Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)

Staff Vaccination Requirements

On November 5, 2021, the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) issued an interim final rule (CMS-3415-IFC) requiring Medicare and Medicaid-certified providers and suppliers to ensure that their staff were fully vaccinated for COVID-19 (i.e., obtain the primary vaccination series), which was a critical step to protect patients. On April 10, 2023, the President signed legislation that ended the COVID-19 national emergency. On May 11, 2023, the COVID-19 public health emergency is expected to expire. In light of these developments and comments received on the interim final rule, CMS will soon end the requirement that covered providers and suppliers establish policies and procedures for staff vaccination. CMS will share more details regarding ending this requirement at the anticipated end of the public health emergency. We continue to remind everyone that the strongest protection from COVID-19 is the vaccine. Therefore, CMS urges everyone to stay up to date with your COVID-19 vaccine.

Emergency Preparedness: Training and Testing Program Exemption

The following information supersedes the previously issued QSO-20-41-ALL-REVISED memo for all certified providers/suppliers. CMS regulations for Emergency Preparedness (EP) require the provider/supplier to conduct exercises to test their EP plan to ensure that it works and that staff are trained appropriately about their roles and the provider/supplier’s processes. During or after an actual emergency, the EP regulations allow for a one-year exemption from the requirement that the provider/supplier perform testing exercises. The exemption only applies to the next required full-scale exercise (not the exercise of choice), based on the 12-month exercise cycle. The cycle is determined by the provider/supplier (e.g., calendar, fiscal or another 12- month timeframe). The exemption only applies when a provider/supplier activates its emergency preparedness program for an emergency event.

See pages 10-12 of the attached document for updates on other home health and hospice-specific waivers.

Also see NAHC's "Ending of the COVID-19 PHE Waivers and Flexibilities" grid. 

Clarification on Technology for Hospices After the End of the PHE

From NHPCO

CMS has answered the use of technology for hospices after the end of the public health emergency.  This answer was also shared in the National Stakeholder Office Hours on Ending the PHE on April 25, 2023.  Here is the transcript for that call, which shares the same information:  TranscriptOfficeHoursEndingPHE04252023 (cms.gov)

The regulatory flexibility at 42 CFR 418.204 is explicitly for the provision of routine home care services during the COVID-19 PHE. After the end of the COVID-19 PHE, the expectation is that routine home care hospice services will be provided in-person.  There is nothing precluding hospices from using technology to have follow-up communication with the patient and the family as long as the use of such technology does not replace an in-person visit. Additionally, such follow up contact should be documented in the hospice medical record similar to the way telephone calls would be documented and in accordance with the standards of practice and the hospice’s own policies and procedures. We cannot enumerate all of the scenarios in which there could be such contact via technology because each patient, family, and situation is different. Decisions about when such follow-up contact using technology is made need to be based on the needs of the patient and family and the hospice’s own policies and procedures. 

-CMS Hospice Policy

Updates to Coverage for COVID-19 Tests

The COVID-19 Public Health Emergency is to end on May 11, 2023. The ending of the Public Health Emergency may impact an individual’s coverage of COVID-19 tests. We encourage you to know these changes and share the New Consumer Fact Sheet on COVID-19 tests.

Consumer Fact Sheets:

• English - https://www.cms.gov/files/document/covid-over-counter-test-coverage.pdf

• Spanish - https://www.cms.gov/files/document/covid-over-counter-test-coverage-spanish.pdf

Before May 11, 2023

If you have any type of health insurance, you can get up to eight over-the-counter tests per month with no out-of-pocket costs. Over-the-counter tests are available in most pharmacies and may also be available online for delivery.

After May 11, 2023

Laboratory tests for COVID-19 that are ordered by your provider will still be covered with no out-of-pocket costs for people with Medicare. Over-the-counter tests will still be available, but there may be out-of-pocket costs. Coverage of over-the-counter tests may vary by your insurance type, as described below.

What does this mean for Medicare Beneficiaries?

Generally, Medicare doesn’t cover or pay for over-the counter products. The demonstration that has allowed us to offer coverage for COVID-19 over-the-counter tests at no cost ends on May 11, 2023.

However, if you are enrolled in Medicare Part B, you will continue to have coverage with no out-of-pocket costs for appropriate laboratory-based COVID-19 PCR and antigen tests, when a provider orders them (such as drive-through PCR and antigen testing or testing in a provider’s office).

If you are enrolled in a Medicare Advantage plan, you may have more access to tests depending on your benefits. Check with your plan.

What does this mean for people with Medicaid or Children’s Health Insurance Program?

If you have coverage through Medicaid or the Children’s Health Insurance Program, you will have access to COVID-19 over-the-counter and laboratory testing through September 30, 2024. After that date, coverage of testing may vary by state.

What does this mean for people with Private Insurance?

If you have private insurance, coverage will vary depending on your health plan. However, private plans won’t be required by federal law to cover over-the counter and laboratory-based COVID-19 tests after May 11, 2023.

If your insurance chooses to cover COVID-19 testing, they may require cost sharing, prior authorization, or other forms of medical management.

HCAOA Analyzing How CMS’s Newly Proposed Rules Would Affect Home Care Industry

From HCAOA

Last week, the Centers for Medicare & Medicaid Services (CMS) unveiled two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM), that together address access to and quality of care across Medicaid programs.
 
HCAOA’s Policy Committee is currently reviewing the proposed rules and will provide additional information.

If adopted as proposed, the rules would attempt to establish national standards for access to care regardless of whether that care is provided through managed care plans or directly by states through fee-for-service (FFS). Specifically, they would establish access standards through Medicaid or CHIP managed care plans as well as transparency for Medicaid payment rates to providers.
 
Within the HCBS realm, the proposed rule seeks to:

• Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
• Strengthen person‑centered service planning and incident management systems in HCBS;
• Require states to establish grievance systems in FFS HCBS programs;
• Require that at least 80% of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for the direct care workforce (as opposed to administrative overhead or profit);
• Require states to publish the average hourly rate paid to direct care workers delivering personal care, home health aide, and homemaker services;
• Require states to establish an advisory group for interested parties to advise and consult on provider payment rates and direct compensation for direct care workers;
• Require states to report on waiting lists in section 1915(c) waiver programs; service delivery timeliness for personal care, homemaker and home health aide services; and a standardized set of HCBS quality measures; and
• Promote public transparency related to the administration of Medicaid‑covered HCBS through public reporting of quality, performance, and compliance measures.