Update May 12, 2020: This Medicaid Special Bulletin revises the previous guidance in the Special Medicaid Bulletin #72 published April 30, 2020, by removing the statement: “This does not change the prior approval (PA) process” from the provision statement: “Allowing licensed practitioners as defined in the CMS announcement, such as, but not limited to Nurse Practitioners and Physician Assistants, and practicing within their North Carolina scope of practice, to order Medicaid home health services.” This allowance does not require a PA. Please refer to Home Health Clinical Coverage Policy No: 3A Section 5.1, which addresses areas where a PA is required for Home Health services.
On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an amendment of 42 CFR 440.70 through an Interim Final Rule (IFR), focused mostly on changes to the Medicare policy addressing COVID-19 response. Of the items in the interim rule, one policy change affects home health services for Medicaid. Specifically, the interim rule allows licensed practitioners practicing within their scope of practice, such as, but not limited to Nurse Practitioners and Physician Assistants, to order Medicaid home health services during the existence of the COVID-19 pandemic.
In response to the recent CMS announcement, effective March 30, 2020, NC Medicaid is adjusting home health requirements currently in Home Health Clinical Coverage Policy No: 3A to align with this recent CMS regulatory change as well as other provisions related to Home Health in the CMS changes during the existence of the COVID-19 pandemic. Changes include:
- Allowing licensed practitioners as defined in the CMS announcement, such as, but not limited to Nurse Practitioners and Physician Assistants, and practicing within their North Carolina scope practice, to order Medicaid home health services.
- Waiving the 3A policy 6.1.1 requirement for a nurse to conduct onsite supervisory visits every two weeks.
- Allowing, during the period of the State of Emergency, visits to be conducted, but allowing them to be conducted utilizing eligible technologies that allow the supervising Registered Nurse (RN) to remotely communicate and evaluate services rendered. Supervisory visits can be delivered via any HIPAA-compliant, secure technology with audio and video capabilities including (but not limited to) smart phones, tablets and computers.
- Requiring if remote technology is used, that it be real-time communications and ensuring the platform is a type consistent with one described in the HHS Office for Civil Rights: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html. The use of remote technology and patient consent should be properly documented in the participant’s medical record.
- Allowing the above described methods of eligible technologies in all areas of home health so long as it is part of the patient’s plan of care and does not replace needed in-person visits.
These temporary changes are effective March 30, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded.
Contact
NC Medicaid Contact Center: 888-245-0179