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“Every day, heroic
nurses, doctors, and other healthcare workers are dedicating long hours to
their patients. This means sacrificing time with their families and risking
their very lives to care for coronavirus patients,” said CMS Administrator
Seema Verma. “Front line healthcare providers need to be able to focus on
patient care in the most flexible and innovative ways possible. This
unprecedented temporary relaxation in regulation will help the healthcare
system deal with patient surges by giving it tools and support to create
non-traditional care sites and staff them quickly.”
Other temporary CMS
waivers and rule changes dramatically lessen administrative burdens, knowing
that front line providers will be operating with high volumes and under
extraordinary system stresses.
CMS recently approved
hundreds of waiver requests from healthcare providers, state governments,
and state hospital associations in the following states: Ohio; Tennessee;
Virginia; Missouri; Michigan; New Hampshire; Oregon; California;
Washington; Illinois; Iowa; South Dakota; Texas; New Jersey; and North
Carolina. With today’s announcement of blanket waivers, other states and
providers do not need to apply for these waivers and can begin using the
flexibilities immediately.
Administrator Verma
added that she applauds the March 23, 2020, pledge by America’s Health
Insurance Plans (AHIP) to match CMS’s waivers for Medicare beneficiaries in
areas where in-patient capacity is under strain. “It’s a terrific example
of public-private partnership and will expand the impact of Medicare’s
changes,” Verma said.
CMS’s temporary actions
announced today empower local hospitals and healthcare systems to:
- Increase
Hospital Capacity – CMS Hospitals Without Walls:
CMS will allow
communities to take advantage of local ambulatory surgery centers that have
canceled elective surgeries, per federal recommendations. Surgery centers
can contract with local healthcare systems to provide hospital services, or
they can enroll and bill as hospitals during the emergency declaration as
long as they are not inconsistent with their State’s Emergency Preparedness
or Pandemic Plan. The new flexibilities will also leverage these types of
sites to decant services typically provided by hospitals such as cancer
procedures, trauma surgeries and other essential surgeries.
CMS will now temporarily
permit non-hospital buildings and spaces to be used for patient care and
quarantine sites, provided that the location is approved by the State and
ensures the safety and comfort of patients and staff. This will expand the
capacity of communities to develop a system of care that safely treats
patients without COVID-19, and isolate and treat patients with COVID-19.
CMS will also allow
hospitals, laboratories, and other entities to perform tests for COVID-19
on people at home and in other community-based settings outside of the
hospital. This will both increase access to testing and reduce risks of exposure.
The new guidance allows healthcare systems, hospitals, and communities to
set up testing sites exclusively for the purpose of identifying
COVID-19-positive patients in a safe environment.
In addition, CMS will
allow hospital emergency departments to test and screen patients for
COVID-19 at drive-through and off-campus test sites.
During the public health
emergency, ambulances can transport patients to a wider range of locations
when other transportation is not medically appropriate. These destinations
include community mental health centers, federally qualified health centers
(FQHCs), physician’s offices, urgent care facilities, ambulatory surgery
centers, and any locations furnishing dialysis services when an ESRD
facility is not available.
Physician-owned
hospitals can temporarily increase the number of their licensed beds,
operating rooms, and procedure rooms. For example, a physician-owned
hospital may temporarily convert observation beds to inpatient beds to
accommodate patient surge during the public health emergency.
In addition, hospitals
can bill for services provided outside their four walls. Emergency
departments of hospitals 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. New rules ensure that patients can be
screened at alternate treatment and testing sites which are not subject to
the Emergency Medical Labor and Treatment Act (EMTALA) as long as the
national emergency remains in force. This will allow hospitals, psychiatric
hospitals, and critical access hospitals (CAHs) to screen patients at a
location offsite from the hospital’s campus to prevent the spread of
COVID-19.
- Rapidly
Expand the Healthcare Workforce:
Local private practice
clinicians and their trained staff may be available for temporary
employment since nonessential medical and surgical services are postponed
during the public health emergency. CMS’s temporary requirements allow
hospitals and healthcare systems to increase their workforce capacity by
removing barriers for physicians, nurses, and other clinicians to be
readily hired from the local community as well as those licensed from other
states without violating Medicare rules.
These healthcare workers
can then perform the functions they are qualified and licensed for, while
awaiting completion of federal paperwork requirements.
CMS is issuing waivers
so that hospitals can use other practitioners, such as physician assistants
and nurse practitioners, to the fullest extent possible, in accordance with
a state’s emergency preparedness or pandemic plan. These clinicians can
perform services such as order tests and medications that may have
previously required a physician’s order where this is permitted under state
law.
CMS is waiving the
requirements that a certified registered nurse anesthetist (CRNA) is under
the supervision of a physician. This will allow CRNAs to function to the
fullest extent allowed by the state, and free up physicians from the supervisory
requirement and expand the capacity of both CRNAs and physicians.
CMS also is issuing a
blanket waiver to allow hospitals to provide benefits and support to their
medical staffs, such as multiple daily meals, laundry service for personal
clothing, or child care services while the physicians and other staff are
at the hospital and engaging in activities that benefit the hospital and
its patients.
CMS will also allow
healthcare providers (clinicians, hospitals and other institutional
providers, and suppliers) to enroll in Medicare temporarily to provide care
during the public health emergency.
- Put
Patients over Paperwork:
CMS is temporarily
eliminating paperwork requirements and allowing 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.
During the public health
emergency, hospitals will not be required to have written policies on
processes and visitation of patients who are in COVID-19 isola
CMS is providing
temporary relief from many audit and reporting requirements so that
providers, healthcare facilities, Medicare Advantage health plans, Medicare
Part D prescription drug plans, and states can focus on providing needed
care to Medicare and Medicaid beneficiaries affected by COVID-19.
This is being done by
extending reporting deadlines and suspending documentation requests which
would take time away from patient care.
- Further
Promote Telehealth in Medicare:
Building on prior action
to expand reimbursement for telehealth services to Medicare beneficiaries,
CMS will now allow for more than 80 additional services to be furnished via
telehealth. During the public health emergencies, individuals can use
interactive apps with audio and video capabilities to visit with their
clinician for an even broader range of services. Providers also can
evaluate beneficiaries who have audio phones only.
These temporary changes
will ensure that patients have access to physicians and other providers
while remaining safely at home.
Providers can bill for
telehealth visits at the same rate as in-person visits. Telehealth visits
include emergency department visits, initial nursing facility and discharge
visits, home visits, and therapy services, which must be provided by a
clinician that is allowed to provide telehealth. New as well as established
patients now may stay at home and have a telehealth visit with their
provider.
CMS is allowing
telehealth to fulfill many face-to-face visit requirements for clinicians
to see their patients in inpatient rehabilitation facilities, hospice and
home health.
CMS is making it clear
that clinicians can provide remote patient monitoring services to patients
with acute and chronic conditions, and can be provided for patients with
only one disease. For example, remote patient monitoring can be used to
monitor a patient’s oxygen saturation levels using pulse oximetry.
In addition, CMS is
allowing physicians to supervise their clinical staff using virtual
technologies when appropriate, instead of requiring in-person presence.
These actions, and
earlier CMS actions in response to COVID-19, are part of the ongoing White
House Coronavirus Task Force efforts. To keep up with the important work
the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete
and updated list of CMS actions, and other information specific to CMS,
please visit the Current Emergencies Website.
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