In The News

 

CDPHE Intends Soon To Update Rules To Match This Week's Relief from CMS

Posted: April 3, 2020

The Colorado Department of Public Health and Environment Is working to match "blanket waivers and additional guidance" issued this week by CMS that would allow Colorado licensed and certified agencies to move forward without fear of related deficiencies in mandated surveys later. 

"We want to align with CMS waivers," said Cheryl McMahon, CDPHE's Home & Community Facilities Branch Chief.  McMahon said she expected an amended waiver to be issued through CDPHE's portal either today or early next week. 

CMS earlier this week waived some significant provisions of the home health Conditions of Participation, including:

  • The initial evaluation under 484.55 (a) will not require an on-site visit and may be conducted remotely or through medical review. This does not apply to the comprehensive assessment requirement under 484.55(b). Allowing HHAs to conduct the initial evaluation in this manner will help agencies comply with 48-hour rule for the initial evaluation visit if agencies are required to conduct an on site visit to determine eligibility and immediate care.
  • The requirement to submit the comprehensive assessment within 30-day of the date of completion is waived, and CMS will allow HHAs complete the comprehensive assessment.
  • 14-day HCA supervisory visits are waived during the public health emergency (PHE). CMS encourages HHAs to use virtual technology.
  • Several coverage and payment requirements have also been waived that include extending the time frame for auto-cancellation of requests for advanced payments (RAPs), NPPs may certify and write orders for home health services; physician face-to-face encounters may be conducted using two-way audio/visual communication; homebound status based on a physician order indicating that leaving the home is medically contraindicated; extended time frame for request for advanced payment auto cancel.
  • Agencies may provide visits through telehealth or any two audio/visual technology and not be subject to HIPAA compliance enforcement. The visits must be ordered by the physician and on the Plan of Care. Telehealth may substitute for an ordered on-site visit. Unfortunately, agencies may not receive reimbursement for telehealth visits.
  • Flexibilities under Medical review include halting targeted probe and educate reviews. Any additional documentation request (ADR) that has been requested will be withdrawn and the claim will process and be paid. CMS is pausing review choice demonstration (RCD) in Illinois, Ohio, and Texas . North Carolina and Florida will not begin on May 4, as previously scheduled. All claims submitted will be processed and paid and not be subject to a 25 percent reduction. Agencies wanting to continue with pre-payment review under RCD may do so.

McMahon spoke Thursday afternoon on a CDPHE call for trade associations representing home care, hospice, assisted living centers, nursing homes, skilled nursing facilities, EMS and paramedics, and other health-care providers and first responders. 

On the same call, CDPHE officials addressed testing of health-care workers by noting that CDC guidance remains that -- owing to a scarcity of tests -- workers must be symptomatic prior to receiving testing. Some hospice and home-care agencies already report they are treating COVID-19 positive patients, and the state has identified nursing homes and other senior living centers with COVID-19 -positive residents. 

 

 

HHAC Launches COVID-19 Discussion Circle

Posted: April 3, 2020

HHAC has launched a COVID-19 Discussion Circle. Click here to join the circle and to immediately start a discussion thread or reply to a discussion post. You must be signed in as a member to view. 

The COVID-19 is one of a number of discussion circles available at the Home Care & Hospice Association of Colorado website. Others are Background Checks, Electronic Visit Verification, Best Practices, Private Pay and West Slope Forum. See all the discussion circles here.

To find discussion circles in the future go to the HHAC website > Member Center > My Community > View All Circles

 

 

National Associations Make Push For Home Health To Alleviate Strain On Hospitals, Alternative Care Settings

Posted: April 2, 2020

As hospitals nationwide continue to struggle with unprecedented demand for critical services related to the COVID-19 pandemic, home healthcare providers are well prepared to help alleviate the growing strain on the system by caring for patients in the home, according to a new report from the National Association for Home Care & Hospice (NAHC) and Partnership for Quality Home Healthcare (PQHH).

“Our dedicated providers are ready to relieve some of the mounting pressure in hospitals and emergency rooms across the country,” said Joanne Cunningham, Executive Director of PQHH. “Our workforce is skilled, trained and prepared to offer essential care for Americans in the safety of their homes – hopefully clearing inpatient settings for the sickest patients.”

Their report outlines how lawmakers can rapidly eliminate barriers to home healthcare and allow for a nationwide response from agencies and providers to care for patients as a looming rise in cases mounts in the coming weeks. Doing so, home health leaders say, will help hospitals and facilities alleviate overall capacity issues and help prevent the spread of the virus to the overall community – especially our most vulnerable population: the frail and elderly.

  • Caring for patients with chronic illnesses or post-acute challenges, who are well enough to be discharged from inpatient care but still require close monitoring and ongoing care—especially to help avoid rehospitalizations, which will only exacerbate the pressure on the system.
  • Treating confirmed COVID-19 patients who no longer require inpatient care, and those whose symptoms are manageable at home with close monitoring and care delivered by a skilled clinician.
  • Addressing the healthcare needs of patients under investigation (PUI) for COVID-19.

Download the report

NAHC Webinar: Home Health and Hospice Pandemic Relief -- Medicare and more

NAHC presented a webinar on March 31 to discuss the many changes CMS made this week and how they will impact home health and hospice. If you missed it, watch it here for free. 

 

 

Colorado Is Creating Guidelines To Help Make Excruciating Coronavirus Care Decisions

Posted: April 2, 2020

What if four patients in respiratory distress need a ventilator to keep them alive, but a hospital has just one available? Who makes that call? And how?

Public health and community leaders are contemplating excruciating dilemmas just like that before demand for medical help in the coronavirus crisis peaks in coming weeks, The Colorado Sun reports.

They’re updating protocols, called “crisis standards of care,” for the most urgent medical decision-making possible, guidelines to determine, as resources get scarce, who gets care and at what level and who does not.

Full story

 

 

Home Health Provider Feeling COVID-19 Heat: ‘We Are Not the Fire, We Are the Fire Department’

Posted: April 2, 2020

On Friday, Feb. 28, just after 10 p.m. PT, Brent Korte — chief home care officer at EvergreenHealth — got a call that changed everything. It was from his boss.

“She asked me if I was sitting down,” Korte told HomeHealthCareNews.com. “She told me that EvergreenHealth not only had patients who had tested positive for COVID-19, … but that a patient passed away in our hospital. This was the first death from COVID-19 in the United States.”

Based just outside of Seattle, EvergreenHealth is one of the largest home health and hospice providers in the Pacific Northwest. The not-for-profit provides about 250,000 visits per year and is affiliated with a local small hospital system.

Full story

Evergreen's Korte on PPE

Korte recommends PPE conservation based around science. That means making tough choices and being prepared to defend them, while also communicating to staff that overprotecting now may mean no protection later.

But providers should also keep in mind that, as things change, so should their protocols.

“We started with N95 mask respirators for positive patients, and then we moved to droplet precautions, which are goggles, gloves, surgical masks and gowns,” Korte said. “Then we laid off the gowns for some patients; then we went to no masks for all visits; then to limiting visits; and then we chose to start limiting visits to [those] that are only clinically, essentially necessary in person.”

Those changes all happened over the course of 26 days. At the time of the webinar, Evergreen’s protocol was back to mandating surgical masks and droplet precautions for all patients because “infection rates have increased, and we’re trying to make sure that we’re not the vector,” Korte said.

 
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