Updated: Home Care Telehealth Waiver Now a Blanket Waiver

To: Class A and Class B Homecare Agencies From: Cheryl McMahon On March 31st, the Division made a waiver application available for licensed-only agencies to meet specified observation, supervision, and evaluation requirements through telehealth methods rather than in-person or on-site, and subsequently updated that waiver on April 3rd to include certified agencies, due to changing CMS waivers. Since that time, many waivers have been issued and we are beginning to get questions about whether those waivers will need to be renewed at the time of license renewal. In considering the issue, the Division is now changing the waiver from being by application only, to being a blanket waiver for all agencies. This prevents the need for additional waiver applications and waiver renewals, and is responsive to the need to protect both healthcare workers and homecare clients. The Division is now waiving the following regulations, without need for application. The Home Care Agency must document and implement policies and procedures detailing how the requirements of the waiver, as well as the applicable rules, will be met. These policies and procedures, as well as any related staff training, must be available for review at the Department’s request. For Home Care Agencies providing skilled care (Class A licensees) 6 CCR 1011-1, Chapter 26, Home Care Agencies, Part 7.9, Initial and Comprehensive Assessments. The waiver allows Home Care nursing services to conduct comprehensive patient assessment and provide ongoing patient assessment by telephone, via live chat, or through video conferencing. All other general requirements, such as documentation and meeting the standard of care must be met. 6 CCR 1011-1, Chapter 26 Home Care Agencies, Part 7.15, Nurse Aide Services and Part 7.16, Nurse Aide Training and Orientation. The waiver allows the agency to meet the requirement for direct observation of a CNA through telehealth as follows (Note: all other rules in these Parts remain applicable as written and are not modified by this waiver): For Certified Nurse Aide (CNA) Care and Services--The agency must continue to ensure that skills learned or tested elsewhere can be transferred successfully. This review of skills must be done before the nurse installs an aide into a new consumer care situation. The supervising nurse must evaluate, and maintain documentation of the evaluation, of any skills that the CNA will utilize.  The review of skills may be performed by the supervising nurse verbally, via video demonstration by the CNA, or by written form.  The review must include an evaluation of the step by step process for how the CNA is to safely carry out the task(s). A review of skills is not necessary for currently employed CNA staff who are being newly assigned to clients who will be receiving care and services for which the CNA was previously evaluated by the supervising nurse. For Certified Nurse Aide (CNA) Supervision--The agency must continue to provide supervision to ensure consumer care and treatment are delivered in accordance with a plan of care that addresses the consumer’s status and needs.  The supervising nurse may evaluate the delivery of care and services by telephone and/or video conference with the CNA and consumer. The results of the supervisory visit must be documented by the supervising nurse.  The supervising nurse MUST conduct an in-person supervisory visit to evaluate consumer complaints related to the delivery of care by CNA staff when such concerns cannot be successfully addressed remotely by telephone and/or video.  6 CCR 1011-1, Chapter 26, Home Care Agencies, Part 7.17, Therapy Services. The waiver allows the agency to modify how this part is met, as follows: For therapy services, such as physical therapy, occupational therapy, and speech therapy, services and supervision may be provided and supervised through an interactive audiovisual connection. All other general requirements, such as documentation and meeting the same standard of care must be met. For Home Care Agencies providing personal care service (Class B licensees, and Class A licensees that are providing personal care service): 6 CCR 1011-1, Chapter 26, Home Care Agencies, Part 8.5, Personal Care Worker, and Part 8.6, Personal Care Worker Training. The waiver allows the agency to meet the requirement for observation, evaluation, and on-site supervision of a Personal Care Worker through telehealth as follows (NOTE: All other rules in these Parts remain applicable as written, and are not modified by this waiver): For Personal Care Workers (PCW), the agency must continue to ensure that skills learned or tested elsewhere can be transferred successfully. This review of skills must be done before the agency assigns a PCW to provide care for a new consumer or new assignment of tasks. Any skills evaluated by the agency supervisor must be documented by the supervisor.  The review of skills may be performed by the supervisor verbally or by video demonstration by the PCW.  The review must include an evaluation of the step by step process for how the PCW is to safely carry out the task(s). A review of skills is not necessary for currently employed PCW staff who are being newly assigned to consumers for which the PCW was previously evaluated by the supervising nurse.  For Personal Care Worker (PCW) supervision, the agency must continue to provide supervision to ensure consumer care and treatment are delivered in accordance with a service plan that addresses the consumer’s status and needs.  The supervisor may evaluate the delivery of care and services by telephone and/or video conference with the PCW and consumer. The results of the supervisory visit must be documented by the supervisor.  The supervisor MUST conduct an in-person supervisory visit to evaluate consumer complaints related to the delivery of care by PCW staff when such concerns cannot be successfully addressed remotely by telephone and/or video. Please note: This waiver is only for Colorado state regulations for Home Care Agencies, and does not waive the Centers for Medicare and Medicaid Services (CMS) regulations. CMS-certified agencies must implement the waiver only to the extent allowed under current CMS waivers and regulations. CDPHE continues to explore additional options to ease the burden for providers during this public health emergency. We will provide updates as they become available. For questions regarding this waiver, contact Cheryl McMahon (cheryl.mcmahon@state.co.us). Cheryl McMahon Branch Chief Home and Community Facilities Branch Chief