Is Your Home Health Agency Ready for the Ending Public Health Emergency? How to Adjust to the New Landscape of Home Health

What The End of Blanket 1135 Waivers Means for Home Health Providers

On January 30, 2022, President Biden declared that the COVID-19 Public Health Emergency (PHE) would end on May 11, 2023. The federal PHE allowed for significant changes in the way home health agencies operated, including increased reimbursement rates, telehealth expansions, and relaxed regulations.  

The most significant change coming is the end of Blanket 1135 Waivers. These waivers enabled temporary flexibilities for home health providers during the PHE, such as the relaxation of face-to-face certification requirements, the easing of training and supervision requirements, and reporting requirements. 

Some of the main flexibilities that Blanket 1135 Waivers offer that are ending with the PHE include: 

1. Face-to-Face Encounters: Allowed the required face-to-face encounters to be conducted via telehealth. This flexibility is ending, although there is an extension through December 31, 2024.
2. Request for Clinical Records: Agencies had 10 days to provide patients with a copy of their medical records upon request, as opposed to the 4 business-day requirement.
3. Reporting: OASIS: Extended the five-day completion requirement for the comprehensive assessment to 30 days and waived the 30-day OASIS submission requirement, allowing delayed submissions during the PHE. This flexibility will end at the conclusion of the PHE.
4. Detailed Information Sharing for Discharge Planning for Home Health Agencies: CMS waived the requirements to provide detailed information on discharge planning to patients, caregivers, or the patient’s representative in selecting a post-acute care provider. This flexibility will end at the conclusion of the COVID-19 PHE.
5. Training and Assessment of Home Health Aides: CMS waived requirements for annual onsite supervisory visits and postponed onsite assessments. These waivers will end at the conclusion of the PHE, and any postponed assessments are required to be conducted within 60 days of the PHE expiration.
6. Waive onsite visits for HHA Aide Supervision: Waived the requirements for a nurse to conduct an onsite visit every two weeks and encouraged virtual supervision. This flexibility will end at the conclusion of the PHE.
7. Twelve-hour annual in-service training requirement for home health aides: CMS modified the 12-hour annual in-service training requirement for home health aides during the PHE. This flexibility will end and return to pre-PHE requirements at the end of 2023.
8. Quality Assurance and Performance Improvement (QAPI): The QAPI program’s scope was narrowed to focus on infection control issues and adverse events during the PHE period. CMS will end this waiver at the conclusion of the COVID-19 PHE.

As you can see, there are many changes that will be coming down the line with the end of the PHE. With the 1135 blanket waivers ending May 11, 2023, providers need to plan accordingly to ensure that they are prepared. 

Preparing Your Agency for the Post-PHE Landscape

To ensure a smooth transition and maintain the quality of care, home health agencies should take the following steps to prepare for the end of the PHE:

1. Telehealth Strategy
   Home Health Agencies were temporarily allowed to use telehealth visits in conjunction with in-person visits during the PHE, a provision that is now permanent with new guidelines. These guidelines include amended plan of care requirements, mandatory telehealth reporting, and data collection by CMS. To set your agency up for success, you need to evaluate your agency’s telehealth services and determine which aspects have been most successful and beneficial for your clients. Developing a long-term telehealth strategy that aligns with regulations and requirements is essential. Stay informed about any changes in telehealth policies and be prepared to adjust your services as needed.
2. Staff Education and Training
   Review the regulatory requirements that will return once the PHE ends, and ensure your agency is prepared to meet these standards. It is vital to educate all staff members about the end of the PHE and how it affects their roles and responsibilities. Staff should be kept up to date on the changes in policies, procedures, and documentation requirements. Providing ongoing training and support will help staff adapt to the changes and ensure a smooth transition as the PHE comes to an end.
   
   Maintaining compliance with state and federal guidelines will be crucial to avoiding penalties and protecting your agency’s reputation. That is why you also need to make sure that any postponed Home Health Aide assessments are completed no later than 60 days after the expiration of the PHE. With the end of the postponement of the twelve-hour annual in-service training requirement for home health aides ending, you should also be sure that your aides get their required training in by the end of 2023 to avoid penalties.
3. Reassess Staffing Needs
   Many training, reporting, and service requirements were waived, or deadlines extended during the PHE. This will no longer be the case. As the PHE ends and regulations tighten, providers need to reassess staffing needs and adjust accordingly. This could involve hiring additional staff, reassigning existing employees, or investing in staff training to ensure your team is well-equipped to handle the increased regulatory requirements. Consider collaborating with local healthcare organizations, educational institutions, and professional associations to recruit and train qualified personnel.
4. Be Transparent with Clients 
   Things are not just changing for you, but for your clients as well. Be sure to inform your clients and their families about the upcoming changes resulting from the end of the PHE. Be transparent about any adjustments in services, fees, or care plans, and work together with your clients to address their concerns and provide the best possible care. Maintaining open communication and fostering trust will be vital in navigating this transition smoothly.
   
5. Stay Informed
   The most important thing agencies can do is stay informed. You must keep an eye out for any updates or clarifications from CMS regarding the waiver status and other state and federal regulatory changes. This will ensure that you are well-prepared and compliant with any new requirements that emerge as the PHE concludes. The good news is that the team at XtraGlobex can assist with that. We’ve been keeping our pulse on the PHE unwinding and can assist your agency with any preparation to ensure you comply with changing regulations and are set up for future success. 

Advocates Perspective

The end of the Public Health Emergency brings significant changes for home health providers. By being proactive and preparing for these changes, providers can ensure they continue to deliver high-quality care to their clients while remaining financially viable and compliant with state and federal regulations. The COVID-19 pandemic disproportionately affected seniors and people with disabilities, especially those utilizing long-term services and supports (LTSS) to meet daily self-care and independent living needs. It is important that home health providers adjust to the ending PHE and continue providing quality services that don’t just meet requirements, but also allow these individuals to remain healthy and living independently in the community.