The Department of Health has just released two Dear Administrator Letters (“DALs”) that will require home care agencies’ immediate attention. The first DAL discusses health assessments and immunization requirements for healthcare personnel, including PCAs and HHAs working for LHCSAs. It is available HERE. The second DAL discusses home care aide in-service requirements, and it is available HERE. These DALs do not appear applicable to CDPAP.

Annual Health Assessments and Immunizations

The annual health assessment for personnel of CHHAs, LHCSAs, LTHHCPs, and AIDS home care programs was suspended on April 10, 2020. As of October 14, that suspension is lifted and all personnel must obtain their annual health assessments by December 31, 2020.


With respect to in-service, the DOH’s DAL nots that the DOH will exercise “enforcement discretion when surveying providers for compliance” with the 12-hour annual in-service requirements for home health aides, CHHAs, LTHHCPs, and AIDS home care programs. However, with respect to the 3-hour semi-annual in-service education requirements for PCAs, the DOH will exercise enforcement discretion “only where such semi-annual education was due between January and June 2020.” The Department will continue to exercise its discretion until the end of the “first full quarter following the declaration of the end of the State Disaster Emergency or expiration of Executive Order 202, whichever is sooner.” Nonetheless, in the DAL, the DOH is urging providers to have their aides complete both annual and semi-annual in-services as soon as practicable. The DAL emphasizes that:

“In-services can be conducted remotely or through other off-site methods. Online in-services may be used as a means of in-service completion provided it is under the supervision of an RN, includes an opportunity for questions and answers, and there is an evaluation that validates that learning took place. The online in-service training must also be pertinent to the aide’s job responsibilities. The agency should document remote in-service training in the agency’s personnel files and this documentation must be made available upon request for surveillance purposes.”

Orientation and Supervision

The DAL notes that CMS has waived the requirements at 42 CFR § 418.76(h)(2) for Hospice and 42 CFR § 484.80(h)(1)(iii) for Home Health Agencies, which require a registered nurse, or in the case of a Home Health Agency, a registered nurse or other appropriate skilled professional (physical therapist, occupational therapist, speech language pathologist), to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. The DAL notes that all postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the public health emergency.

The DAL further notes that EO 202.5, issued on March 18, 2020 and extended by subsequent orders, permits CHHAs, LHCSAs, LTHHCPs, AIDS home care programs, and hospices serving individuals affected by the disaster emergency to conduct in-home supervision of HHAs and PCAs as soon as practicable after the initial service visit, or to permit in-person and in-home supervision to be conducted through indirect means, including by telephone or video communication. Note, the part of the DAL discussing PCA and HHA supervision requirements seems to contain a typographical error regarding the EO 202.5 expiration date. We are following up with the DOH to confirm that EO 202.5 is still in effect and that PCAs and HHAs can be supervised through indirect means, including telephone or video communication.

Opening Cases via Technology
The DAL reaffirms that LHCSAs, CHHAs, LTHHCPs, and AIDS home care cases may be opened using remote technology.

View PDF