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COVID-19: 1135 Waiver explained

Link Healthcare Advantage and MatrixCare have teamed up to help give insight into what is happening within the industry and hopefully address some of those unanswered questions, that maybe you didn’t even know to ask.

Do you feel like your agency is out there all alone trying to figure out what to do? Guess what- you are not alone in feeling that way. I receive questions daily from all over the country just looking for some guidance or clarification on what the regulation waivers are or how to respond to COVID-19 related questions from staff.

I figured a good place to start was with the 1135 Waiver and what it means for home health and hospice providers. These waivers went into effect beginning of March and will run until the Public Health Emergency has ended.

  • Face to Face Encounters
    • Home Health can now utilize face to face encounters that were performed by telehealth. The telehealth encounter includes 2-way communication of both video and audio. The physician can bill for the telehealth visit including visits done by “house call” practitioners.
      • Implementation tip: You still need to have documentation to support that a visit was completed. If possible, be on the call and document the encounter. Also, request a “visit” note from the physician to support the telehealth visit.
    • Hospice can now utilize telehealth visits by the hospice practitioner for face to face encounters. Again, remember this must be a 2-way communication of both video and audio
    • HIPAA violation penalties have been waived by the Office of Civil Rights if the healthcare provider has provided communication in good faith through everyday communication such as Skype, FaceTime or Zoom during the public health emergency
  • Home Health Initial Assessment
    • An initial assessment is used to determine Medicare eligibility including homebound status and skilled needs under the care of a physician. This cannot be done remotely or by chart review. This will help agencies meet the 48-hour initial assessment requirement. This is not the comprehensive assessment (OASIS) visit that still needs to be done in person.
      • Implementation tip: Upon acceptance of a referral, designate a clinician (intake staff or another clinician) to contact patient and establish Medicare eligibility, patient care needs, and acuity of care
    • Allows Occupational Therapist to perform initial and comprehensive assessments for all patients receiving therapy services only. Cases that have skilled nursing would continue to be required to have skilled nursing perform the assessment.
      • Implementation tips:
        • Ensure that the most appropriate discipline based on the patient’s needs is assigned to complete the assessment
        • Verify state scope of practice and home health regulations to ensure that it is permitted under state regulations
        • Nursing should review the mediation record and collaborate on any comprehensive assessment questions as needed
    • Hospice Comprehensive Assessment and Services
      • Updates to the comprehensive assessment time requirement has been extended from 14 days to 21 days
      • Hospice requirement for providing Non-Core Services (PT, OT, ST) has been waived
      • Volunteer service requirement (5% of patient care service hours) has been waived
        • Implementation tips:
          • Before delaying the updated comprehensive assessment to 21 days make sure that it is appropriate for the patient
          • Interdisciplinary Team (IDT) Meetings should still be occurring within 15 days. Be creative with your IDT meetings– use telecommunication and document on sign-in sheet who attended via phone
        • OASIS Timing
          • Comprehensive Assessment completion has been extended to 30 days
          • Submission of OASIS data– requirement for 30 days has been suspended
            • Implementation tip: Don’t take advantage of this delay– you still will not receive payment until submission is completed. Hold your staff to the documentation completion policy with a little leeway if there is a patient surge
          • ICD 10 Codes
            • Effective 4/01/2020 the correct code for positive COVID-19 patients is U07.1 followed by manifestation code (pneumonia, bronchitis, lower respiratory)
              • There is no code for suspected or pending results of COVID-19 only if testing occurred and results were positive.
            • Home Health and Hospice Aide Supervisory Visits
              • Waived the requirement for onsite every 14 days for Medicare patients. CMS did recommend that virtual supervision still occur
                • Implementation tip: Check your state regulations and state waivers to see if this applies to your agency
                • Hospice Aide Inservice and Competency Waiver
                  • Waives the requirement for 12 hours of in-service training for hospice aides
                  • Allows hospice aide competency evaluation to be performed on a pseudo patient
                    • Implementation tips:
                      • Pseudo patient can be a person trained to participate in role-play situation
                      • The lab should be set up to represent the home setting and the challenges of care in the home
                    • Telehealth Visits
                      • CMS has allowed for telehealth (2-way communication visual and audio) to be used to supplement on-site visits when appropriate. There is no reimbursement for these visits. If the agency has met the LUPA threshold for visits (onsite) then they will receive full 30-day reimbursement. These visits are NON-REIMBURSED and should not be included on claims.
                        • Implementation Tip
                          • Get consent from your patient
                          • You need physician order to do telehealth visits including frequency of visits
                          • Need to document visit completion including subjective assessment, education provided, and any coordination of care (template is available at HomecareEducationWithLink.com for a minimal fee)

We hope this has helped clear up some of the 1135 Waiver confusion and provided you some important implementation tips. Remember to review your state regulations to verify that there is no conflicts. Future blogs will focus on the CARES Act, HR issues, and FAQ submitted. Don’t forget to send me questions to diane@linkhealthcareadvantage.com.

Learn more about how MatrixCare Home Health & Hospice is supporting providers through COVID-19 and beyond.

Disclaimer: we are not endorsing this information for accuracy or validity of the content. We encourage you as appropriate, to verify clinical and regulatory content with your own trusted sources.


Diane Link
Diane Link

Diane Link has over 25 years of home health and hospice experience. She is currently owner of Link Healthcare Advantage, providing home health and hospice consulting services including operation assessments, survey readiness, regulatory and compliance programs, outsource QAPI program and outcome improvements. Diane is also COO and partner with Curaport, an online education platform for post-acute care providers. Her experience includes a variety of roles in home health and hospice from field nurse to executive director, and was a surveyor for home health, hospice, and private duty services for CHAP (Community Health Accreditation Partners) for the past five years as both an independent consultant and as a director of clinical consulting at a large consulting company.

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