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The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) has announced a set of sweeping regulatory changes and waivers to give healthcare providers maximum flexibility to treat patients during the 2019 Novel Coronavirus pandemic. The new changes will allow healthcare providers to act as healthcare delivery coordinators in their areas.
The temporarily changes will ease restrictions are intended to create hospitals without walls, which will make it easier for hospitals and health systems to cope with an expected massive increase in COVID-19 patients over the coming weeks.
Under normal circumstances, federal restrictions require hospitals to provide medical services within their existing facilities, but this will cease to be possible as patient numbers increase. As the number of COVID-19 cases grow, hospitals will soon reach capacity. If they do not develop additional sites to provide treatment to patients, they will be overwhelmed.
To ensure all patients can receive treatment and no one is left behind, the CMS has relaxed restrictions and has issued temporary new rules that will allow treatment to be provided in other locations. Many ambulatory surgery centers have taken the decision to cancel elective procedures during the public health emergency. Hospitals and health systems would be permitted to use those locations along with inpatient rehabilitation hospitals, and even hotels and dormitories, and would still be eligible to receive reimbursement for services under Medicare. The new locations could be used to provide medical services to non-COVID-19 patients to free up inpatient beds for COVID-19 patients that require intensive care and respirators.
The CMS explained that ambulatory surgery centers have two options. They can either contract with local healthcare systems to provide services on behalf of the hospital or they can enroll and bill CMS as hospitals during the public health emergency declaration, provided that is not in conflict with their State’s Emergency Preparedness or Pandemic Plan. Healthcare providers will not be permitted to operate outside of organized plans at the local level.
To further increase capacity, the CMS has issued a waiver that will allow doctor-owned hospitals to increase the number of beds without facing sanctions. Hospitals are permitted to set up drive-through screening centers for COVID-19, use off-campus testing sites, and coverage will be given to laboratory technicians who need to travel to a Medicare beneficiary’s home to collect samples to perform COVID-19 testing. CMS will be providing additional reimbursement for ambulances, which are likely to be required to transfer patients between healthcare facilities and doctor’s surgeries to ensure they receive the treatment they need. Medicare coverage for respiratory-related devices and equipment has now been extended to cover any medical reason.
Changes have also been made to facilitate the rapid expansion of the healthcare workforce. These changes include making it easier for providers to enroll in Medicare and allowing teaching hospitals to have medical residents provide services under the supervision of a teaching physician. The CMS has also issued a blanket waiver to allow hospitals to provide more benefits to support their medical staff, including multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital providing patient care.
Changes have also been made to ease the administration burden on healthcare providers with the CMS putting patients above paperwork by eliminating paperwork requirements to ensure that clinicians can spend more time treating patients.
The CMS has previously announced that there is additional flexibility for the provision of telehealth services, with reimbursement now being provided for all Medicare beneficiaries in all areas. Coverage is now included for more than 80 additional services provided through telehealth, as long as those services are provided by clinicians allowed to provide telehealth services.
These new changes and waivers are only temporary and will last for the duration of the national public health emergency for COVID-19, after which the CMS will evaluate how best to return to the current system.