Regulatory Requirements

Regulatory Requirements | 04.03.20

CMS Provides Hospitals Flexibilities to Support COVID-19 Efforts

By NAMSS Staff

This blog was originally posted on NAMSS Insights: A Blog for Medical Services Professionals.

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)
- 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.
- Paperwork Reduction
  - Waives certain paperwork requirements for hospitals facing significant strain from COVID-19.
  - See CMS guidance for the specific waived requirements.
- 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.
- 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.
- Critical Access Hospital Length-of-Stay
  - Waives the 25 CAH-bed requirement.
  - Lifts the 96-hour length-of-stay requirement.
- 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.
- 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.
- 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
- Grants facilities flexibility for verbal orders.
- Maintains read-back verification requirements but extends the authentication requirement to 48 hours.
Reporting Requirements
- Extends the time period hospitals have to report intensive-care patient deaths who required soft-wrist restraints.
- Increases the reporting period to close of the next business day.
Limit Discharge Planning for Hospital and CAHs
- Waives certain requirements regarding discharge planning and care goals.
- 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
- Waives requirements to establish emergency preparedness communication policies.
- Lifts requirements to provide contact information for staff, entities providing services under arrangement, practitioners, and volunteers.
Provider Enrollment
- Makes available toll-free hotlines for providers.
- Waives certain screening requirements, postpones all revalidation actions, and expedites pending or new provider applications.

Workforce

Medical Staff Requirements
- Waives COPs to allow physicians with expiring privileges to continue practicing at their current facilities.
- Enables new physicians to start practicing in a hospital before medical staff or governing body approval to help meet patient surges.
Physician Services
- Lifts requirements that Medicare patients be under a physician’s care.
- Enables physician’s assistants and nurses to help meet patient surges.
Anesthesia Services
- Lifts current nurse anesthetist supervision requirements and permits facilities to set temporary supervision parameters, in accordance with applicable state law.
- Allows nurse anesthetists to function at the fullest extent of their licenses, as it complies with facilities’ activated emergency plans.
Respiratory Care Services
- Waives requirement that facilities designate in writing qualified personnel to perform specific respiratory-care procedures and their appropriate supervision levels.
- Requires state and activated emergency plan alignment.
CAH Personnel Qualifications
- Waives federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants.
- The above practitioners must still meet state-licensure requirements and scope parameters.
CAH Staff Licensure
- 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.
- Defers all licensure, certification, and registration requirements for CAH staff to the state.