$1.4 Trillion Spending Package Extends Sequestration Holiday, Grants Home Health OTs More Authority

As different health care stakeholders combed through the new $1.4 trillion spending package approved by Congress on Monday, many likely felt a mix of excitement and disappointment.

Included in the nearly 6,000-page spending package was a $900 billion COVID-19 relief bill, changes to home health therapy rules, certain hospice provisions and more. That’s really just the tip of the iceberg, too, as it’s unlikely that even the lawmakers who voted on the package read it in its entirety.

Home-based care insiders are in the process of doing so. So far, there’s reason to be happy about the relief package, which now awaits President Donald Trump’s signature.

“We are grateful that Congress recognized the need to support home care and hospice during the pandemic,” William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News in an email.

In addition to the previously noted items, Dombi called attention to the package extending the Medicare sequestration holiday, which was initially set to expire at the end of this month. More CARES Act grants, an extension of the Medicaid Follows the Person (MFP) program and extra spousal impoverishment relief are likewise victories for home health and hospice operators, NAHC’s president said.

“[There is also] the expanded SBA Paycheck Protection Program (PPP) and more that will help keep [home health] and hospice operational,” Dombi added.

Specifically, $284.5 billion more has been added for a second round of PPP loans for businesses with less than 300 employees and a demonstrated revenue loss greater than 25%.

The extended sequestration suspension is a major win for all Medicare-reimbursed health care providers, which have faced a 2% cut since 2014. Providers across the country continue to deal with new, previously unexpected expenses and erratic revenue patterns.

The new pause on sequestration runs through March 31.

Additionally, the spending package and COVID-19 relief includes nearly $70 billion to purchase and distribute vaccines, plus funds to help states conduct testing. About $20 billion of that funding will be dedicated to making the vaccine available at no cost for certain individuals.

Other COVID-19 specifics include $22.4 billion for testing, contact tracing and other prevention practices necessary for combatting the virus. Another $3 billion was included for additional grants for health care providers to be reimbursed for expenses or lost revenues tied to COVID-19.

For Medicare-funded home health businesses, $175 billion more has been put into the Provider Relief Fund, which could grant them a lifeline until the pandemic subsides.

Therapy changes

Similar to NAHC, the American Occupational Therapy Association (AOTA) celebrated certain provisions on the $1.4 trillion spending package.

In what AOTA called a “historic home health victory,” the package includes language from the Medicare Home Health Flexibility Act that enables occupational therapists (OTs) to open home health therapy cases. The U.S. Centers for Medicare & Medicaid Services (CMS) will have one year to implement a rule allowing for that change.

“Today we celebrate hard-fought victories for occupational therapy scope of practice and payment, following extensive AOTA-led advocacy initiatives,” the advocacy organization wrote in a statement.

OTs were granted the flexibility to open up home health cases during the public health emergency, but this bill will allow them to do so moving forward. AOTA said it has worked for “decades” on this measure.

The bill also made COVID-19-related telehealth flexibilities permanent.

Funding for hospice providers, small businesses

The “Rural Access to Hospice Act” and the “Helping our Senior Populations in Comfort Environments (HOSPICE) Act” were also included in the spending package.

Rural health clinics and federally qualified health centers cannot currently bill under Medicare Part B for hospice, which often becomes a barrier to caring for remote populations. With the Rural Access to Hospice Act in place, providers will be able to receive payment for services to patients in hospice, which will help those populations.

The National Hospice and Palliative Care Organization’s (NHPCO) was happy with the hospice provisions.

“NHPCO appreciates this bi-partisan, bi-cameral agreement,” NHPCO President and CEO Edo Banach said in a statement. “Hospice patients and families will benefit from improved access in rural and underserved communities as well as needed relief during this public health emergency. This legislation will enable hospice providers to continue providing uninterrupted care during this unprecedented time.”

Adult day providers weren’t as lucky. There were no specific provisions aimed at helping those operators during the public health emergency.

Katie Smith Sloan, the president and CEO of the aging-focused organization LeadingAge, previously discussed how Congress has fallen short in its efforts when it comes to helping adult day centers around the country.

What may help these providers, as well as other home care organizations, is the new round of PPP money that’s included in the package. If they are able to qualify, which most should be able to, that will at least ease some of the payroll burden that they’ve faced amid the public health emergency.

The post $1.4 Trillion Spending Package Extends Sequestration Holiday, Grants Home Health OTs More Authority appeared first on Home Health Care News.

Stimulus Money, Therapy Changes and COVID-19 Strategies: Top Home Health Stories of 2020

The Patient-Driven Groupings Model (PDGM) was supposed to define home health care in 2020.

Instead, this year was almost entirely shaped by COVID-19, a point that’s reinforced by the most widely read stories on Home Health Care News. Of the top-10 stories on HHCN in 2020, eight were related to coronavirus coverage.

From the first outbreak in Kirkland, Washington, to the latest developments in government support for health care providers, HHCN was on top of it all. Reflect back on this unprecedented year in home health care by browsing through the content below.

“House Stimulus Package Sets Aside $200 Billion for Front-Line Worker Hazard Pay” (May 13)

There have been several different federal COVID-19 stimulus packages passed since spring, with the House and Senate often locked in tense political debates on the details. HHCN’s top story of 2020 was an inside look at a May House proposal — the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act.

While nothing came of the Democrat-backed bill, it did highlight the growing recognition of front-line health care workers. Specifically, the proposed relief package included a $200 billion fund for essential-worker hazard pay.

As of Thursday, lawmakers were reportedly close to signing off on a roughly $900 billion relief deal that would include another round of stimulus checks and other much-needed financial benefits for Americans. Liability protections for businesses — something Republicans have pushed for — are likely not included in the deal.

“AOTA, APTA Sound Off on PDGM’s ‘Terrifying’ Therapy Consequences” (Feb. 3)

Going into this year, one of the main storylines of PDGM was the reimbursement overhaul’s impact on in-home therapy services.

After the Patient-Driven Payment Model (PDPM) was implemented in the skilled nursing facility (SNF) space in October 2019, many operators opted to cut or furlough therapy staff. Some industry experts expected home health agencies to do the same.

Certainly, some providers did shift their therapy strategies. But it’s almost impossible to identify whether home health therapy cuts were tied to PDGM or the ongoing public health emergency.

“Home Health Providers Likely to Face Future COVID-19 Fallout” (May 6)

Early on, home health providers had to adapt to care for a surge of COVID-19-positive patients. Quickly, though, it became clear they would have to respond to other challenges as well.

Among those challenges: the influx of non-COVID patients that were getting discharged from hospitals faster to maintain acute care capacity. By not recovering in the hospital for longer, patients discharged to home health care in 2020 have been weaker and more deconditioned than in the past.

A similar trend has emerged — higher patient acuity levels — as referral sources looked to avoid congregate care settings like SNFs.

“Loopholes in COVID-19 Unemployment Program Threaten to Deplete Home Care Workforce” (April 7)

On one hand, labor experts predicted that a depressed economy and the closure of certain businesses would lead to a larger worker pool for in-home care agencies. On the other, initially robust unemployment benefits meant some caregivers could get paid more by opting out of work.

In conversations with HHCN, most home health and home care executives have said the recruitment and retention of workers remains extremely difficult.

“Calm Before the Storm: In-Home Care Providers Brace for COVID-19 Surge” (April 16)

Although COVID-19 outbreaks started to surface in mid-March, home-based care agencies didn’t start feeling pandemic pressures until mid- to late-April. Leading up to that time, operators scrambled to secure enough personal protective equipment (PPE) and educate their patients on the safety of their services.

“‘No Strings Attached’: CMS Sending $30 Billion to Home Health Agencies, Other Medicare Providers” (April 9)

In April, CMS announced that it was sending a first tranche of $30 billion to all Medicare-reimbursed health care organizations, with funding coming from the Public Health and Social Services Emergency Fund under the CARES Act. More tranches followed, with HHS releasing another $1.1 billion in direct aid to nursing homes on Wednesday.

“CMS Announces $165M to Support Home Care, Reduce ‘America’s Over-Reliance’ on Nursing Homes” (Sept. 23)

In September, CMS announced the availability of up to $165 million in supplemental funding to states operating Money Follows the Person (MFP) demonstration programs. While that news was exciting, it was related comments from Administrator Seema Verma that really piqued home-based care agencies’ interest.

The tragic devastation wrought by the coronavirus on nursing home residents exposes America’s over-reliance on institutional long-term care facilities,” Verma said at the time. “Residential care will always be an essential part of the care continuum, but our goal must always be to give residents options that help keep our loved ones in their own homes and communities for as long as possible.”

“Home Care Careers ‘Are Suddenly on the Map,’ But Recruiting Remains a Challenge” (Nov. 4)

Staffing continues to be a challenge for home-based care providers. Even as unemployment rose to record-highs during the COVID-19 crisis and demand for home-based care skyrocketed, providers found it hard to find qualified workers.

But one undeniable tailwind was how spotlighted home care careers became during the public health emergency. President-elect Joe Biden outlined a plan to boost the caregiver workforce, politicians vied for home-based care on both sides of the aisle, and everyday Americans become more aware of what home-based care workers did on a daily basis.

“One positive thing that I think came out of COVID — and I think this is just a real positive thing for the whole industry — is home care careers are suddenly on the map,” Brandi Kurtyka, the CEO of myCNAjobs told HHCN. “Senior care just got the biggest ‘Got Milk’ campaign that we’ve ever seen.”

“[Updated] House Passes CARES Act, Fast Forwarding Home Health Care Innovation Beyond COVID-19” (March 27)

Efforts have certainly stalled since, but when the initial relief packages came out in March, home-based care providers could not get enough of the details — of which there were many.

When the record-breaking $2 trillion stimulus package known as the CARES Act passed, providers were granted monetary and regulatory relief. It was the first shoe to drop in a litany of changes ultimately made to the home-based care space.

It created the Provider Relief Fund and made temporary, beneficial changes to reimbursement. But it also created a more virtual industry, rendering face-to-face requirements and other traditionally in-person practices as relics of the past.

As Confirmed Cases Rise, Home Health Industry Turns Its Attention to Coronavirus” (March 4)

This is the story that kicked everything off — the first time that HHCN reported on the coronavirus in 2020. “People have been asking me, ‘Where are we with the coronavirus?’” National Association for Home Care & Hospice (NAHC) President William A. Dombi was quoted saying. “It’s scary.” Those fears would soon turn out to be well founded.

The post Stimulus Money, Therapy Changes and COVID-19 Strategies: Top Home Health Stories of 2020 appeared first on Home Health Care News.