CMS Homecare Agency Moratorium


States may be complicating non-physician certifications in home health care, as hospitalizations and homecare needs rise. In this edition of the Homecare Software blog…the CARES Act has made it possible for nurse practitioners, physician assistants, and clinical nurse specialists to certify eligibility for home health. This has facilitated movement in the home health care industry towards eliminating Medicare’s rigid physician certification requirements and policies. Congress first warmed to the idea of allowing non-physician certification in the early spring just as the COVID-19 pandemic was beginning to surge. At the end of the day, in spite of the federal government’s efforts, states by law have the final say when it comes to making these overtures into reality.

Home health industry professionals and industry stalwarts in the past have been very vocal regarding their opinions on Medicare’s physician-certification policy being somewhat outdated and draconian. The overriding consensus among these homecare industry experts is that the policy itself created obstacles that made it hard for older adults to gain meaningful access to homecare services. This had a negative downturn effect on provider profits and bottom financial lines. With the past rules of home health services requiring certification (and sometimes recertification by a doctor, the process was filled with long delays, exacerbated by physician unavailability. Additionally, PAs and doctors are often not in the same location when working, which hampers their ability to practice. This is one of the factors that has lead to vocal calls for PA’s to have greater ability to administer a more comprehensive range of patient services.

Distance, communication, and complexity can be inhibitors to timely care, particularly with the healthcare system in both homecare and hospitals strained under the one-two punch of COVID-19 and a known national shortage of qualified caregivers. If patients are unable to receive needed home health care services when they need them, the delays result in cost increases and poor patient outcomes.

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Longer hospital stays can lead to greater costs for patients, and the entire healthcare system, meaning the added need for home health is even greater than in the past. The risk to the patient is higher, and many experts suggest that the negative effect on the whole process and system should be avoided at all costs. The inception of the CARES Act at its heart was an attempt to intervene and improve those types of situations, relying heavily on the ethos of the 2019 Home Health Care Planning Improvement Act (an act which previously attempted to grant NPs, PAs, and CNSs the ability to certify home health permanently).

Forging more manageable relationships between homecare agencies, patients, and health care facilities is a win/win. The NAHC has been vocal regarding removing roadblocks, stating that each element of care inclusive of a patient’s plan of care, electronic document signing, and agency submissions for payments for example, can all be streamlined to reduce administrative delays. State-level regulatory language and policies have been revealed to “Stand in the way” of NPs, Pas and CNAs working effectively at patient care, in spite of the relief intended by the federal government and Cares Act. Issues like “scope of practice” for NPs is a problem in specific states, as well as the way these caregivers are divided into different classes with regard to physician collaboration. Fewer than 26 states grant full independent practice, leading to more inefficiency and red tape. A majority of states have a requirement stating that PAs must work under the watchful supervision of a doctor. PAs are empowered to take on the tasks like ordering care and certifying eligibility IF supervisory status exists. Licensing is also an issue.

A large number of states have a licensing process for homecare agencies in place, however, quite a few others have not updated licensing standards to reflect the conditions with Medicare policy. Medicaid also throws uncertainty into the mix, as a good number of states have Medicaid payment rules that require updates to allow practitioners instead of only doctors, to authorize plans of care and certify eligibility.

The reality may well be that certain states will never allow non-physician practitioners to have independent practice, which may be within their rights, but certainly complicates quality healthcare outcomes for all involved.

To date, thirty states have instituted temporary or permanent changes to authorize NPs to order home health services. California and New Mexico for instance, just recently updated their regulations to permanently authorize NPs to order home health care services. The NAHC has also continued its work with state associations in states like New York, Massachusetts, and California to implement similar changes.

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 The Alora Homecare Software Blog

Read the Alora blog for industry news, including recent news, articles, and commentaries, as well as other issues that pertain to Homecare in the U.S and beyond. For more information on this topic, or others in the homecare spectrum, please send us an email to HomeHealthSoftware@Alorahealth.com

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