CMS provides regulatory relief on staffing, paperwork as COVID-19 cases surge

hospital
The Centers for Medicare & Medicaid Services released a raft of regulatory changes to help hospital and health systems meet the COVID-19 outbreak, including changes focused on expanding hospital capacity and staff. (Pixabay)

The Trump administration released a raft of regulatory changes intended to bolster hospitals including setting up alternative sites of care and methods to rapidly boost healthcare workers.

The Centers for Medicare & Medicaid Services (CMS) outlined the changes Monday that will continue through the duration of the COVID-19 emergency declaration. CMS got the authority to make the changes through President Donald Trump's emergency declaration and emergency rule-making.

“This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly,” CMS Administrator Seema Verma said in a statement Monday.

The regulatory changes include:

  • Increasing hospital capacity. The agency will now temporarily permit non-hospital buildings and spaces to be used for patient care or quarantine sites, CMS said in a release. It also enables hospital emergency departments to test and screen patients in their parking lots. Some facilities have already set up screening sites in their parking lots, and New York has converted a convention center into a hospital. Physician-owned hospitals also can temporarily increase their number of licensed beds as well as operating or procedure rooms. Hospitals would also be able to bill Medicare just as normal in these alternative sites of care.
  • Boosting payments for ambulatory surgical centers. The centers can contract with a local health system to help provide hospital services, the agency said. However, any contract must be consistent with their state's emergency preparedness and pandemic plan. The surgery centers will get paid at the hospital level for any such services under the contract. "It will be paid in accordance with hospital fee schedule," Verma said on a call with reporters Monday.
  • Enabling hospitals to test COVID-19 people at home or in other settings outside a hospital. CMS said new guidance enables a system to set up a testing site “exclusively for the purpose of identifying COVID-19-positive patients in a safe environment.”
  • Removes barriers to boost workforce capacity. CMS outlined a series of changes to enable hospitals and healthcare systems to quickly hire more staff to meet the swell of COVID-19 cases.

The agency is issuing waivers to hospitals so that other practitioners such as physician assistants and nurse practitioners can perform services like order a test or medications that previously only a physician could order, permitting that this is allowed under state law.

CMS also will allow providers to enroll in Medicare temporarily during the emergency period.

  • Waiving requirements for nurse anesthetists. The waiver removes a requirement that nurse anesthetists need supervision by a physician. The goal is to free up the physicians to expand capacity.
  • Boosting benefits to healthcare workers. CMS allowed hospitals to provide benefits and support to healthcare workers that range from child care, laundry for personal clothes and multiple daily meals. A concern among providers has been how to take care of their children since schools across many states are closed.
  • Covering respiratory-related devices and equipment under Medicare. The agency is temporarily covering these services under Medicare to remove paperwork requirements for physicians.

“Previously Medicare only covered them under certain circumstances,” CMS said. Since the novel coronavirus is a respiratory disease, it has spiked demand for respirators and similar services.

  • Enabling Medicare to cover more than 80 telehealth services. CMS also allows providers to bill for telehealth visits at the same rate as in-person visits.

“During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services,” CMS said. “Providers also can evaluate beneficiaries who have audio phones only.”

This is the latest move by CMS to boost telehealth services as residents are staying at home to avoid infection from COVID-19.

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