April 1, 2020
In an effort to allow healthcare providers to focus on patient care during the COVID-19 emergency, the Centers for Medicare & Medicaid Services (“CMS”) further relaxed regulations and administrative burdens by providing for additional 1135 waivers and temporarily amending regulations during the pandemic. These waivers and changes have a retroactive effective date of March 1, 2020 through the end of the emergency declaration and do not require a waiver request to be made to any of CMS’s regional offices. Below is a general overview of certain of the March 30, 2020 published waivers:
Hospital/Health Care Facility Capacity Actions
- Non-hospital buildings are now temporarily permitted to be used as patient care and quarantine spaces. These buildings can be used as long as they are approved by the State and they ensure the comfort of patients and staff.
- Ambulatory surgery centers (“ASCs”) that have cancelled all elective procedures can contract with local healthcare systems to provide hospital services, or they can enroll and bill as a hospital during the emergency as long as that is not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. This will allow ASCs to provide services such as cancer procedures, trauma surgeries and other essential procedures.
- Hospitals, laboratories and other entities can test for COVID-19 on patients at home and in community-based areas.
- Hospital emergency departments may test for COVID-19 in drive-through and off-campus test sites.
- Physician-owned hospitals may temporarily increase the number of licensed beds, operating rooms and procedure rooms during the emergency.
- Ambulances may transport patients to a wider range of locations when other transportation is not medically appropriate, including to physician offices, urgent care facilities and ASCs.
- Hospitals can bill for services outside of their four walls and may establish and operate as part of the hospital any location meeting those conditions of participation for hospitals that continue to apply during the COVID-19 emergency. This waiver also allows hospitals to change the status of their current provider-based department locations to the extent necessary to address the needs of hospital patients as part of the state or local pandemic plan. Under an additional initiative, CMS will allow currently enrolled ASCs to temporarily enroll as hospitals and to provide hospital services. Other interested entities such as freestanding emergency departments could pursue enrolling as an ASC and then pursue converting their enrollment to a hospital during the public health emergency. For more information, please visit here.
- Emergency departments can also use telehealth services to assess the most appropriate site of care for a patient.
- Patients can be screened at an alternate treatment and testing site that is not subject to EMTALA as long as the national emergency remains in effect. This off-site screening will help prevent the further spread of COVID-19 to both healthcare workers and patients.
- Hospitals can now provide benefits to their medical staff, such as daily meals, laundry and child care services.
Physician/Provider-Focused Actions
- Private practice physicians and their staff may now be available for temporary employment in order to allow hospitals to hire outside physicians, and physicians and their staff to perform their duties in the hospital while waiting on federal paperwork.
- CMS has temporarily waived the requirement that a certified registered nurse anesthetist (“CRNA”) needs to be supervised by a physician. CRNA supervision will be at the discretion of the hospital and state law. This waiver applies to hospitals, critical access hospitals and ASCs.
- Hospitals can now provide benefits to their medical staff, such as daily meals, laundry and child care services.
- Providers may temporarily enroll in Medicare to provide services to patients during this emergency.
Further Telehealth Expansion Actions
- More than eighty additional services can now be provided via telehealth. Both new and current patients may stay at home and use apps with audio and visual technology to connect with their provider for a broader range of services. For a list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth, please visit here.
- These telehealth visits can be billed at the same rate as in-person visits by providers. Telehealth visits include certain emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services.
- Physicians may supervise their staff via virtual means if appropriate, rather than having to supervise in-person.
- Clinicians can provide remote patient monitoring services to patients with acute and chronic conditions.
- For more information on these topics, including provider-specific fact sheets, please visit the CMS page here.
