Mask with the end written on it

Telehealth. Home care aide training. Hospice volunteer hours. The COVID-19 public health emergency (PHE) initiated waivers for many areas of home health and hospice. As of May 11, according to President Biden this week, the PHE will end, thus summoning the end of many of these flexibilities.

While providers have a little more than three months to plan for the change, LeadingAge President & CEO Katie Smith Sloan said her organization still has questions about how the administration plans to transition to a true post-COVID environment.

“We are actively reaching out to CMS, HUD, and other agencies to better understand what their plans are for the end of the PHE and preparing for how we can best support members,” Sloan said in a statement.

The key now, according to Katie Wehri, director of home health and hospice regulatory affairs for the National Association for Home Care & Hospice, is for providers to determine the status of the waivers they have been using and act accordingly.

Katie Wehri

“What they do need to do is to take a look at all of the waivers that they have utilized,” she told McKnight’s Home Care Daily Pulse on Tuesday. “If they are still utilizing any of those waivers they need to determine whether this waiver was made permanent … through legislation or regulatory change. If it was not made permanent, what is the plan for tapering off the use of this waiver?”

The telehealth waivers, one of which permitted home health agencies to provide more services to beneficiaries using telecommunications within the 30-day plan of care, are among the few that have become more established. The Consolidated Appropriations Act, passed in December, extended telehealth provisions through the end of 2024. And as part of the 2022 Physician Fee Schedule, CMS permanently expanded coverage for telehealth used in the treatment of mental health issues.

Other waiver situations are more nuanced. For example, a Condition of Participation waiver that allows home health aides to forego 12-hour annual in-service training will end with the conclusion of the PHE. But the deadline for completing the requirement is one quarter after the termination of the PHE. And while the waiving of annual training and assessment of aides in home health and hospice is also ending, postponed on-site visits must be completed within 60 days after the expiration of the PHE.

Still other waivers may require clarification from the Centers for Medicare & Medicaid Service, Wehri noted. For example, CMS waived the 5% level of activity for hospice volunteers due to COVID-19. But because many hospices have lost their volunteer corps, how will they fulfill the volunteer requirement at all? She asked.

“They can waive the 5% requirement, but they can’t eliminate that requirement. It’s part of the Conditions of Participation,” Wehri said. “So how will hospices really ramp up to reach that 5%? That’s a big question, I think, for many hospices.”

Some organizations are taking a broader view of the PHE’s end. SCAN Group CEO Sachin Jain, MD, whose California-based firm delivers patient-driven care to seniors in their homes, told McKnight’s Home Care Daily Pulse he hopes the government will rethink the way healthcare is delivered in the United States.

“I think the pandemic gave us a view into what some of the opportunities are,” Jain said. “Some of it is moving more care to the home and some of it is moving more care from expensive facilities and delivering it more virtually.” 

While an off-ramp for the PHE had not been set until this week, the government has been keeping providers on alert. CMS in August created a roadmap for the end of the PHE. Learn more about the status of home health waivers and hospice waivers.