On January 30, 2023, the Biden administration announced an to end the COVID-19 national emergency and the Public Health Emergency (PHE) effective May 11, 2023. Certain federal waivers and flexibilities put in place during the pandemic by the Centers for Medicare & Medicaid Services (CMS) have expired. However, some CMS waivers and flexibilities are set to expire at a later date.

COVID-19 affected hospices and home health agencies, whose staff had to overcome physical and mental burdens of visiting patients’ homes, especially during the days before a COVID-19 vaccine. These providers took advantage of several Medicare program flexibilities during the PHE.

Expired Flexibilities

Hospice flexibilities that ended with the expiration of the PHE include:

• Comprehensive Assessments: During the PHE, CMS waived required timeframes for updates to the comprehensive assessments from 15 to 21 days. The waiver was terminated at the end of the PHE.
  
  
• Non-Core Services: During the PHE, CMS waived the requirement for hospices to provide certain non-core services such as physical therapy, occupational therapy, and speech language pathology.  The waiver was terminated at the end of the PHE.
  
  
• Training Requirements: During the PHE, CMS waived the requirement for a registered nurse to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency, allowing for postponement of such visits to no later than 60 days after the expiration of the PHE. CMS also postponed the requirement for annual assessment of the skills and competence of all individuals furnishing care and provision of in-service training and education programs where required. Such assessments and training must now be completed by the end of the first full quarter after the end of the PHE. Providers are encouraged to remain mindful of these deadlines.
  

Extended Flexibilities

The following hospice flexibilities will be temporarily or permanently extended beyond the PHE expiration date:

• Face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit can now be conducted via telehealth. The waiver allowing telehealth for recertification visits is set to expire December 31, 2024.
  
  
• The annual training waiver put in place during COVID-19, which suspended in-service training requirements, expired May 11, 2023. Hospices will be required to provide necessary in-service training and education programs no later than September 30, 2023.
  
  
• Annual onsite supervisory observation for each aide that provides services on behalf of the agency must be completed no later than 60 days after the expiration of the PHE (July 10, 2023.)
  
  
• Medicare requires that volunteers provide at least 5% of the total patient care hours. Due to the pandemic and social distancing restrictions, CMS waived several hospice regulations, including the 5% volunteer requirement. This waiver will be reinstated at the end of the calendar year 2023.

Conclusion

CMS hopes, with the end of the PHE and various waivers, providers can return to normal operations and slowly eliminate various flexibilities that are no longer considered critical. The Centers for Medicare & Medicaid Services issued a Fact Sheet providing guidance on the impact of the federal COVID-19 Public Health Emergency on waivers, legislative changes, and flexibilities.

References:

1. Hospice: CMS Flexibilities to Fight COVID-19 [Internet]. 2023 [cited 2023 May 22]. Available from: https://www.cms.gov/files/document/hospice-cms-flexibilities-fight-covid-19.pdf