Bulletin: May 12th, 2020

May 12th, 2020


COVID-19 Resource Center

HOME HEALTH and HOSPICE: CMS updated its COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, NAHC, May 10, 2020 – Late May 8, 2020 CMS updated its COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers document with welcome changes for home health agencies and hospices. CMS expanded the types of therapists able to perform the initial and comprehensive assessment for all home health patients to include PTs and SLPs in addition to OTs for the duration of the PHE, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. CMS also expanded the waivers of the Life Safety Code pertaining to hospice inpatient units, specifically alcohol-based hand-rub dispensers, fire drills and temporary construction sections of the LSC. 
HOME HEALTH and HOSPICE: New IRS Guidance Eliminates all Tax Benefits of PPP Loan Forgiveness, NAHC Report, A special report from Ted Cuppett of The Health Group, May 7, 2020 – The IRS has released guidance (Notice 2020-32) to explain that a taxpayer that receives a loan through the Paycheck Protection Program (PPP) is not permitted to deduct expenses that are normally deductible under the Code, to the extent the expenses were reimbursed by a PPP loan that was then forgiven. This Notice would effectively eliminate all the tax benefits to employers that were provided for in the CARES Act.
HOME HEALTH and HOSPICE: CARES Act Funding Update: HHS Release of Long-Awaited FAQs on Provider Relief Fund General Distribution, NHPCO COVID-19 Update, May 7, 2020 – On May 7, 2020, the Department of Health and Human Services (HHS) released long-awaited FAQs on Provider Relief Fund General Distribution. In the release, HHS announced that “Generally, HHS does NOT intend to recoup funds as long as a provider’s lost revenue and increased expenses exceed the amount of Provider Relief funding a provider has received.”
HOME HEALTH and HOSPICE: HHS announces the Deadline Extension to 45 Days for Signing the Attestation for the CARES Act Provider Relief Fund , NHPCO COVID-19 Update, May 7, 2020 HHS announced they have extended the deadline for healthcare providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. Providers will now have 45 days, increased from 30 days, from the date a provider received a payment to attest and accept the Terms and Conditions or return the funds. HHS used an example: the initial 30-day deadline for providers who received payment on April 10, 2020 is extended to May 24, compared to the old deadline of May 9, 2020. If payment is not returned within 45 days of receipt, the payment will be viewed as acceptance of the Terms and Conditions.
HOME HEALTH and HOSPICE: CDC/HRSA Provider Relief Fund Allocations Posted, NHPCO COVID-19 UPDATE, May 7, 2020 – On May 7, 2020, the dataset was released with the list of providers who received a payment and the amount of the payment from the CARES Act Provider Relief Fund. This list includes all providers who have attested to the payments and agreed to the Terms and Conditions. The list is up to date as of May 4, 2020.

HOME HEALTH and HOSPICE: Health Care Supply Chain, Provider Self-Care, and Emergency Preparedness Resources, CMS MLN Connects, May 7, 2020 – The most recent Express from the Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) highlights recently developed resources, including:

For More Information: >>>RCD/PDGM UPDATES –                                                                                                                  

If you have PDGM or RCD QUESTIONS PLEASE SEND THEM TO helpdesk@ochch.org
Use PDGM or RCD as the subject title.
If you need OCHCH to contact Palmetto GBA regarding a PCR NON-AFFIRMATION,
Please e-mail a short description and the UTN and your provider number.
DO NOT e-mail any info that could be non-compliant with the HIPAA regulations
Please check out the toolkits for PDGM and also RCD!

>>>RCD UPDATES –                                                                                                                  

NEW: Option to Stay in PCR, Palmetto GBA – For Home Health providers participating in the Review Choice Demonstration (RCD), you will now have the option to keep Pre-Claim Review (PCR) as your review choice for future cycles. This will avoid having to reselect PCR for each selection cycle. Providers can withdraw from this option and still change to another review choice in a future cycle.

New: RCD Tip: PCR Task Signed Documentation, Palmetto GBA – The Medical Review (MR) team has noticed an increased number of providers in Pre-Claim Review (PCR) who are submitting documentation (plan of care, therapy orders, etc.) that are not signed. As a reminder, for tasks 1 through 4, a signature is required. Documents submitted without a proper physician signature will result in a non-affirmation. Oral orders must be countersigned and dated by the physician before the home health agency submits the final bill.

We Are Going Green with RCD Cycle Results eLetters, Palmetto GBA – Palmetto GBA is going green with RCD Cycle Results eLetters. We will send home health agencies their RCD Cycle Results via eLetter in eServices. Please review and share with your staff.

RCD Tip: Using the Correct Provider Transaction Access Number (PTAN), Palmetto GBA – If you are a part of a Home Health Agency (HHA) with more than one location and multiple PTANs, please make sure you are using the correct PTAN when submitting Pre-claim Review (PCR) requests.

RCD for Ohio’s Home Health Services Has Been PAUSED

Ohio Providers Transition to Review Choice Demonstration (RCD) Cycle Two, Palmetto GBABeginning May 1, 2020, you will be able to choose the next round’s review option. Typically, the selection period is open for a two-week period. Due to the current Public Health Emergency (PHE) related to COVID-19, the last day to make a selection has not yet been determined. Palmetto GBA will announce the last day to make a selection as soon as possible on their website and via email update. If you are not signed up for the Palmetto GBA email updates, please visit https://tinyurl.com/GetListserv to sign up.

Our Take

Advocacy in Action: Ohio Association of Advanced Practice Nurses (OAAPN) and Ohio Council for Home Care and Hospice (OCHCH)
Thanks to the newly implemented federal CAREs Act, Advance Practice Registered Nurses (APRN)s are now able to order home health services and have oversight of the plans of care on the Medicare level - a thirteen year effort! This issue has also been a priority for OAAPN. Working together with our partners, OCHCH put out a webinar for APRNs to learn the “ins and outs” of home health orders and the plans of care; however, there was still one issue that we needed to overcome together. Under Ohio Medicaid rule: 5160-12-01, only a physician may issue home health orders for Medicaid patients. This is very burdensome for Home Health Agencies (HHAs) and APRNs to rely solely on physicians to sign orders. Therefore, the OAAPN association sent a letter to the Department of Medicaid urging them to permit APRNs to sign home health orders. They advocated that this order be removed permanently to align with federal guidelines - just as we have! We are very excited to work with our partners and the Ohio Department of Medicaid (ODM) to achieve our goal.

Additionally, OCHCH has been a part of the Ohioans for Health Care Access Coalition- which supports the removal of the Standard Care Arrangement (SCA) between physicians and APRNs. The SCA is a contractual agreement with a physician that APRNs need in order to practice. Because of the COVID-19 pandemic, access to health care is critical for Ohioans. APRNs are a part of the solution to this crisis. Ending the Standard Care Arrangement (SCA), would allow Ohio patients to receive more access to healthcare. Surrounding states have removed the collaborative restrictions during the COVID-19 pandemic such as Tennessee, Kentucky and also New York and New Jersey. OCHCH will be advocating for the Director of Health to sign and executive order for the temporary removal of the SCA to improve care for patients during the pandemic.

Advocacy in action- associations working together to reduce provider burden and to improve access for patient care!


By Alexandra Weingarth, Advocacy Director

HelpDesk Question of the Week

HOME HEALTH: Maintenance Therapy by Assistants
Question: Are there special payment codes for therapy assistants that provider maintence therapy?
Answer: Yes. The payment per visit will remain the same regardless of whether a therapist assistant is furnishing maintenance or other therapy services.
The two new G-codes are:
G2168: Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes
G2169: Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes

Learn about new G-codes that describe therapy assistant services.


Regulatory & Policy Digest


HOME HEALTH: Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify, Palmetto GBA – Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections 1814(a) and 1835(a) of the Social Security Act to allow Nurse Practitioners (NPs), certified Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) to certify beneficiaries for eligibility under the Medicare home health benefit and oversee their plan of care. This is a permanent change that will continue after the Public Health Emergency. Effective for claims with dates of service on or after March 1, 2020, these non-physician practitioners (NPPs) may bill the codes listed in this article. Please share with the NPPs.

HOME HEALTH and HOSPICE: Information on Telehealth Coverage by Managed Care or Commercial Insurance Plans, NHPCO COVID-19, May 8, 2020 If you have questions about telehealth coverage, waiving patient co-pays, and even possible emergency advance payments by managed care or commercial insurance plans, Acevedo Consulting has provided a link to the AHIP (America’s Health Insurance Plans) website. The site provides an easily searchable alphabetical format to find individual plans and what each plan is doing during the public health emergency.

HOME HEALTH and HOSPICE: Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635, CMS MLN Connects, May 7, 2020 – A new MLN Matters Article MM11765 on Addition of the QW modifier to Healthcare Common Procedure Coding System (HCPCS) code U0002 and 87635 (PDF) is available.CLIA regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare & Medicaid only pay for laboratory tests performed in certified facilities, each claim for a HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level.  

HOSPICE: Hospice FY 2021 Proposed Rule--The FY 2021 Hospice Proposed Rule includes the following: 
  • Update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2021
  • Proposes changes to the hospice wage index by adopting the most recent Office of Management and Budget statistical area delineations,with a 5% cap on wage index decreases
  • Summarizes the changes to the hospice election statement finalized in the FY 2020 Hospice Wage Index and Rate Update final rule and effective for October 1, 2020; and provides hospices with a model election statement and sample addendum 
  • The proposed FY 2021 hospice payment update percentage is 2.6 percent
CMS has released a model election statement and sample addendum. While it is not required the CMS election statement model be utilized by Hospice providers, OCHCH recommends agencies adopt the model to ensure all requirements for the Election Statement are met.
OCHCH will be submitting comments on the FY 2021 Hospice Proposed Rule.  The comment period ends June 9, 2020.  Please send your comments to Kathy Royer, OCHCH Hospice Regulatory Director at kathy@ochch.org by June 5, 2020 as she will be compiling the comments for submission.  Please put Hospice Proposed Rule in the subject line.

HOSPICE: CMS Issues Guidance to State Survey Agencies for Nursing Homes on Interim Final Rule, NHPCO COVID-19 Update, May 7, 2020 On May 6, CMS released a guidance memo to State Survey Agencies on the Interim Final Rule which updates the requirements for notification of confirmed and suspected COVID-19 cases among residents and staff in nursing homes. Question #19 below references hospice in the facility.
Q: Do facilities need to inform anyone who walks through their doors (e.g., a hospice or other healthcare provider) of the same numbers of suspected and confirmed COVID-19 cases that they are sharing with residents, their representatives, and families?
A: No. Facilities are not required to provide the same COVID-19 information reported to residents, their representatives, and families. However, facilities would share with the visiting healthcare provider, if the resident receiving care is suspected of, or has laboratory confirmed COVID-19. Any precautions the provider should take while in the facility (e.g., specific personal protective equipment) will be communicated to that provider by the facility as part of their standard practices under the infection prevention and control program requirement.

Home Care & Hospice COVID-19 Town Hall
Wednesday, May 13, 2020  |  1:00-2:30 PM Eastern
NAHC is hosting virtual town halls on Wednesdays devoted to spreading knowledge about COVID-19 from those in home care and hospice who have been on the front lines of this battle to the rest of the industry. Register now
COVID-19 Employment Law & Other Important Updates
Thursday, May 14, 2020 |  12:00-1:30 PM Eastern
NAHC is co-hosting a weekly webinar series with Littler Mendelson and the Home Care Association of America on legal and regulatory changes caused by the COVID-19 pandemic. The goal of the series is to provide the industry with substantive legal updates, shed light on advocacy efforts, and provide an opportunity for you to get answers to your questions. Learn more

Education & Events

News Clips & Links

HOSPICE and PALLIATIVE CARE: Telehealth Rules Complicate Opioid Access for Hospice, Palliative Patients During COVID-19, Hospice News, May 8, 2020
PALLIATIVE CARE: Palliative Care Principles Can Guide Care for COVID-19 Patients, Hospice News, May 6, 2020
HOSPICE: Hospice Providers Work to Boost Staff Morale Amid Pandemic Pressures, Hospice News, May 6, 2020
HOSPICE: The Changing Scope of Telehealth for Hospice Care, Hospice News, May 8, 2020
HOSPICE: Indiana Nurse, Building Contractor Begin Work on New Hospice Facility, Hospice News, May 11, 2020

Ohio Council for Home Care & Hospice  1105 Schrock Rd., Suite 120, Columbus, OH 43229
(614) 885-0434   www.ochch.org