HHS Issues Roadmap for End of COVID-19 Public Health Emergency

The U.S. Department of Health and Human Services (HHS) has released a roadmap for the eventual end of the COVID-19 public health emergency (PHE) and the termination of the various waivers of regulatory requirements that have ensured continued access to care during the pandemic. The PHE is currently slated to end in mid-October; however, HHS has committed to giving states and the health care community 60 days’ notice before terminating it. Thus, it is likely that the PHE will be extended again in October. Nevertheless, HHS is urging providers to prepare for the cessation of the waivers and return to normal operations. Providers would be wise to examine the roadmap and the applicable fact sheets to identify the waivers that will be terminating and their schedule for termination. In a blog post accompanying the roadmap, Centers for Medicare and Medicaid Services (CMS) officials noted that, unless otherwise specified in the fact sheets, these waivers will end with the PHE.

The following are some highlights from the fact sheets:

Vaccine Administration

Medicare will continue to pay approximately $40 per dose for administering COVID-19 vaccines in outpatient settings through the end of the calendar year in which the PHE ends. Effective Jan. 1^st of the year following the year that the PHE ends, CMS will align the payment rate for administering COVID-19 vaccines with the payment rate for administering other Part B preventive vaccines. In addition, instead of an additional $35.50 per dose for vaccine administration in the home, Medicare will pay a total of $75 per dose to administer the COVID-19 vaccine in the patient's home once the PHE ends through the end of the calendar year.

Telehealth

As a result of the Consolidated Appropriations Act of 2022, many of the telehealth flexibilities implemented during the pandemic will expire 151 days after the conclusion of the PHE. These include:

• the waiver of geographic and setting-based limitations on where beneficiaries may access telehealth, which allowed beneficiaries outside of rural areas and patients in their homes to receive telehealth services; and
• the waiver of limitations on the types of health care professionals who can furnish distant site telehealth services, which allowed physical therapists, occupational therapists, and speech language pathologists to deliver services via telehealth.

(See below for telehealth provisions specific to home health and hospice.)

Nursing Homes

The nursing home fact sheet addresses a broad array of waivers, as well as regulatory requirements, including, among others:

• Three-Day Prior Inpatient Hospital Stay: The waivers of the three-day hospital stay as a prerequisite for Medicare coverage of skilled nursing facility (SNF) services and the 60-day period of wellness to renew SNF benefits will terminate at the end of the PHE.
• NHSN Reporting and Family Notification Requirements: The regulatory requirements to submit weekly data to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) and to notify residents and families of new COVID-19 cases were extended by regulation until Dec. 31, 2024.
• Staff and Resident COVID-19 Testing Requirements: During the PHE, CMS promulgated regulations requiring nursing homes to establish COVID-19 testing protocols consistent with CMS guidance. The fact sheet indicates that these regulations are applicable for the duration of the PHE. 

Several other blanket waivers were previously terminated, including the provision allowing nursing homes to employ temporary nurse aides (TNAs) for more than four months without certification. That waiver ended on June 6^th, and facilities are reminded that TNAs working under the waiver must be trained and certified by Oct. 6^th. More information about the transition of TNAs is available here. Similarly, the waiver allowing paid feeding assistants to work without the required 15 hours of training (eight hours under CMS regulations) also terminated on June 6^th.

Home Health

The following are selected waivers of home health requirements that will end with the PHE or within a period of time after the termination of the PHE:

• Telehealth: Face-to-face encounters may continue to be conducted via two-way audio-video telehealth beyond the PHE. However, the waiver only extends the "originating site" to the patient's home during the PHE.
• Homebound: The clarification that a beneficiary is considered homebound when their physician advises them not to leave home because of confirmed or suspected COVID-19 infection, or if the patient has a condition that makes them more susceptible to COVID-19, will remain in effect regardless of the PHE.
• On-Site Nurse Supervision of Aides: The waiver of the requirement of a nurse visit every two weeks to evaluate the aides will end at the conclusion of the PHE. However, the 2022 Home Health Prospective Payment System Final Rule revised the frequency of aide supervision by professionals.
• On-Site Professional Assessments of Aides: The waiver of the requirement that a nurse or other professional annually provide on-site supervision of each aide will terminate with the PHE, and all on-site assessments must be completed no later than 60 days after the end of the PHE.
• In-Service Aide Training: Annual in-service training requirements were postponed during the PHE, but must be completed by the end of the first full quarter after the PHE ends.

Hospice

The hospice fact sheet includes, among other items, information about the following waivers:

• Telehealth: The waiver allowing hospice programs to provide routine home care through telecommunications technology will expire at the end of the PHE. Similarly, the use of telehealth for purposes of patient recertification for the Medicare hospice benefit will also expire at the end of the PHE.
• On-Site Professional Assessments of Aides: The waiver of the requirement that a nurse or other professional annually provide on-site supervision of each aide will terminate with the PHE, and all on-site assessments must be completed no later than 60 days after the end of the PHE.
• Annual Training: The deadline for completing the annual assessment of the skills and competence and the in-service training requirement for all individuals furnishing care will be the end of the first full quarter after the conclusion of the PHE.
• Volunteers: The waiver of the requirement to use volunteers will terminate at the end of the PHE.
• Non-Core Services: Hospices will again be required to provide non-core hospice services at the conclusion of the PHE.

In the blog post accompanying the release of the roadmap, CMS stated that it continues to seek and receive input as it updates regulatory requirements and sub-regulatory guidance.

Contact: Karen Lipson, klipson@leadingageny.org