CMS Issues a Series of Updated Guidance Documents

Recently, CMS issued a series of updated guidance documents based on CDC guidelines to address a variety of issues. This guidance affects a broad range of providers, including hospitals, Critical Access Hospitals (CAHs), psychiatric hospitals, Ambulatory Surgical Centers (ASCs), Community Mental Health Centers (CMHCs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Outpatient Physical Therapy or Speech Pathology Services (OPTs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs), and Psychiatric Residential Treatment Facilities (PRTFs). These waivers are in effect with a retroactive effective date of March 1, 2020, and remain effective through the end of the emergency declaration.

For hospitals and CAHs, CMS is waiving the enforcement of the medical screening requirement of EMTALA, allowing hospitals to screen patients at a location offsite from the hospital’s campus as long as the national emergency remains in force and screening patients at a location offsite is not inconsistent with a state’s emergency preparedness or pandemic plan. CMS has also waived requirements regarding organization and staffing of the medical records department and record retention requirements and now provides flexibility in the 30-day requirement to complete records after discharge in order to allow clinicians to focus on patient care. Additionally, these guidelines make it easier for telemedicine services to be furnished to hospital patients through an agreement with an off-site hospital. In addition, the guidance document provides expanded recommendations on screening and visitation restrictions, discharge to subsequent care locations for patients with COVID-19, recommendations related to staff screening and testing, and return-to-work policies.

For long term care facilities and skilled nursing facilities (SNF), CMS is waiving the requirement for a 3-day prior hospitalization for coverage and also authorizes renewed SNF coverage for a beneficiary who recently exhausted SNF benefits without first having to start a new benefit period. The requirement that residents participate in in-person resident groups is waived to allow the SNF to restrict in-person meetings to comply with social distancing. CMS is also waiving the requirement for physicians and non-physician practitioners to perform in-person visits and allowing those visits to be conducted, as appropriate, via telehealth options.

Additionally, the guidance includes instructions for dialysis facilities protecting patients with end-stage renal disease. These patients are some of the most vulnerable to complications arising from COVID-19, given their immunocompromised state and need for frequent trips to health care facilities. CMS is, therefore, waiving the requirements that require periodic monitoring of the patient’s home dialysis treatment, including requirements that facility personnel visit the patient’s home. CMS also now allows dialysis facilities to provide service to patients in the nursing home or skilled nursing facility rather than at the dialysis facility. These temporary changes allow facilities to treat these vulnerable patients in separate locations. These guidelines also waive requirements to allow residents with respiratory illness/symptoms and/or residents with a confirmed COVID-19 diagnosis to be separate from other asymptomatic residents (i.e., waiving the requirement to provide for a resident to share a room with his or her roommate of choice).

This guidance is designed to allow local hospitals and healthcare systems to expand their capacity to treat patients and provide flexibility in responding to the COVID-19 pandemic. We will continue to monitor the latest CMS updated regulations and guidance. In the interim, to view these latest updates, click here.