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:
