Tuesday, April 28, 2020

CMS Recommendations on Non-Emergent Non-COVID-19 Health Services

The Centers for Medicare & Medicaid Services (CMS) issued updated guidance to healthcare providers “on providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with low and stable incidence of COVID-19.”  This guidance is a part of Phase 1 of the Trump Administration’s Guidelines for Opening Up America Again.

CMS recognizes the need to be flexible and to allow facilities in regions with low and stable COVID-19 incidences to provide non-emergent, non-COVID-19 healthcare to patients who need this care. When states or regions meet Opening Up America’s Gating Criteria for COVID-19 symptoms, cases, and hospital capacity they can begin to enter Phase I of the Administration’s Plan.

CMS encourages providers and patients to use virtual-care services, such as telehealth when appropriate, to limit COVID-19 exposure.

Stay connected by visiting NAMSS COVID-19 Response Page.

Guidelines for Reopening the Government

In mid-April, President Donald Trump recently released Guidelines for Opening Up America Again. The initiative provides gating criteria that states and regions can use to determine the appropriate time for states to begin taking steps to reopening businesses, schools, and public spaces. The plan enables state governors to decide when their states and regions within their states should begin reopening. Each phase of the Administration’s reopening plan includes guidelines for states, individuals, and employers.

The Opening Up America Gating Criteria requires states to meet the following milestones before beginning the phased re-opening process:

  • A downward trajectory in flu-like and COVID-like syndromic cases for 14 days;
  • A downward trajectory in COVID-19 cases over a 14-day period; and
  • Hospital capacity to provide crisis care and implement/activate

Stay connected by visiting NAMSS COVID-19 Response Page.

Friday, April 24, 2020

HHS Launches Telehealth Resource Site

HHS has launched a Telehealth site to provide guidance to patients and providers during the COVID-19 Public Health Emergency. The HHS Telehealth site’s patient page includes telehealth definitions, policies, and tips on navigating telehealth options. The provider page includes recommendations on integrating telehealth into practice, updates on COVID-19-related policy changes, and assistance on shifting processes to accommodate telehealth appointments. 

Stay connected by visiting NAMSS COVID-19 Response Page.

HHS Workforce Toolkit and Preparedness Gateway for Stakeholders

This week, the Health and Human Services Assistant Secretary of Preparedness and Response (ASPR) launched a COVID-19 Workforce Virtual Toolkit to help state and local healthcare decision makers expand workforce flexibilities during the COVID-19 pandemic. The Toolkit provides guidance for states on funding flexibilities, liability protections, workforce training, best practices, and peer-to-peer communication. It also helps states administer these flexibilities to increase frontline medical staff and care for patients at local hospitals, clinics, and other healthcare facilities. This effort is part of the ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE), a healthcare emergency preparedness information gateway that provides information and resources for stakeholders through participation in a public-private information sharing exchange that requires registration and approval. 

Stay connected by visiting NAMSS COVID-19 Response Page.

Thursday, April 16, 2020

HRSA Temporarily Waives NPDB Query Fees

Effective immediately, HRSA will waive National Provider Data Bank (NPDB) query fees through May 31, 2020 to help facilities respond to, and prepare for, the COVID-19 emergency.  HRSA will host two teleconferences to provide more information about the fee waiver on Thursday, April 16 and Thursday, April 23, 2020—both at 1pm EDT. 

This fee waiver is retroactive from March 1, 2020. HRSA will issue query credits to entities that have paid querying fees between March 1, 2020 and April 15, 2020. The Federal Register will post this official notice on Friday, April 17, 2020.

For more information about NPDB fee waivers, visit HRSA’s NPDB page. 
Stay up to date on NAMSS’ COVID-19 Response.

Wednesday, April 15, 2020

ECFMG/FAIMER Provide a Critical Role in Verifying IMGs

As states continue to waive certain licensure requirements and licensure renewal requirements to respond to the COVID-19 emergency, efforts to provide streamlined and appropriate verification are critical. To help verify international medical school certifications and has passed components of the U.S. Medical Licensing Examination, the Education Commission for Foreign Medical Graduates (ECFMG) is working to provide verification information on international physicians to states as quickly as possible.

ECFMG and its non-profit arm, the Foundation for Advancement of International Medical Education and Research (FAIMER), stands by as a resource for providing state medical licensing personnel information on IMG. Upon request, ECFMG will verify an IMG’s certification, provide basic identity verification and primary-source verification for a physician’s medical education credentials. The ECFMG/FAIMER can also verify provide previously verified credentials, as well as verify new credentials such as medical diplomas, transcripts, medical licenses, and registration certificates.

Contact ECFMG/FAIMER (casemanager@ecfmg.org) for verification assistance, USMLE exams, IMG credentials, and other inquires related to IMGs. ECFMG does not issue physician licenses and does not have information on physician eligibility for credentialing and/or privileging.

Stay up to date on state licensure waivers from FSMB.
Stay connected by visiting NAMSS COVID-19 Response Page.

Friday, April 10, 2020

The Joint Commission Provides a Follow-Up FAQ to its Homemade Face Masks Statement

On April 6, The Joint Commission posted an FAQ in response to their statement on homemade PPE. The FAQ provides background and additional protocol for the Joint Commission’s position on healthcare workers using homemade PPE and on hospitals prioritizing N95 masks and N95 respirators for high-risk staff exposed to aerosolized viral particles.

The FAQ also provides additional prioritization guidance to help hospitals conserve N95 masks and other PPE for high-risk personnel.  

Visit the NAMSS COVID-19 Page for more MSP resources.

Thursday, April 9, 2020

Healthcare Groups Call Upon Federal Government to Address PPE and Medical Equipment Shortages

In late March, the Joint Commission, American College of Physicians, American Hospital Association, American College of Surgeons, American Medical Association, and the American Dental Association called upon the federal government to drastically increase PPE and other medical equipment production and distribution. In a public statement these groups state their concern with PPE, ventilators, swab kits, shortages, as well as overall testing capacity for COVID-19. These organizations represent frontline caregivers, institutions, and personnel who are at greater risks for COVID-19 exposure   and need more critical PPE immediately. The lack of PPE poses an additional risk to patients and caregivers compounded by the lack ventilators and other life-saving medical equipment, places healthcare facilities at a dangerous disadvantage against COVID-19. Efforts to increase PPE and medical-equipment production and distribution, as well as expands telehealth services are critical to preserving PPE and stopping the COVID-19 spread.  

Tuesday, April 7, 2020

Joint Commission Issues Statement on Homemade Personal Protective Equipment

On March 31, the Joint Commission released a statement supporting policies that permit healthcare workers to bring their own facemasks or respirators to work if their healthcare facilities cannot provide enough PPE to protect them from COVID-19 risks. The Joint Commission statement recognizes that:
  1. Hospitals must conserve PPEs during shortages for workers who perform high-risk procedures.
  2. Privately owned PPE’s full ability to protect hospital workers from COVID-19 is unknown, but may provide some degree of protection.
  3. The Joint Commission does not have standards or regulations prohibiting hospital staff from using homemade PPE. 
  4. Hospital workers should only use homemade masks when standard PPE is unavailable.
Read more about the evidence the Joint Commission used to develop this position.

Friday, April 3, 2020

CMS Provides Hospitals Flexibilities to Support COVID-19 Efforts

The Centers for Medicare and Medicaid Services (CMS) recently issued a series of waivers and modifications to help prepare and equip healthcare systems and workers to meet patient-demand resulting from COVID-19. These efforts seek equip hospitals for COVID-19 surges, expedites healthcare practitioner onboarding, and expands telehealth services, increases site-based COVID-19 testing, and reduces paperwork requirements.

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.
o   Telemedicine
§  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. 
Workforce
    •  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: