Since the COVID-19 pandemic began, the healthcare industry has grappled with how to provide high-quality services that protect both the patient and the provider.

For home health agencies, it’s been especially challenging. With a population that’s typically older and often immuno-compromised, providers have scrambled to obtain personal protective equipment and train staff on new protocols. Not only that, clients may decline services out of fear, which can affect patient outcomes and agency revenue.

Telehealth has emerged as a viable solution. While there are still hurdles ahead, the extraordinary events of the past few months have greatly accelerated its development.

Let’s talk about how this shift toward telehealth will impact the home health industry. Learn the historical roadblocks to telehealth, how the pandemic has altered the legislative landscape, and what you can do as a home health provider to stay ahead of the changes.

A History of Reimbursement Challenges

The patchwork of coverage for telehealth has made it difficult for home health agencies to understand and access reimbursement for telehealth services. While some successful home health programs rely on foundation or government grants, this isn’t feasible for all providers.

Greg Strobel, HHAeXchange CEO notes, “Reimbursement limitations are a significant barrier for home health agencies who want to adopt telehealth. In particular, Medicare is the most restrictive, offering limited coverage for telehealth in a home health environment.”

Under Medicare, reimbursement is typically limited to beneficiaries who live in rural or underserved areas. Plus, they usually require the person receiving telehealth to be physically located at “originating sites,” such as practitioners’ offices, hospitals, rural health clinics, and nursing homes.

Since Medicaid is administered by each state, there’s a great deal of variation in telehealth reimbursement. Most states have legal policies governing telehealth services, but they differ significantly in terms of where the service can occur, types of technology allowed, and the amount of reimbursement (if any).

These obstacles have prevented many home health agencies from embracing telehealth, even though they recognize it could provide greater access, safety, and continuity of care for their clients.

Pandemic Prompts Changes

The dramatic need for telehealth in light of the pandemic created an opening for long-advocated policy changes.

Passed in March 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act allows for more flexibility in using telehealth during the emergency. Home health agencies can deliver services using telecommunications technology as long as they’re part of the patient’s plan of care and don’t replace needed in-person visits. Home health providers can also satisfy physician face-to-face requirements using telehealth.

Despite these gains, the Centers for Medicare and Medicaid Services (CMS) guidelines have not yet provided for reimbursement. But there’s hope on the horizon.

  • An emergency bill making its way through the U.S. Office of Management and Budget would allow CMS to potentially compensate providers for telehealth services. It would also permit home health agencies to assess patients remotely.

  • Sen. Susan Collins, a Republican from Maine, indicated that she would soon introduce a bill paving the way for telehealth reimbursement for home health providers.

At a minimum, home health advocates are pressing legislators to allow virtual visits to count toward low utilization payment adjustment (LUPA) thresholds.

Given these historic changes, there’s no doubt that more legislation will soon follow to keep these advances in place. STAT reports, “COVID-19 has pushed the inevitable telemedicine revolution forward by a decade, if not more, according to health care leaders.”

How Home Health Providers Can Prepare for Telehealth

Stay Abreast of Legislative Changes

The legislative category on Home Health Care News is an excellent place to monitor changing federal laws on telehealth. In addition, the American Telemedicine Association maintains an annual state-by-state scorecard of telemedicine policies and laws. This is a good way to gauge whether telehealth is a viable option for your home health service areas now or in the near future.

Implement a Telehealth-Capable Technology Platform

With public demand growing for telehealth services and laws changing to accommodate them, telehealth will soon be a clear differentiator for home health agencies. Investing in technology now will position your agency well for the future. For example, the state of New York opened up reimbursement pathways for home health providers in response to the pandemic.

HHAeXchange is among many vendors helping NY providers meet the NY Department of Health guidelines for telehealth services. During spring 2020 alone, our NY customers completed thousands of remote clinical assessments using the HHAeXchange clinical module.

Take Advantage of Funds from the CARES Act

The CARES Act has allocated $29 million annual from fiscal year 2021 to 2025 for Telehealth Resource Centers (TRCs). These are a consortium of state and regional organizations, managed by the Department of Health and Human Services. Each center provides assistance, education and information to organizations and individuals providing telehealth or planning to implement a program.

In addition, the Federal Communications Commission launched a new telehealth program using $200 million from the CARES Act. The program offers qualified healthcare providers the means to provide telehealth by fully funding their telecommunications services, information services, and devices.


Telehealth may still be in its infancy within the home health industry, but all signs point toward a massive adoption in the years to come. Home health providers should make plans now to prepare their staff, technology, and operations for a successful transition toward this new model of care.