SPECIAL BULLETIN COVID-19 #81: Hospice Clinical Coverage Policy: Changes due to CMS Amendment and Other Flexibilities

Monday, May 4, 2020

On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an amendment of 42 CFR 440.70 through an Interim Final Rule, focused mostly on changes to the Medicare policy addressing COVID-19 response. Of the items in the Interim Final Rule, two policy changes affect hospice services for Medicaid during the COVID-19 pandemic.

In response to the recent CMS announcement, effective March 30, 2020, NC Medicaid is adjusting hospice requirements currently in Clinical Coverage Policy 3D, Hospice Services to align with these recent CMS regulatory changes. Changes include:

  • Waiving the 3D policies and 7.4 requirements for a nurse to conduct onsite supervisory visits every two weeks 
  • Allowing during the period of the State of Emergency, supervisory visits to be conducted, but allowing them to be conducted utilizing eligible technologies that allow the supervising registered nurse 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. 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 hospice so long as it is part of the patient’s plan of care and does not replace needed in-person visits.

NC Medicaid is also extending the following additional temporary flexibilities in Clinical Coverage Policy 3D:

  • Waiving the requirement to send to NC Medicaid for prior approval for third and subsequent benefit periods; however, continue same process of decisions of eligibility (Section:
  • Waiving the requirement to fax PA confirmation sheet to NC Medicaid; however, election statement must continue to be uploaded to NC Medicaid as required by current policy (Section: 5.12.4).

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will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded.

Questions regarding the temporary changes in this bulletin may be sent to mailto:Medicaid.COVID19@dhhs.nc.gov.