COVID-19 Questions and Answers

Question: How is Palmetto GBA making determinations for RCD on NPs and PAs, and whether or not they “are working under supervision or in collaboration” with a physician?

Answer: Plans of care and Certifying/Recertifying Patient Eligibility: HHS is utilizing enforcement discretion with regards to the requirements at §§ 409.43 and 424.22 in order to allow a patient to be under the care of a nurse practitioner or clinical nurse specialist (as such terms are defined in section 1861(aa) (5)) who is working in accordance with State law, or a physician assistant (as defined in section 1861(aa)(5)) who is working in accordance with state law, and for such physician/practitioner to 1) order home health services; 2) establish and periodically review a plan of care for home health services (e.g., sign the plan of care); and 3) certify and re-certify that the patient is eligible for Medicare home health services. This will provide the flexibility needed for more timely initiation of services for home health patients, while allowing providers and patients to practice social distancing. HHS will not conduct audits to ensure that only physicians provided orders, signed and dated the plans of care, and certified/recertified patient eligibility for claims submitted during this public health emergency.

Question: What are the requirements concerning using telehealth technology during a 30-day episode of care?

Answer: Home Health Agencies (HHAs) can provide more services to beneficiaries using telehealth within the 30-day episode of care if it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care. We acknowledge that the use of such technology may result in changes to the frequency or types of in-person visits outlined on existing or new plans of care.

Reference: CMS website (PDF, 230 KB).

Question: Medicare requires that a patient have a face-to-face encounter with a physician or an allowed nonphysician practitioner in order to qualify for Medicare home health care. Can this encounter occur via telehealth during a pandemic outbreak of an infectious disease?

Answer: The face-to-face encounter, as described at 1814(a)(2)(C) and 1835(a)(2)(A) of the Social Security Act, can be performed via telehealth in accordance with the requirements under 1834(m)(4)(C) of the Social Security Act. Under the expansion of telehealth under the 1135 waiver, beneficiaries are able to use telehealth technologies with their doctors and practitioners from home (or other originating site) for the face-to-face encounter to qualify for Medicare home health care.

Reference: CMS website (PDF, 157 KB).