Using its authority granted under Section 1812(f) of the Social Security Act, CMS has issued several new Section 1135 blanket waivers to waive or modify certain Medicaid, Medicare, CHIP, or HIPAA requirements when a federal emergency has been declared. The new waivers focus on expanding staff and giving healthcare facilities more flexibility to organize staff in a way that will allow key personnel to effectively respond to the potential surge in patients. These new waivers are now in effect with a retroactive effective date of March 1, 2020 and will last until the emergency declaration ends. To receive a blanket waiver, no request is required, and providers do not need to notify the CMS regional offices. These new waivers come after CMS issued several blanket waivers last month. A summary of the waivers issued on March 30 is available here.
CMS has updated its website to include these additional waivers with a comprehensive list of all blanket waivers available here.
Rural Health Clinics and Federally Qualified Health Centers
A new blanket waiver modifies the nurse practitioner supervision requirements at Rural Health Clinics and Federally Qualified Health Centers, permitting nurse practitioners to practice without medical supervision to the extent permitted by state law. However, physicians are still responsible for providing medical direction to the clinics but may do so remotely. Physicians are also permitted to work across state lines to provide care directly for rural hospital patients, using phone, radio, or online communication. Physicians are not required to be physically present with the patient at the rural clinic, allowing remotely-located physicians to coordinate with on-site nurse practitioners. This waiver permits nurse practitioners to practice to the full extent possible while allowing physicians to turn their attention to other demands. To address potential staffing shortages, CMS is also waiving the requirement that nurse practitioners, physician assistants, and nurse-midwives be available to provide care at least half the time that the rural health clinic operates.
Long-Term Care Facilities and Skilled Nursing Facilities (SNFs)
Nurse practitioners, physician assistants, and clinical nurse specialists are now permitted to perform certain physician-delegated tasks on SNF patients that previously required a physician’s presence. However, any physician who delegates a task must continue to provide supervision and physicians may not delegate tasks that are prohibited under state law or the facility’s policy. Further, physicians may delegate physician visits to nurse practitioners, physician assistants, or clinical nurse specialist who work with the physician as long as the task does not require the assistant to perform any service that is outside of the state’s scope of practice law. Given these new flexibilities it is important to note that the number of required physician visits has not changed under these waivers, even if an assistant may perform these visits. The purpose of these waivers is to ensure that SNF patients continue to receive care when physician resources are strained to meet the demands of the COVID-19 pandemic.
Home Health Agencies (HHAs)
HHAs are now allowed to perform Medicare-covered initial assessments to determine an individual’s homebound status either by record review or remote assessment. Occupational therapists at home health agencies are also allowed to perform initial assessments on all patients who are receiving therapy services—not just occupational therapy services—as a part of the patient’s plan of care. In addition, CMS is waiving the bi-weekly, on-site nurse visit requirement so long as in the nurse’s absence an aide is providing care consistent with the patient care plan. These new waivers are intended to relieve home health nurses and give them more time to perform direct patient care.
Hospices
Under the new waiver, hospice nurses are no longer required to perform hospice aide in-service training tasks, giving them more time to spend with patients. Another hospice-focused waiver waives bi-weekly, on-site nurse supervisory visits. Under these newly-issued waivers, hospices are also no longer required to use volunteers for at least 5% of patient-care hours because of the potentially limited availability of volunteers during quarantine. These waivers are intended to alleviate staffing pressures and allow hospices to operate with limited staff and volunteers.
