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Plus: Comprehensive assessments will go back to 15-day deadline.

Most hospice flexibilities offered during the COVID-19 public health emergency are going away this year 鈥� and some of those departures will take a major toll on providers.

According to a hospice-specific 鈥淐MS Flexibilities to Fight COVID-19鈥� sheet updated on Feb. 1, these waiver flexibilities will end with the PHE:

• Telehealth F2F. Recent legislation bought hospices some time when it comes to the face-to-face encounter for recertification via telehealth, but it鈥檚 still set to expire 鈥渢he first day after the 151st day following the end of the PHE,鈥� CMS says 鈥� Oct. 9, 2023.
• Volunteers. CMS will again require that hospices use volunteers for at least 5 percent of patient care hours. The agency offers no grace period in the updated sheet.
• Comprehensive assessments. The allowed time frame for updating the comprehensive assessment will go back down to 15 days, compared to 21 days during the PHE.
• Non-core services. CMS will no longer waive the requirement to provide certain non-core services, including physical therapy, occupational therapy, and speechlanguage pathology, when the PHE ends.
• Training and assessment of aides. Like with home health, RNs must again 鈥渕ake an annual onsite supervisory visit [direct observation] for each aide that provides services on behalf of the agency,鈥� although CMS is 鈥減ostponing completion of these visits,鈥� it says. 鈥淎ll postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the PHE.鈥�
• Annual training. CMS will once again require hospices 鈥渢o annually assess the skills and competence of all individuals furnishing care and provide in-service training and education programs where required.鈥� But it is 鈥減ostponing the deadline for completing this requirement 鈥� until the end of the first full quarter after the declaration of the PHE concludes,鈥� it says.
• QAPI. CMS is ending the waiver allowing agencies to narrow the scope of their Quality Assurance and Performance Improvement program to infection control issues. It will end with the PHE.
• Various enrollment, appeals and Medicare Advantage waivers will end.

Meanwhile, as with home health, CMS will continue to pay about $40 per dose for administering COVID-19 vaccines through the end of 2023, the newly updated sheet says. 鈥淓ffective January 1 of the year following the year that the PHE ends, CMS will set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines.鈥� The sheet also notes that 鈥渨e鈥檒l continue to pay a total payment of approximately $75 per dose to administer COVID-19 vaccines in the home for certain Medicare patients through the end of the calendar year that the PHE ends,鈥� but makes no mention of continuing the payment after 2023.

Note: See more details in the nine-page sheet at .