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House of Representatives
Session of 2021 - 2022 Regular Session


Posted: March 7, 2022 02:02 PM
From: Representative Jeff C. Wheeland
To: All House members
Subject: Home Health Care Regulatory Relief
A number of regulatory waivers went into effect over the course of the pandemic. Many health care-specific waivers are still in place today to ensure continued access to quality care. The past two years have taught us that some of these flexibilities should stay in place permanently as we have learned that the regulations themselves are outdated.
In the home health care space, where individuals receive acute skilled nursing care in their homes, two waivers have provided more flexibility for providers, resulting in increased access to care. I intend on introducing legislation that will make permanent (1) the ability of non-physician practitioners to order and oversee orders for home health care services and (2) allow for the continued use of remote supervisory visits by registered nurses in limited circumstances.
Non-Physician Practitioners (NPPs) Ordering/Overseeing Home Health
In March of 2020, with the passage of the federal CARES Act, Congress permanently changed federalthe law to allow NPPs (Certified Registered Nurse Practitioners and Physician Assistants) to order and oversee orders for home health services. However, the PA Department of Health’s home health care agency licensure regulations still require a physician to order and oversee home health care services. In May 2020, the Department waived that requirement, and this waiver was continued under Acts 21 and 73. Pennsylvania should permanently adjust this rule to bring home health care agency regulationslaws in line with federal law.
Additionally, the Center for Medicare and Medicaid Services’ (CMS)Medicare rule gives agencies significantly more time to obtain a signature for the order for home health services, while Pennsylvania’s regulations have retained an outdated, often unattainable 7-day rule for physician signatures. Obtaining this signature is often out of the home health care agency’s control, and the extension to 30 days would have no negative impact on patient care. In fact, more resources could be directed toward patient care as opposed to hunting down a signature.
Remote Supervisory Visits
Every fourteen days, home health agencies are required to conduct a supervisory visit where a registered nurse is required to visit with a patient to ensure that they are receiving satisfactory services and that their plan of care is being met. Since May 2020, agencies have been able to perform these visits remotely. More recently, the Centers for Medicare and Medicaid Services (CMS) updated the federal Home Health regulations to make permanent this extension noting that, “While we are proposing to allow this telecommunications flexibility, we expect that in most instances, the home health agencies (HHA) would plan to conduct the 14-day supervisory assessment during an on-site, in person visit, and that the HHA would use interactive telecommunications systems option only for unplanned occurrences that would otherwise interrupt scheduled in-person visits.”
My office has worked with stakeholder groups to update Pennsylvania’s regulations while at the same time ensuring that patient care is not compromised.
Both regulatory flexibilities have proven to increase access to quality care, and I ask for your support in bringing Pennsylvania law in line with federal law to best meet our constituents’ health care need.

Please join me in cosponsoring this bill.

Introduced as HB2401