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DOH Issues DAL Clarifying Home Care/Hospice Guidance

The Department of Health (DOH) issued a Dear Administrator Letter (DAL) on Oct. 13th clarifying its position on several waiver provisions issued at the state and federal levels for Certified Home Health Agencies (CHHAs), Licensed Home Care Services Agencies (LHCSAs), Long Term Home Health Care Programs (LTHHCPs), AIDS home care programs, and Hospices. The guidance clarifies where DOH stands on in-service requirements, orientation and supervision of aides, and the use of technology.

In-Service Requirements

DOH addresses the provisions issued by the Centers for Medicare and Medicaid Services (CMS) which waived the 12-hour in-service requirement for Home Health Aides (HHAs) and three-hour semi-annual in-service for Personal Care Aides (PCAs) (only where semi-annual education was due between January and June 2020). DOH states that it will "exercise enforcement discretion" when surveying providers for compliance regarding these in-service requirements.

Providers should know that this does not mean that DOH is waiving this requirement, but rather may choose to not cite providers for violation of these provisions. It stresses that providers should try to make a good faith attempt to have aides complete these requirements as soon as practicable. This period of "exercising enforcement discretion" will continue until the end of the first full quarter following the declaration of the end of the State Disaster Emergency or expiration of Executive Order (EO) 202, whichever is sooner. In-services can be conducted remotely or by other methods as long as the training offered follows conditions and requirements laid out in the DAL.

Orientation and Supervision

The Governor's EO 202.5 permits CHHAs, LHCSAs, LTHHCPs, AIDS home care programs, and Hospices to conduct in-home supervision of HHAs and PCAs as soon as practicable after the initial service visit, or to permit in-person and in-home supervision to be conducted through indirect means, including by telephone or video communication.

Similarly, CMS has waived the requirements for Home Health Agencies, which require a registered nurse, or in the case of a Home Health Agency, a registered nurse or other appropriate skilled professional (physical therapist, occupational therapist, speech language pathologist), to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. All postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the public health emergency.

Use of Technology

The DAL also recognizes EOs that allow several provider types, including home care providers, to utilize telehealth to deliver services within their scope of practice. These flexibilities also continue until further notice.

Providers with COVID-19-related questions may contact DOH at covidhomecareinfo@health.ny.gov. Members may also contact me with any questions or concerns they may have.

Contact: Meg Everett, meverett@leadingageny.org, 518-929-9342