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LEGISLATION House Passes CARES Act, Fast Forwarding Home Health Care Innovation Beyond COVID-19

The House of Representatives passed a $2 trillion stimulus package Friday, officially clearing one of the last major hurdles for the emergency bill set to aid both American companies and individuals during the COVID-19 crisis. 

The record-breaking stimulus package also includes several provisions aimed at home health providers. Once signed into law, it will likely change how the home-based care industry operates — both on a permanent and temporary basis.

Per direction of the bill, the U.S. Centers for Medicare & Medicaid Services (CMS) is expected to allow non-physicians to certify home health services moving forward. The stimulus package specifically uses the framework of the April 2019 Home Health Care Planning Improvement Act, which sought to give nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs) the ability to certify home health permanently.

Now that the bill is out of Congress and headed to the president’s desk, the change from CMS could come tomorrow or sometime within the next six months, William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), recently told Home Health Care News.

The bill — known as the CARES Act — does a number of other things for home health providers as well. Specifically, it:

— Encourages the use of telehealth in home health care, though it does not provide reimbursement for the use of such tools

— Suspends the 2% Medicare sequestration, effectively boosting reimbursement rates for providers during an eight-month period

— Creates a $100 billion health care fund for recovering COVID-19 costs

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— Increases Medicare reimbursement to providers for taking care of COVID-19 patients

The House passed the CARES Act by voice vote, using an unorthodox tactic to block a Republican represenative’s effort to force a more formal recorded vote.

The Partnership for Quality Home Healthcare (PQHH) was among the early home health advocates that praised the development.

“We commend Congress for providing temporary financial relief to providers by hitting pause on the sequestration cuts,” PQHH Executive Director Joanne Cunningham said in a statement. “We also applaud lawmakers for enabling nurse practitioners to certify eligibility for home health – a critical step forward that will improve access to home health for Medicare beneficiaries who are under the care of nurse practitioners and physician assistants. This is a meaningful and much needed change that improves the health care system for seniors.”

Despite the secured aid in the CARES Act, Cunningham noted that more support is still needed.

“[We] remain highly concerned that more must be done to support the delivery of home health during the COVID crisis – and quickly,” she said.

HHCN will continue to review the CARES Act for home health highlights as more details emerge.

Fast forward

The CARES Act adds to multiple impactful measures that regulators and lawmakers have already taken.

On March 17, for example, CMS announced that home health providers could satisfy physician face-to-face requirements via telehealth technology — a first for the industry. Throughout March, CMS has issued roughly three dozen Medicaid 1135 waivers as well.

Additionally, CMS officially released COVID-19 guidance on March 10.

“I really believe that in just one week, we’ve had five years of evolution in this space,” Virgilio Bento, the CEO of Sword Health, told HHCN.

New York-based Sword Health is a tech-enabled physical therapy provider that conducts visits that are monitored remotely by clinical teams. HHCN interviewed Bento after CMS began relaxing telehealth restrictions.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” CMS Administrator Seema Verma said in a mid-March statement. “These changes allow seniors to communicate with their doctors without having to travel to a health care facility so that they can limit risk of exposure and spread of this virus.”

Even after the CARES Act, it’s unlikely that home-based care providers have seen the last of CMS granting increased flexibility for providers during the COVID-19 pandemic.

Many within the industry are cautiously optimistic that CMS will further recognize the benefits of home-based care during the crisis, thus paving an easier way forward for the in-home care world once it subsides.

“We are hopeful that the flexibilities being granted to home health agencies … become the rule — not the exception — after the outbreak concludes,” Aaron Tripp, the VP of reimbursement and financing at LeadingAge, told HHCN.

The U.S. has no other choice but to rely on alternate forms of treating patients outside of long-term care settings. In New York, the epicenter for the coronavirus in the states, there are 23,000 available hospital beds. That number will not be able to sustain the influx of patients if cases continue to proliferate.

New York Governor Andrew Cuomo announced Friday that he believed the state is 21 days out from its coronavirus apex in hospitals.

Home-based care is primed to be one of the solutions to the overcrowding problem, even if that’s for managing non-COVID-19 patients that would be in a hospital or alternate long-term setting otherwise.

That creates an opportunity for an industry that has long been championing its methods as a way to improve care and reduce costs.

A turn toward telehealth

The coronavirus is forcing the government to stretch out of its pre-epidemic comfort zone. Likewise, It’s also forcing providers to further lean into their technological capabilities — or scrambling to acquire some. 

Under Medicare, roadblocks to reimbursement have kept providers from investing heavily in telehealth.

In a 2019 study of 159 home health agencies, only 28% of respondents said they would be advancing their telehealth capabilities in 2020. That was according to Definitive Healthcare, a Framingham, Massachusetts-based provider of health care data and analytics.

Now, as both patients and caregivers become cognizant of the risks of coming into contact with each other, communicating via telehealth technology — or even through a phone or tablet — becomes a no-brainer.

CMS has recognized that remote communication is vital to agencies’ success right now, and has reacted by reducing restrictions and potentially clearing a pathway for reimbursement for telehealth services.

At the very least, the stimulus package is urging CMS to encourage telehealth.

Currently, there is an emergency rule making its way through the U.S. Office of Management and Budget (OMB), which could enable providers the chance to be compensated for telehealth services. Additionally, the current homebound restrictions for home health would be relaxed.

As CMS scrambles to make it easier for patients to receive care at home and through telehealth services, the agency may realize the benefits of both sooner than they would have without the pandemic.

“I was always hopeful that in the next year or two years, [these restrictions] would be lifted all together,” Mordy Eisenberg, CEO of Tapestry Telehealth, told HHCN. “So when I see these things being lifted in an emergency, it’s like — I think [CMS] gets it. They recognize that this is really effective and this needs to be done. I think ultimately, they’re going to recognize that the costs are far lower, and maybe just accelerate some of the changes to the laws and make them more permanent.”

If providers are able to work efficiently and effectively with relaxed restrictions during the crisis, they’ll be left with a strong argument afterward.