By the National Association for Home Care and Hospice

On August 18, 2022, the Centers for Medicare & Medicaid Services (CMS) issued extensive materials providing guidance related to the planned phase-out of various waivers, regulations, enforcement discretion, and sub-regulatory guidance that were utilized to ensure access to care and give health care providers the flexibilities needed to respond to COVID-19 Public Health Emergency (PHE). According to the documents — issued under the rubric “Creating a Roadmap for the End of the COVID-19 Public Health Emergency” (Roadmap) — most of these waivers and broad flexibilities will terminate at the eventual end of the PHE, as they were intended to address the acute and extraordinary circumstances of a rapidly evolving pandemic and not replace existing requirements.

As previously indicated by Administration officials, to minimize any disruptions including potential coverage losses following the end of the PHE, the materials state that HHS Secretary Becerra will give states and the health care community writ large 60 days’ notice before ending the PHE. In the meantime, CMS is encouraging health care providers to prepare for the end of these flexibilities as soon as possible and to begin moving forward to reestablishing previous health and safety standards and billing practices.  Even though providers will receive 60 days’ notice before the ending of the PHE, they should begin preparing for the end of the waivers now.  In order to come into compliance with the conditions of participation at the end of the PHE, it may take some providers a significant amount of time. Therefore, NAHC recommends that providers utilizing any of the PHE waivers assess the need for continued use of the waiver(s) and begin transitioning away from utilization, as possible.  If it is not possible to stop utilizing the waivers, providers should develop a plan for tapering use, if possible.

While the COVID-19 PHE remains in effect CMS will use its Pandemic Plan as a guidebook for evaluating all existing flexibilities, while developing a comprehensive long-term approach for the health care system based on recovery and resiliency. Given the importance of this effort, CMS’ strategic plan includes a cross-cutting initiative to address the current PHE and ensure that CMS has a roadmap to support a health care system that is more resilient and better prepared to adapt to future disasters and emergencies. This work complements the work already underway to ensure as many eligible individuals as possible maintain a source of coverage, whether through Medicaid/CHIP, Marketplace, employer coverage, or Medicare.

As part of its Roadmap CMS has issued provider-specific guidance that details plans for the phase out of various waivers and flexibilities. NAHC previously posed questions to CMS regarding some of the waivers and flexibilities and had hoped answers to those questions would be found in this most recent Roadmap.  However, NAHC has continuing questions and concerns.  Below are links to two documents that address home health and hospice waivers and flexibilities:

• COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (Updated 8/18/2022)

• Fact Sheet: Home Health