­COVID-19 Stimulus Bill – Key Provisions Related to Home Health and Hospice Providers

March 27, 2020

On March 25, 2020, the U.S. Senate passed the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) with a 96-0 vote. Thereafter, on March 27, 2020, the U.S. House of Representatives passed the CARES Act (H.R. 478), with a voice vote.  President Donald Trump is expected to sign the bill into law later today.

The CARES Act provides over $2 trillion in stimulus benefit for the economy. Highlights of the law include certain sick leave and family leave benefits, expanded unemployment benefits, tax provisions that support employers during the 2019 novel coronavirus (COVID-19) pandemic, loans for small businesses, and significant financial appropriations for certain industries. In addition, the CARES Act includes numerous provisions related to the healthcare industry as the federal government continues to address the COVID-19 pandemic. These healthcare provisions include efforts on drug and equipment shortages, and revisions to covering COVID-19 testing.

Read on for 3 key things healthcare providers should know about the CARES Act and its impact on Medicare-enrolled home health and hospice providers in responding to the current pandemic.  The CARES Act expands telehealth options for Medicare home health agencies and hospice providers to utilize in appropriately and safely providing care to patients.  The CARES Act makes law previous guidance announced by the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) related to telehealth, as discussed in a March 18 McGuireWoods legal alert.

Expect HHS and CMS to announce supplemental guidance on the use of telehealth by home health agencies and hospice providers.

1. Expanded Access to Telehealth for Recertification of Hospice Eligibility

Under current law, Medicare hospice conditions of participation require a hospice patient’s primary care physician to perform a face-to-face evaluation of a patient every 60 days to recertify that the patient continues to be eligible to receive the Medicare hospice benefit. Historically, neither hospice physicians nor nurse practitioners have been permitted to conduct the face-to-face recertification encounter via telehealth.

The CARES Act (Section 3706) permits providers to use telehealth technologies to conduct the Medicare-required face-to-face recertification of the patient’s terminal illness during the COVID-19 national health crisis. Now, a hospice physician or nurse practitioner may use telehealth technologies to conduct the Medicare-required face-to-face recertification of terminal illness.

While the CARES Act expands the use of telehealth for conducting face-to-face recertification evaluations, the CARES Act has not changed any of the statutory requirements for patients to obtain a face-to-face initial certification of hospice eligibility or for hospices to continue conducting an in-person assessment of a hospice patient every 14 days. Therefore, hospices should continue to follow the Medicare hospice conditions of participation requiring an initial certification of hospice eligibility and a 14-day in-person assessment, unless and until additional guidance is issued on these items.

2. Expanded Access to Telehealth for Home Health Agencies

The CARES Act (Section 3707) also requires the secretary of HHS to issue clarifying guidance to Medicare-enrolled home health agencies encouraging the use of telecommunications systems, including remote patient monitoring, to furnish home health services consistent with the Medicare beneficiary care plan during the COVID-19 emergency period. In the near future, HHS will expand the Medicare reimbursable home health services that home health agencies will be able to provide to patients via telehealth during the public health emergency. Expanded access to the use of telehealth will allow home health agencies to properly and adequately provide care to patients while also protecting and ensuring the safety of patients and in-home caregivers during the COVID-19 health crisis.

3. Expanded Authorization for Nurse Practitioners and Physician Assistants to Order Medicare Home Health Services

While historically only physicians have been permitted to order home health services for patients, the CARES Act (Section 3708) now permits physician assistants, nurse practitioners and other mid-level providers to order home health services for Medicare beneficiaries. Typically, a physician must order and periodically review any home health services for a Medicare beneficiary, but changes under the CARES Act now allow a mid-level to make home health orders as the primary healthcare provider for the Medicare beneficiary in the home setting. With this increase in the number of providers authorized to make orders for home health services, Medicare beneficiaries should see reduced delays in obtaining necessary orders for home health services. As a result, home health agencies can now rely on written orders for home health services from a physician assistant, nurse practitioner or other mid-level provider as the provider in charge of a patient’s care from start to finish. 

Please contact the authors for additional guidance on how these issuances and other COVID-19 considerations will affect the delivery of patient care and the related rules. McGuireWoods has published additional thought leadership related to how companies across various industries can address crucial coronavirus-related business and legal issues