COVID19 April 05

Summary of Centers for Medicare and Medicaid Services (CMS) temporary regulatory waivers and new rules effective during the COVID-19 crisis.

Temporary CMS regulatory changes during the COVID-19 patient surge

Under President Trump’s recent emergency declaration and emergency rule making, the Centers for Medicare & Medicaid Services (CMS) issued the following temporary regulatory waivers and new rules effective March 30, 2020.

Disclaimer: The information below is a summary of key points from CMS rulings released March 30, 2020. This does not reflect Medline direction or guidance, and further clarification or questions should be directed to CMS.

Purposes:

  • To equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic
  • To empower hospitals and healthcare systems to rapidly expand treatment capacity that allows them to separate patients infected with COVID-19 from those who are not affected

Timeline:

  • These temporary changes apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration

Increase Hospital Capacity – CMS Hospitals without Walls

Goal: Expand the capacity of communities to develop a system of care that:

  • Safely treats patients without COVID-19
  • Isolates and treats patients with COVID-19

Surgery centers can:

  • Contract with local healthcare systems to provide hospital services
  • Enroll and bill as hospitals as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan
  • Provide services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries

Non-hospital buildings and spaces can:

  • Be used for patient care and quarantine, provided the location is approved by the State and ensures the safety and comfort of patients and staff

Hospitals, laboratories, and other entities can:

  • Perform COVID-19 tests on people at home and in other community-based settings outside of the hospital to help increase access to testing and reduce risks of exposure

Healthcare systems, hospitals, and communities can:

  • Set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment

Hospital emergency departments can:

  • Test and screen patients for COVID-19 at drive-through and off-campus test sites.

When other transportation is not medically appropriate, ambulances can transport patients to:

  • Community mental health centers
  • Federally qualified health centers (FQHCs)
  • Physician offices
  • Urgent care facilities
  • Ambulatory surgery centers
  • Any locations furnishing dialysis services when an end-stage renal disease (ESRD) facility is not available

Physician-owned hospitals can:

  • Temporarily increase the number of their licensed beds, operating rooms, and procedure rooms (e.g., convert observation beds to inpatient beds to accommodate patient surge)

Hospitals can bill for services provided outside their four walls:

  • Emergency departments can use telehealth services to quickly assess patients to determine the most appropriate site of care, freeing emergency space for those that need it most — allowing hospitals, psychiatric hospitals, and critical access hospitals (CAHs) to screen patients offsite to prevent the spread of COVID-19

Rapidly Expand the Healthcare Workforce

Goal: Allow hospitals and healthcare systems to increase their workforce capacity

  • Remove barriers for licensed physicians, nurses, and other clinicians to be hired from the local community and other states without violating Medicare rules
  • Make local private practice clinicians and their trained staff available for temporary employment while nonessential medical and surgical services are postponed
  • Waivers so that hospitals can use physician assistants and nurse practitioners in accordance with a state’s emergency preparedness or pandemic plan to order tests and medications that may have previously required a physician’s order where this is permitted under state law
  • Waivers so that certified registered nurse anesthetists (CRNAs) can function to the fullest extent allowed by the state, and free up physicians from the supervisory requirement, expanding the capacity of both CRNAs and physicians.
  • Waiver to allow hospitals to provide benefits and support while physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients:
    • Multiple daily meals
    • Laundry service for personal clothing
    • Child care services
  •  Healthcare providers (clinicians, hospitals and other institutional providers, and suppliers) can enroll in Medicare temporarily to provide care during the public health emergency

Put Patients over Paperwork

Goal: Temporarily eliminate paperwork requirements to allow clinicians to spend more time with patients.

  • Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously Medicare only covered them under certain circumstances
  • Hospitals will not be required to have written policies on processes and visitation of patients in COVID-19 isolation
  • Hospitals will also have more time to provide patients’ a copy of their medical record
  • Temporary relief from many audit and reporting requirements (extending reporting deadlines and suspending documentation requests) to allow the following to focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19:
    • Providers
    • Healthcare facilities
    • Medicare Advantage health plans
    • Medicare Part D prescription drug plans
    • States

Further Promote Telehealth in Medicare

Goal: Ensure patients have access to physicians and other providers while remaining safely at home.

  • CMS will now allow for more than 80 additional services to be furnished via telehealth.
  • During this time, individuals can use interactive apps with audio and video capabilities to visit with their clinician
  • Providers also can evaluate beneficiaries who have audio phones only
  • Providers can bill for telehealth visits (provided by a clinician that is allowed to provide telehealth) at the same rate as in-person visits:
    • Emergency department visits
    • Initial nursing facility and discharge visits
    • Home visits
    • Therapy services
    • Clinicians who see patients in inpatient rehabilitation facilities, hospice and home health.
  • Clinicians can provide remote patient monitoring services to patients with acute and chronic conditions (e.g., remote patient monitoring of patient’s oxygen saturation levels using pulse oximetry)
  • Physicians can supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.

Additional CMS resources

Background on waivers and rule changes
 https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient
Information on COVID-19 waivers and guidance and the Interim Final Rule
https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers
White House Coronavirus Task Force efforts www.coronavirus.gov.
For a complete and updated list of CMS actions, and other information specific to CMS, visit the Current Emergencies Website.