CMS Updates 1135 Waiver Resources to Assist Home Health and Hospice Providers with PHE Wind-Down

The recent announcement of the wind-down of the federal COVID-19 Public Health Emergency (PHE) by May 11, 2023 means that flexibilities provided under the Centers for Medicare and Medicaid Services (CMS) 1135 waivers for home health and hospice will be coming to an end. CMS has updated its 1135 waiver resources detailing the provisions that have already expired and the status of the others soon to expire. Please note that the State recognized several of these provisions, but not all, during the pandemic. The Department of Health (DOH) issued this Dear Administrator Letter (DAL) back in 2021 acknowledging departmental discretion for some provisions and their own compliance dates.

The 2021 DAL urged agencies to resume in-home and in-person supervision of home care aides. With the end of the federal PHE, DOH will no longer exercise discretion regarding this practice.

The guidance also urged resumption of in-home initial assessments and reassessment within 24 hours, but allowed for enforcement discretion by the Department. Once the federal PHE ends, agencies must demonstrate to the Department that they have implemented policies and procedures to restart conducting initial patient visits within 24 hours as soon as practicable.

The DAL also noted that all 16 hours of supervised home health aide practical training may be conducted in a laboratory setting under the direct supervision of a nurse instructor. This will continue to be allowed until further notice per the DAL. Also, agencies were required to resume pre-employment health assessments for new employees, and annual health assessments, as well as annual performance evaluations per the DAL.

For annual 12-hour in-service for home health and hospice aides, the Department will continue to exercise enforcement discretion until the end of the first quarter following the declaration of the end of the federal PHE. Other provisions are addressed in the DAL as well.

Providers are urged to carefully review both the State guidance here and the updated federal 1135 waiver documents for hospice and home health providers.

LeadingAge NY will be working to understand the full implications of the end of the federal PHE and its impact on all long term care providers and patients. This will likely be a fairly drawn out process and involve both federal and State guidance. We will keep members updated as this unfolds.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871