CMS: Hospice Recertification Via Telehealth Ends With COVID PHE

The U.S. Centers for Medicare & Medicaid Services (CMS) has reiterated that the agency will not allow hospices to use telehealth to recertify patients after the COVID-19 public health emergency expires. 

CMS published a blog and a series of fact sheets today that the agency described as a “roadmap” for health care providers to navigate the regulatory changes that will come when the PHE ends. This includes the fate of 1135 waivers that established temporary regulatory flexibility to help providers roll with the pandemic’s punches.

Among these flexibilities was the expansion of telehealth utilization, including recertification.

“Face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit can now be conducted via telehealth (i.e., two-way audio-video telecommunications technology that allows for real-time interaction between the hospice physician/hospice nurse practitioner and the patient),” CMS said in a fact sheet. “This waiver will expire at the end of the PHE.”

The statement from CMS does not represent a shift in policy. The agency has never indicated that it would extend the recertification waiver. CMS has previously said it would review the 1135 waivers to determine which could be made permanent. Many providers and industry stakeholders have had their fingers crossed that recertification would be one of them.

Since the height of the pandemic, a wide swathe of hospices had to invest in technology and other infrastructure for expanded telehealth programs. What started as a stop-gap solution to prevent the virus from spreading has become an integrated component of care delivery.

Telehealth has also enabled providers to boost efficiency, reduce travel times to patient locations, and increase clinical touchpoints — critical considerations in a time of rising expenses and workforce shortages.

A consortium of industry stakeholders noted these concerns in a letter to Congressional leaders earlier this year, urging legislators to make the waiver permanent, including the National Hospice and Palliative Care Organization (NHPCO) and the American Academy of Hospice and Palliative Medicine.

“Many of the telehealth flexibilities that have helped dramatically improve patient access to care are temporary and limited to the duration of the COVID-19 [public health emergency] – and impact both public health programs and private health coverage …,” the organizations wrote in the letter. “As it stands today, providers must weigh the costs of investing in the technological and clinical infrastructure required to maintain telehealth programs at scale against the possibility that Congress may ultimately decide not to support permanently expanded telehealth coverage.”

The PHE is currently slated to end in mid-October. The U.S. Department of Health & Human Services (HHS) has the authority to extend it, which the agency has done repeatedly during the past two years.

While HHS hasn’t said whether or not it would renew the PHE in October, the federal department has indicated that it would give providers 60-days advance notice of its expiration. To fulfill that pledge, an announcement would have to come before the end of this month. If it does, the telehealth waivers would remain in place for 151 days to give operators time to retool.

The CMS position may not be the final word. Congress also has the option to make telehealth recertification permanent. Discussion of this issue actually predates the pandemic. A proposed 2019 bill, the CONNECT for Health Act, would have allowed telehealth recertifications had it been enacted.

The U.S. House of Representatives recently passed a bill that would extend all the PHE telehealth flexibilities through 2024. The legislation has now gone to the Senate for consideration. Congress has already made permanent some expanded provisions for mental health services through the 2021 Consolidated Appropriations Act.

“Through telehealth, Americans are able to take care of immediate and necessary health needs at home without the costs or health risks associated with in-person appointments,” said Rep. Michael C. Burgess (R-Tex.), in a statement. “Telehealth is the start of future innovation in technology that will further influence how we deliver care to American patients.”