What Terminating the COVID PHE Means for Hospices

To a certain extent, hospices will soon be operating under pre-pandemic rules in a “post-COVID” world.

With the COVID-19 Public Health Emergency (PHE) going away on May 11, many of the temporary flexibilities that came with it are expected to end, though Congress did extend some through 2024, including hospice re-certifications via telehealth.

The flexibilities enabled hospice and palliative care providers to maintain continuity of care while reducing safety risks, according to Ben Marcantonio, COO and interim CEO of the National Hospice and Palliative Care Organization (NHPCO).

“Hospice and palliative care providers have long prepared for the end of the PHE, and we believe they will manage the transition seamlessly,” Marcantonio told Hospice News in an email. “It’s also important to remember that separate from the PHE, there are telehealth flexibilities that allow hospice patients and providers to continue to use telehealth for low-touch, face-to-face visits prior to recertification for the hospice benefit.”

The expanded availability of telehealth has become an integral part of care delivery for most hospices, even though this was introduced as a temporary exemption during the pandemic. Hospices and other providers have been furrowing their brows over the possibility that former restrictions would eventually return.

If hospices were to lose those capabilities, their workforce would come under greater strain, potentially causing some to leave the field, according to Kathleen Benton, president and CEO of Georgia-based Hospice Savannah.

“For any of us to survive financially and be able to continue to care for people, it’s going to take innovative health care and technology to help make us more efficient in care delivery,” Benton previously told Hospice News. “We should feel compelled and called to make telehealth part of our expectations because health care can’t look the same as it did prior to COVID.”

In addition to recertifications, Congress has extended flexibilities for audio-only visits, as well as some related to originating sites, eligible practitioners, rural health and mental health services. Some states also have enacted laws extending telehealth in their Medicaid programs.

The end of the PHE should not be the last word on possible extensions of additional waivers, according to Bill Dombi, president of the National Association for Home Care & Hospice (NAHC).

“[The U.S. Centers for Medicare & Medicaid Services (CMS)] needs to consider what other flexibilities that emerged with the PHE can be made permanent, particularly several administrative, supervisory parts of the Conditions of Participation,” Dombi told Hospice News.

Additionally, some waivers pertaining to telehealth, hospitals, skilled nursing facilities and other facets of the health care system are set to expire with the PHE on May 11, the Kaiser Health Foundation reported.

Soon, hospices will have to resume compliance with volunteer requirements, as well as rules for the training and assessment of aides. Also, payers — including private companies, Medicare and Medicaid — will no longer be required to offer free COVID-19 tests, vaccines and some treatments.

Hospices are now working to prevent any potential disruption from affecting patient care, the National Partnership for Hospice and Healthcare Innovation (NPHI) indicated in an email to Hospice News.

“NPHI appreciates the flexibilities and waivers that CMS was able to offer hospice providers which enabled them to sustain operations throughout the COVID-19 pandemic,” the emailed statement stated. “We look forward to working with our partners in government and our members across the country to ensure a smooth transition out of the COVID-19 public health emergency and a seamless care experience for patients and their families.”

CMS last year published a “roadmap” to help health care organizations adapt to the changing environment.

Nevertheless, the transition will be difficult, according to LeadingAge President and CEO Katie Smith Sloan.

“The declaration of a public health emergency has provided valuable flexibility and access to critical resources providers desperately need to ensure the wellbeing of older adults, who are among the most vulnerable to falling ill or worse from COVID-19, and also of the people who care for them. On May 11, many of those resources and flexibilities will be gone,” Sloan said in a statement. “While we appreciate the administration giving our mission-driven, nonprofit providers some time to plan, our members are severely overstretched and now face a new landscape of funding and rules while simply trying to survive.”

The White House Office of Management and Budget (OMB) announced the May 11 expiration date on Monday, indicating that the timeline complies with the administration’s pledge to give providers 60-day notice of the PHE’s termination.

The announcement comes as the U.S. House of Representatives mulls two pieces of legislation designed to end the PHE earlier than May 11.

Rep. Brett Guthrey (R-Ky.) has introduced H.R. 382, the “Pandemic Is Over Act,” which, if enacted, would end the PHE immediately. Also before the House is Joint Resolution 7, introduced by Rep. Paul Gosar (R-Ariz.), which would likewise end the PHE upon enactment.

“The continued maintenance of this state of affairs is inappropriate for at least two reasons. First, the country has largely returned to normal. Every day, Americans have returned to work and school with no restrictions on their activities,” House Rules Committee Chairman Tom Cole (R-Okla.) said in a recent hearing. “It is time that the government acknowledges this reality: the pandemic is over, and there is no need for these declared emergencies to continue.”

OMB said in its announcement that ending the PHE so quickly would have wide-ranging harmful effects on the health care system.

The proposed bills would not allow certain policies to phase out gradually to ensure an orderly transition, according to OMB. This would include special Medicaid rules designed to ensure continuity of coverage, as well as the Title 42 policy impacting the U.S. border.

OMB also raised concerns that earlier termination could result in reductions in state funding, as well as patients losing their insurance or telehealth services. Also, hospitals and nursing homes would have insufficient time to retrain staff and implement new billing policies, OMB contends.

“An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” OMB indicated.

As of Jan. 25, about 295,000 COVID-19 people in the United States were sick with COVID-19, according to the U.S. Centers for Disease Control & Prevention (CDC). The number of U.S. deaths that week totaled 3,756.

With or without the federally declared PHE, hospices can continue their independent COVID-prevention efforts, Craig Dresang, CEO of California-based hospice provider YoloCares, told Hospice News.

“Ending the COVID PHE in May makes sense,” he said. “We will continue to monitor for symptoms and infection rates, and implement testing and masking policies based on the data and on our own initiatives to protect patients, families, employees and the community.”