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Service
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CMS Waiver
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Anesthesia Services
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- Waiving the requirements that a certified registered nurse anesthetist (CRNA) work under the supervision of a physician; CRNA supervision will be at the discretion of the hospital and state law. 42 CFR §482.52(a)(5) and §485.639(c)(2).
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Appraisal of Emergencies at Off-Campus Hospital Departments
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- For surgical facilities, written policies and procedures for staff to use when evaluating emergencies are not required. 42 CFR §482.12(f)(3).
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Critical Access Hospitals
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Personnel Qualifications
- CMS is waiving the minimum personnel qualifications for clinical nurse specialists and physician assistants. 42 CFR §485.604(a)(2), §485.604(b)(1)–(3) and §485.604(c)(1)–(3).
Number of Beds and Lengths of Stay
- CAHs may have more than the usual 25 beds and patients may remain longer than the usual 96 hours. 42 CFR §485.620.
Physician Presence
- CMS is waiving the requirement for CAHs that a physician be physically present as long as the physician is available “through direct radio or telephone communication, or electronic communication for consultation, assistance with medical emergencies, or patient referral.” 42 CFR §485.631(b)(2).
Staff Licensure
- CMS is deferring staff licensure, certification or registration to state law. 42 CFR §485.608(d).
Status and Location
- CMS is allowing CAHs to establish non-rural, temporary locations by waiving the requirement that the CAH be located in a rural area, and allowing the CAH flexibility in establishing temporary off-site locations. 42 CFR §485.610(b) and (e).
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Discharge Planning
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- Hospitals, psych hospitals and CAHs need not comply with the usual discharge planning requirements which give patients (or families) the right to choose the necessary post-discharge care, ranging from home health through skilled nursing facilities and the like. The hospital must merely comply with requirements to discharge patients to an appropriate facility. 42 CFR §482.43 (a)(8), §482.43(c), §482.61(e) and §485.642(a)(8).
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Emergency Medicine
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- Hospitals, psychiatric hospitals and CAHs may screen patients at offsite locations to prevent the spread of COVID-19; this is a waiver of Section 1867(a) of the Emergency Medical Treatment & Labor Act (EMTALA)
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Emergency Preparedness Policies and Procedures
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- Hospitals and CAHs are exempt from requirements to develop and implement policies and procedures for both emergency preparedness and communications. 42 CFR §482.15(c)(1)–(5) and §485.625(c)(1)–(5).
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Extended Neoplastic Disease Care Hospitals
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- CMS is allowing these hospitals to exclude inpatient stays where they admit or discharge patients from the usual greater than 20-day average length of stay requirement. Section 1886(d)(1)(B)(vi) of the EMTLA and §42 CFR 412.22(i).
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Face Masks in Sterile Compounding Areas
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- Face masks may be removed, retained and re-donned during the same shift of work within sterile compounding areas. CMS will not review the use and storage of masks under these requirements. 42 CFR §482.25(b) and §485.635(a)(3).
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Food and Dietetic Services
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- Hospitals are exempt from the usual requirement that a current, approved therapeutic diet manual be readily available to all medical, nursing and food service personnel. Such manuals would not need to be maintained at surge capacity sites. 42 CFR §482.28(b)(3).
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Inpatient Rehab Facilities (IRFs)
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60% Rule
- CMS is allowing IRFs to exclude patients from the freestanding hospital’s or distinct part unit’s inpatient population for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF (commonly referred to as the “60% rule”) as long as the IRF admits a patient solely to respond to the COVID-19 emergency and the patient’s medical record properly identifies the patient as such.
Three-Hour Rule
- Per the CARES Act, the Secretary has waived the requirement of at least 15 hours of rehab therapy per week.
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Long-Term Care Hospitals (LTCH) – Supporting Care
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- CMS has issued a blanket waiver to long-term care hospitals (and applicants for LTCH status) to exclude patient stays where the facility admits or discharges patients in order to meet the demands of the emergency from the 25-day average length of stay requirement, which allows these facilities to be paid as LTCHs.
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Medical Records
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- CMS is waiving requirements for the organization and staffing of the medical records department, for the form, content, and the usual 30-day completion of the medical record, and for record retention requirements; these flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. 42 CFR §482.24(a)-(c).
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Medical Staff Privileges
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- Physicians whose privileges would have otherwise expired may continue to practice at their hospitals; new physicians may practice before the customary review by the credentialing committee, et al. 42 CFR §482.22(a)(1)-(4).
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Nursing Plans of Care – Nursing Services
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- CMS is waiving the requirements which requires the nursing staff to develop and keep current a nursing care plan for each patient, and §482.23(b)(7), which requires the hospital to have policies and procedures in place establishing which outpatient departments are not required to have a registered nurse present. 42 CFR §482.23(b)(4), (b)(7) and 635(d)(4).
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Patient Rights
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- For hospitals in areas CMS deems to be impacted by a widespread outbreak do not have to comply with the usual requirements for providing patients copies of their medical records, the hospital’s written policies regarding seclusion and/or visitation for COVID-19 patients. 42 CFR 482.13(d)(2), (e)(1)(iii) and (h).
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Physical Plant
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- Hospitals, psych hospitals, and CAHs may use non-hospital buildings and spaces for patient care and quarantine sites, provided that the location is approved by the state and so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan. 42 CFR §482.41 and §485.623.
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Physician Services to Medicare Patients
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- CMS is waiving requirements requiring that Medicare patients be under the care of a physician. This waiver may be implemented so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan. 42 CFR §482.12(c)(1)–(2) and §482.12(c)(4).
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Provision of Advanced Health Care Directive Information
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- Hospitals and CAHs are now exempt from the requirements to provide information about their advance directive policies to patients. §1902(a)(58) and 1902(w)(1)(A) of the Social Security Act (the Act) (for Medicaid), §(i) of the Act (for Medicare Advantage); and §1866(f) of the Act and 42 CFR §489.102 (for Medicare).
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Quality Assessment (QA) and Performance Improvement (PI) Program
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- CMS is waiving the regulations that require specific QA/PI programs; still, the requirement that hospitals and CAHs maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement program will remain. 42 CFR §482.21(a)–(d) and (f) and §485.641(a), (b) and (d).
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Reporting Deaths
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- Hospitals may now report the deaths of ICU patients who required soft wrist restraints (typically applied to prevent pulling out IV lines) within standard time limits (instead of the next business day). 42 CFR §485.13(g)(1)(i-ii).
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Respiratory Care
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- Hospitals are exempt from the requirement to designate in writing the personnel qualified to perform specific respiratory care procedures and the amount of supervision required for personnel to carry out specific procedures. 42 CFR §482.57(b)(1).
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Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
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Staffing Requirements
- CMS is waiving the requirement that a nurse practitioner, physician assistant or certified nurse-midwife be available to furnish patient care services at least 50% of the time the RHC and FQHC operates. 42 CFR 491.8(a)(6).
Physician Supervision of NPs in RHCs and FQHCs
- CMS has modified the requirement that physicians must provide medical direction to allow for telehealth and other remote communications. 42 CFR 491.8(b)(1).
Temporary Expansion Locations
- CMS will allow RHCs and FQHCs to operate in more than one permanent location without separate Medicare approval. 42 CFR §491.5(a)(1),(2),(3).
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Telemedicine
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- CMS is waiving the provisions related to telemedicine. 42 CFR §482.12(a)(8)–(9) for hospitals and §485.616(c) for CAHs.
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Temporary Expansion Locations
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- CMS will allow hospitals and Ambulatory Surgical Centers to establish and operate any location meeting those conditions of participation for hospitals that continue to apply during the public health emergency. This waiver allows hospitals to change the status of their current provider-based department locations to the extent necessary as part of the state or local pandemic plan so long as the relevant location meets the conditions of participation and other requirements not waived by CMS. 42 CFR §482.41 and §485.623.
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Utilization Review
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- CMS is waiving certain requirements which normally require that hospitals participating in Medicare and Medicaid must have a utilization review plan that meets specified requirements. 42 CFR §482.1(a)(3) and 42 CFR §482.30.
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Verbal Orders
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Hospitals will have greater flexibility to memorialize a physician’s verbal orders to the nursing staff.
Frequent Verbal Orders Now Permitted
- CMS is waiving the former prohibition on “frequent” verbal orders for drugs and biologicals. 42 CFR §482.23(c)(3)(i).
Verbal Orders Need Not be Signed By the Ordering Physician
- CMS is waiving the requirement for prompt timing, dating and signing of the verbal order by the ordering or attending physician. 42 CFR §482.24(c)(2).
Preprinted/Electronic Standing Orders May Be Used
- Hospitals may use standing orders, order sets and protocols for patient orders. 42 CFR §482.24(c)(3).
CAHs May Use Verbal Medication Orders Subsequently Co-Signed
- CAHs may administer medication based on a verbal orders which are authenticated “as soon as possible” after the fact. 42 CFR §485.635(d)(3).
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