CMS Announces Hospice Flexibilities to Fight COVID-19

CMS has announced a series of temporary regulatory waivers and new rules to provide hospice providers with flexibility to respond to the COVID-19 pandemic.  The goals of these actions are to expand the healthcare system workforce; ensure adequate capacity in hospitals and health systems; increase access to telehealth in Medicare; expand in-place testing; and put patients before paperwork.  These flexibilities include the following:

Medicare Telehealth and Telecommunications Technology

• Hospice providers can provide services to a Medicare patient through telecommunications technology (e.g., remote patient monitoring; telephone calls (audio only and TTY); and two-way audio-video technology), if it is feasible and appropriate to do so. Only in-person visits are to be recorded on the hospice claim.
• Face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit can now be conducted via telehealth (i.e., 2-way audio-video telecommunications technology that allows for real-time interaction between the hospice physician/hospice nurse practitioner and the patient).

Workforce

• Training and Assessment of Aides – CMS postponed the annual onsite hospice aide supervisory visit until 60 days from the end of the public health emergency (PHE).
• Annual Training – CMS postponed the annual assessment of hospice aide skills and competence until the end of the first full quarter following the lifting of the PHE.  This waiver does not alter minimum personnel requirements.
• Quality Assurance and Performance Improvement (QAPI) – During the PHE, CMS is allowing hospices to narrow their QAPI focus to infection control issues, along with a focus on any adverse events.
• Volunteer Requirement – In anticipation that volunteer availability and use will be reduced due to the COVID-19 pandemic, CMS waived the requirement that hospices use volunteers.
• Onsite visits for Hospice Aide Supervision – CMS waived the requirement that a nurse to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan.

Patients Over Paperwork

• Comprehensive Assessments – CMS extended the time to complete required patient assessments and updates from 15 to 21 days.
• Waive Non-Core Services – CMS waived the requirement for hospices to provide certain non-core hospice services during the national emergency (e.g., physical therapy, occupational therapy, and speech/language pathology).
• Accelerated/Advance Payments – As of April 26, 2020, CMS is reevaluating all pending and new applications for the Accelerated Payment Program and has suspended the Advance Payment Program, in light of direct payments made available through the Department of Health & Human Services’ (HHS) Provider Relief Fund.  For providers and suppliers who have received accelerated or advance payments related to the COVID-19 Public Health Emergency, CMS will not pursue recovery of these payments until 120 days after the date of payment issuance.
• Specific Life Safety Code (LSC) for Hospitals and CAHs – CMS modified particular waivers for inpatient hospice.
  • Alcohol-based Hand-Rub (ABHR) Dispensers – CMS waived prescriptive requirements for the placement of alcohol based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control.  However, because ABHRs are considered a flammable liquid, restrictions on the storage and location of ABHR containers remain applicable.  This includes restricting access by certain patient/resident population to prevent accidental ingestion.  Due to the increased fire risk for bulk containers (over five gallons), those will still need to be stored in a protected hazardous materials area.
  • Fire Drills – Due to the inadvisability of quarterly fire drills that move and mass staff together, CMS has permitted a documented orientation training program related to the current fire plan. The training must instruct employees on their current duties, life safety procedures, and the fire protection devices in their assigned area.
  • Temporary Construction – CMS waived requirements that prohibit temporary walls and barriers between patients.

Medicare Appeals in Fee for Service, Medicare Advantage (MA) and Part D

• Medicare Administrative Contractors (MACs) and Qualified Independent Contractor (QICs) in the FFS program, MA and Part D plans, and Part C and Part D Independent Review Entity (IREs) are permitted to do the following:
  • Allow extensions to file an appeal;
  • Process an appeal even with incomplete Appointment of Representation forms;
  • Process requests for appeal that do not meet the required elements using available information; and
  • Utilize all flexibilities available in the appeal process as if good cause requirements are satisfied.
• MA plans may extend the timeframe to adjudicate organization determinations and reconsiderations for medical items and services (but not Part B drugs) by up to 14 calendar days if: the enrollee requests the extension; the extension is justified and in the enrollee’s interest due to the need for additional medical evidence from a noncontract provider that may change an MA organization’s decision to deny an item or service; or, the extension is justified due to extraordinary, exigent, or other non-routine circumstances and is in the enrollee’s interest.
• Cost report filing deadlines have been postponed for fiscal year end (FYE) dates. CMS will delay the filing deadline of FYE 10/31/2019 cost reports due by March 31, 2020 and FYE 11/30/2019 cost reports due by April 30, 2020.  The extended cost report due dates for these October and November FYEs will be June 30, 2020.  CMS will also delay the filing deadline of the FYE 12/31/2019 cost reports due by May 31, 2020.  The extended cost report due date for FYE 12/31/2019 will be July 31, 2020.

For more information on temporary regulatory waivers and new rules for hospices in response to COVID-19, please contact Jason E. Bring.