Amity Healthcare Group Weekly Newsletter Issue date: November 23th, 2021

Issue date: November 23th, 2021


Hello, everyone!

Here are some home health related updates for this week:


Amity Healthcare Group Consulting Services

Amity Healthcare Group is providing continuous support to home health providers.  We have been closely monitoring the events and information associated with COVID -19 vaccination mandates. If  you need assistance with developing Policies & Procedures  related to Mandatory COVID-19 Vaccination Requirements, please call 303-690-2749 or email at

We also provide assistance with:

  • Medicare Certification/Accreditation Survey preparation
  • Regulatory and clinical compliance review
  • QAPI implementation and analysis
  • Emergency Preparedness


Do not forget to schedule your in-person and/or virtual competencies at






OSHA Suspends COVID-19 Vaccination and Testing ETS

U.S. Court of Appeals for the Fifth Circuit ordered OSHA to take “no steps to implement or enforce” the Emergency Temporary Standard (ETS) mandating COVID-19 vaccination or testing of employees for employers with at least 100 employees until further notice.

The Department of Labor has responded by posting the following message on its website: “OSHA has suspended its activities related to the implementation and enforcement of the ETS pending future development in the litigation.”

Please note, the OSHA ETS suspended by the Fifth Circuit is different from the OSHA ETS  for health care workers issued in June of 2021. In addition, the suspension of the OSHA ETS has not impacted CMS vaccination mandate issued on November 4, 2021. CMS mandate continues to be in effect.


Provider Enrollment News

  1. Provider Enrollment Fee

As it was announced during the CMS Provider Open Door Forum last week, the provider enrollment application fee that was waived as the part of the CMS public health emergency flexibility  was set to resume on November 1, 2021.

In addition, effective January 1, 2022, the provider enrollment application fee will be $631 for institutional providers.

B.   HHA Changes of Ownership

CMS CY 22 Home Health Final rule provided additional clarification related to the Change  of Ownership as follows:

“Section 424.550(b) states that if there is a change in majority ownership of an HHA by sale within 36 months after the effective date of the HHA’s initial enrollment in Medicare or within 36 months after the HHA’s most recent change in majority ownership, the HHA’s provider agreement and Medicare billing privileges do not convey to the new owner (hereafter occasionally referenced as the “36-month rule”). Instead, the prospective provider/owner of the HHA must: (1) Enroll in Medicare as a new (initial) HHA; and (2) obtain a state survey or accreditation.

Section § 424.550(b) contains several exceptions to the previously referenced requirement to enroll as a new HHA. One exception (identified in § 424.550(b)(2)(i)) is that the HHA has submitted 2 consecutive years of full cost reports. There has been uncertainty within the provider community as to whether this particular exception applies only to the 2-year cost report period after initial enrollment or also to 2-year cost report periods after the HHA’s previous change in majority ownership. To clarify this, we proposed to revise the first sentence of § 424.550(b)(2)(i) to specify that the HHA submitted 2 consecutive years of full cost reports since initial enrollment or the last change in majority ownership, whichever is later. (The second sentence of § 424.550(b)(2)(i), which clarifies that low utilization or no utilization cost reports do not qualify as full cost reports for purposes of § 424.550(b)(2)(i), would remain intact.)”

CMS Proposes to Test New Mode for HHCAHPs and Shortened Survey Tool

The Centers for Medicare & Medicaid Services (CMS) has submitted a proposal to conduct a  mode  experiment to test the effects of a web-based mode on response rates and scores, to the Office of Management and Budget.

The CMS proposal, an information collection request titled The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment, would be an addition to the three currently approved modes – mail, telephone and mail combined.

CMS is also interested in testing a revised, shorter version of the HHCAHPS survey, based on feedback from patients and stakeholders. The mode experiment is designed to examine the effects of the shortened survey on response rates and scores and to provide precise adjustment estimates for survey items and composites on the shortened survey instrument. Information from this mode experiment will help CMS determine whether the additional mode of administration should be included, and a shortened survey instrument should be used in the current national implementation of the HHCAHPS Survey.

The data collected from the HHCAHPS Survey mode experiment will be used for the following purposes:

  • Test the shortened survey instrument, including several new items;
  • Compare survey responses across the four proposed modes to determine if adjustments are needed to ensure that data collection mode does not influence results; and
  • Determine if and by how much patient characteristics affect the patients’ rating of the care they receive and adjust results based on those factors.


CMS Updates Training Available for Section GG 3-Course Training Series

The Centers for Medicare & Medicaid Services (CMS) is offering an updated web-based training series on the assessment and coding of Section GG. This training is designed to be used on demand anywhere you can access a browser.

This training series consists of three courses:

Each course includes interactive exercises to test your knowledge related to the assessment and coding of Section GG items.


Notice of Public Rulemaking Hearing, December 15, 2021 – 6 CCR 1011-1, Chapter 26 – Home Care Agencies

As you know, CDPHE has been holding Chapter 26- Home Care Agencies revision stakeholder meetings in the past 9 months.

As the final step to the revision process, Colorado Board of Health will conduct a public rule-making hearing on December 15, 2021 at 10 a.m. remotely via Zoom, to consider the amendments to 6 CCR 1011-1 Chapter 26, Home Care Agencies.

The agenda for the meeting and the proposed repeal will be available on the Board’s website, at least seven (7) days prior to the meeting. The proposed rule, together with the proposed statement of basis and purpose, specific statutory authority and regulatory analysis will be available for inspection at the Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South EDO-A5, Denver, Colorado 80246-1530 at least five working days prior to the hearing. Copies of the proposed rules may be obtained by contacting the Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division.

Rule Extension for Professional, Practical Nurses and CNAs Holding Temporary Licenses in Colorado

Based on Executive Order D 2021 121, which was amended and extended by Executive Order D 2021 136, the Director of the Division of Professions and Occupations (DPO) has been granted the authority to promulgate emergency rules for multiple professions to expand the workforce personnel available to provide healthcare services during the recovery from the COVID-19 pandemic in Colorado.

Rules were adopted by the DPO’s Division Director on November 2, 2021, regarding temporary licensure and/or scope expansion, including delegation and vaccination administration, pursuant to Executive Order D 2021 121, which was amended and extended by Executive Order D 2021 136.

DPO wants to keep you informed to ensure all professionals are properly licensed and operating under the rules, laws, and policies set forth by the Colorado Board of Nursing.


  • Temporary licenses issued to professional and practical nursing applicants from non-compact states under the Governor’s Executive Orders on or after November 2, 2021 will be effective from the date of issuance through May 31, 2022. On June 1, 2022, if a full license to practice nursing in Colorado has not been issued, the temporary licensee must cease practice immediately until such time as full licensure to practice nursing in the state has been granted.
  • Professional and practical nursing applicants issued a temporary license from non-compact states between April 6, 2021-Nov. 1, 2021 must cease practice on Jan. 1, 2021 if a full license to practice nursing has not been issued or a second temporary license obtained. Those applicants issued a temporary license between April 6, 2021 and November 1, 2021 may apply here for a second temporary license to be effective from the date of issuance through May 31, 2022.


Due to a backlog in the administration of required skills examinations, the Colorado Board of Nursing may issue a temporary certification to an applicant that is a new graduate of an approved nurse aide training program meeting all qualifications for certification except the successful completion of the required exams as set forth in Section 12-260-108, Colorado Revised Statutes.

New nurse aide graduates must submit an application for temporary certification.

  • A temporary certificate issued to a new nurse aide graduate on or after November 2, 2021 is effective from the date of issuance through May 31, 2022. A full certificate to practice as a certified nurse aide in Colorado must be issued by June 1, 2022, or the temporary certificate holder must cease practice immediately until full certification to practice as a nurse aide in Colorado has been granted.  It is important for employers to ensure their temporarily licensed staff schedule their exam as soon as possible to avoid any staffing gaps once the temporary licenses expire on May 31, 2022.
  • A temporary certificate issued between April 6, 2021 and November 1, 2021 is effective from the date of issuance through December 31, 2021. New graduates issued a temporary certificate between April 6, 2021 and November 1, 2021 may apply for another temporary certificate to expire on May 31, 2022, subject to the following terms:
    • Submission of documentation stating passage of the written exam;
    • Attestation that the registration for the required skills exam will occur in the applicant’s regional area (inside 250 miles of residency) within 60 days of availability;
    • Attestation that the scheduled skills examination is the applicant’s first attempt.

Temporary certificate holders must cease practice as a nurse aide in Colorado on Jan. 1, 2022 if another temporary certificate has not been issued, until such time as full certification has been granted.

Skills examinations may be scheduled through Credentia.

The Board may issue a temporary emergency certification valid through May 31, 2022 to a new reinstatement applicant who meets all qualifications for certification with the exception of successful completion of the required skills examinations OR issue a second temporary certificate for those issued a temporary emergency certificate between April 5, 2021 and Nov. 1, 2021, under terms set forth in emergency rules.

The information above is the latest currently available, and is subject to change based on any extensions or changes to the Disaster Recovery Executive Order. Please make sure to check additional communications from DPO, including its website, alerting the public to any such revisions.

Amity’s Friday emails (newsletters) will be archived on Amity’s Healthcare Group website at  under Weekly Newsletter section.

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Thank you,

Irina Gorovaya, RN BSN, MBA


Amity Healthcare Group, LLC

Home Health Consulting, Education and Outsourcing Services

720-353-7249 (cell)   303-690-2749 (office)   720-398-6200 (fax)


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