CMS Announces New Waivers and Regulatory Changes

March 31, 2020

Late yesterday, the Centers for Medicare & Medicaid Services (CMS) announced new waivers and regulatory changes aimed at allowing hospitals to expand their capacity to treat more patients during the COVID-19 pandemic.

The new flexibilities include allowing ambulatory surgery centers (ASCs), hotels and convention centers to be repurposed to respond to the outbreak. A brief overview of these and other flexibilities is provided below. Additional details are available in a CMS fact sheet.

Hospitals Without Walls: Aimed at increasing hospital capacity, CMS is allowing hospitals and health systems to provide services in locations beyond their existing walls and develop sites dedicated to COVID-19 treatment. Among others, the following changes were announced: 

  • Hospitals may transfer patients to outside facilities, including ASCs, inpatient rehabilitation hospitals, hotels and dormitories, while still receiving payments under Medicare;
  • When end-stage renal disease (ESRD) facilities are unavailable, ambulances may transport patients to a wider range of locations including community mental health centers, federally qualified health centers, physician offices, ASCs, and other locations providing dialysis services; and
  • Emergency departments, under certain circumstances, may test and screen patients for COVID-19 at drive-through and off-campus test sites. Additionally, under certain circumstances, hospitals and other entities will be able to perform tests for COVID-19 for people at home and in other community-based settings.

Expansion of the Healthcare Workforce: Aimed at increasing the healthcare workforce, CMS announced numerous actions, including:

  • A blanket waiver allowing hospitals to provide benefits and supports to their medical staffs, such as meals, laundry service, childcare, and other services;
  • Private practice clinicians and their trained staff may be available for temporary employment while nonessential planned services are postponed during the pandemic;
  • Teaching hospitals have flexibility to allow medical residents to provide services under the direction of the teaching physician; and teaching physicians may now also provide supervision, during key portions of a procedure, using audio/video technology; and   
  • Wider use of verbal orders may be used by hospital doctors.

Patients Over Paperwork: Aimed at eliminating paperwork requirements and maximizing clinician time with patients, CMS announced actions, including:

  • Hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation;   
  • Hospitals will have additional time to provide patients with a copy of their medical record;   
  • Broader access for Medicare beneficiaries of respiratory devices and equipment; Medicare will also cover respiratory-related devices and equipment for any medical reason determined by clinicians; and   
  • Suspension of requests for additional information from providers, healthcare facilities and others.

Telehealth: CMS announced numerous actions to expand access to telehealth for Medicare beneficiaries to allow care in settings such as a patient’s home or a nursing home or assisted living facility. These actions include:

  • More than 80 additional services may be provided using telehealth, including emergency department visits, initial nursing facility and discharge visits, and home visits;
  • Providers may evaluate beneficiaries who only have audio phones;
  • Allowance of telehealth to fulfill numerous face-to-face visit requirements in inpatient rehabilitation facilities, hospice and home health;
  • Virtual Check-In services, or brief check-ins between a patient and their doctor, by audio or video devices may now be provided for both new and established patients; and
  • Clinicians can provide remote patient monitoring services for patients, no matter if it is for the COVID-19 disease or a chronic condition (e.g., to monitor a patient’s oxygen saturation levels using pulse oximetry).

For an overview of federal flexibilities provided by CMS, click here.