These issuances will remain in effect throughout the COVID-19 Public Health Emergency. The following may affect your medical staffs:
• CMS Hospital without Walls (Temporary Expansion Sites)
o Conditions of Participation Modifications
§ Enables ambulatory surgery centers to provide hospital services to help meet patient volume.
§ Grants freestanding emergency departments a pathway for treating patients during the declared emergency.
o Paperwork Reduction
§ Waives certain paperwork requirements for hospitals facing significant strain from COVID-19.
§ See CMS guidance for the specific waived requirements.
o Physical Environment
§ Allows designated health systems to use offsite, non-hospital buildings such as hotels and community facilities for patient care, room and board, and other patient services.
§ Enables facilities to separate non-COVID-19 patients to reduce exposure.
o Temporary Expansion Sites
§ Waives certain COP requirements to allow provider-based departments to establish and operate as a hospital.
§ Enables hospitals to change their provider-based department location status to meet patient needs in a specific area.
o Critical Access Hospital Length-of-Stay
§ Waives the 25 CAH-bed requirement.
§ Lifts the 96-hour length-of-stay requirement.
o CAH Status and Location
§ Lifts the CAH rural-area stipulation to help meet patient surge.
§ Removes location parameters so CAHs can help with surge capacity.
o Hospital Acute-Care Patients in Excluded Distinct Part Units
§ Allows acute-care facilities to house acute-care patients in excluded distinct-part units, as appropriate.
§ Provides documentation guidance via the applicable patients’ medical records.
§ Modifies hospital and CAH telemedicine conditions to expand telehealth services.
§ Enables patients to receive telehealth care through agreements with off-site hospitals.
Patients over Paperwork
• Verbal Orders
o Grants facilities flexibility for verbal orders.
o Maintains read-back verification requirements but extends the authentication requirement to 48 hours.
• Reporting Requirements
o Extends the time period hospitals have to report intensive-care patient deaths who required soft-wrist restraints.
o Increases the reporting period to close of the next business day.
• Limit Discharge Planning for Hospital and CAHs
o Waives certain requirements regarding discharge planning and care goals.
o Facilities should work with patients, families, or patient representatives to select post-acute care providers by using and sharing data with post-acute entities.
• Emergency Preparedness Policies and Procedures
o Waives requirements to establish emergency preparedness communication policies.
o Lifts requirements to provide contact information for staff, entities providing services under arrangement, practitioners, and volunteers.
• Provider Enrollment
o Makes available toll-free hotlines for providers.
o Waives certain screening requirements, postpones all revalidation actions, and expedites pending or new provider applications.
• Medical Staff Requirements
o Waives COPs to allow physicians with expiring privileges to continue practicing at their current facilities.
o Enables new physicians to start practicing in a hospital before medical staff or governing body approval to help meet patient surges.
• Physician Services
o Lifts requirements that Medicare patients be under a physician’s care.
o Enables physician’s assistants and nurses to help meet patient surges.
• Anesthesia Services
o Lifts current nurse anesthetist supervision requirements and permits facilities to set temporary supervision parameters, in accordance with applicable state law.
o Allows nurse anesthetists to function at the fullest extent of their licenses, as it complies with facilities’ activated emergency plans.
• Respiratory Care Services
o Waives requirement that facilities designate in writing qualified personnel to perform specific respiratory-care procedures and their appropriate supervision levels.
o Requires state and activated emergency plan alignment.
• CAH Personnel Qualifications
o Waives federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants.
o The above practitioners must still meet state-licensure requirements and scope parameters.
• CAH Staff Licensure
o Defers all staff licensure, certification, or registration to state law by waiving COP requirements that staff be licensed, certified, or registered in compliance with federal, state, and local laws.
o Defers all licensure, certification, and registration requirements for CAH staff to the state.
The CMS COVID-19 site provides more information on the above modifications, as well as other facility modifications.
Additional CMS Guidance: