requirement for hospices to provide certain non-core hospice services during the national emergency, including the requirements at §418.72 for physical therapy, occupational therapy, and speech-language pathology.

Home Health & Hospice

Waived onsite visits for both HHA and Hospice & Aide Supervision: CMS is waiving the requirements at 42 CFR 418.76 (h) and 484.80(h), which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan as this may not be physically possible for a period of time. This waiver is also temporarily suspending 2-week aide supervision requirement at 42 CFR §484.80(h)(1) by a registered nurse for home health agencies, but virtual supervision is encouraged during the period of the waiver.

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