Hospices Turn to Telehealth, Mostly, to Address COVID-19 Concerns

The Centers for Medicare & Medicaid Services has relaxed its rules to allow hospice care providers to use more telehealth during the Coronavirus pandemic, but the agency is keeping one rule in place that curbs telehealth use during the last week of a patient’s life.

In a March 29 guidance document that followed passage of the CARES Act, CMS announced that it would OK Medicare reimbursement for telehealth sessions to cover routine home care, as well as for patient recertification for the Medicare hospice benefit.

(For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.)

That document specified that Medicare would cover two-way, real-time, interactive telemedicine services between the patient and a distant site physician or NP. It also specified that telehealth services be included in the patient’s care plan and tied to patient-specific needs.

The new guidelines give hospice providers more flexibility to use connected health platforms at a time when in-person visits have been curtailed to avoid transmission of the COVID-19 virus. They also provide momentum at a time when hospice and palliative care programs have been looking at telehealth as a means of improving access to care and reducing the strain on providers.

But those relaxed rules don’t include Service Intensity Add-on (SIA) payments.

Introduced in 2016, SIA payments are administered to care providers – ranging from physicians and nurses to social workers and chaplains - who visit patients in hospice care during the last week of life, and are included in the seven quality measures used by CMS on its Hospice Compare website. The goal is to reward hospices who put more effort into care management during that most difficult period for patients and their family.

According to CMS, Medicare won’t cover those visits if they’re delivered via telehealth.

“The SIA is paid for visits in the last seven days of life, and so the current thinking is telehealth would be part of the routine home care rate and would not rise (to) the level of requiring us to pay an add on for that,” Hillary Loeffler, director of the Home Health and Hospice division at CMS, told Hospice News.

The limitation might cause problems for hospice care providers who will have to balance telehealth visits with in-person visits, not to mention defining what constitutes routine care and care delivered at the end of a patient’s life.