CMS Suspends Additional Rules to Promote Provider Staffing Surge

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Original story posted on: April 10, 2020

The move comes on the heels of other regulations also being suspended amid the COVID-19 pandemic.  

The Centers for Medicare & Medicaid Services (CMS) has temporarily suspended a series of rules in order to allow healthcare facilities nationwide to bolster their medical staffs, federal officials announced Thursday.

Specifically, the move reduces supervision and certification requirements for doctors, nurses, and clinicians, allowing new staff to be “hired quickly and perform work to the fullest extent of their licenses,” CMS said in a press release.

“It’s all hands on deck during this crisis,” CMS Administrator Seema Verma said in a statement. “All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic.”

The decision came after the federal agency has “continuously examined its regulations to identify areas where federal requirements may be more stringent than state laws and requirements,” CMS explained in a press release, adding that the move was made explicitly to help facilities handle an expected influx of COVID-19 cases. The number of confirmed cases in the U.S. surpassed 467,000 on Friday, with deaths topping 16,700.

“Hospitals and health systems throughout the U.S. are seeing increases in patient volumes, leading to significant challenges in delivering vital services,” CMS said in its press release. “Allowing clinicians to practice to the full scope of their licenses is critical to address staffing needs during the public health emergency.”

Specifically, the move by CMS means that:  

  • Doctors can now care for patients at rural hospitals directly, across state lines if necessary, via phone, radio, or online communication, without having to be physically present; by coordinating with nurse practitioners at rural facilities, it is expected that this will provide staffs at such facilities additional flexibility to meet the needs of patients.
  • Nurse practitioners, in addition to physicians, may now perform some medical exams on Medicare patients at Skilled Nursing Facilities (SNFs) so that patient needs can be met, whether COVID-19-related or not.
  • Occupational therapists from home health agencies can now perform initial assessments on certain homebound patients, allowing home health services to begin sooner and freeing home-health nurses to perform more direct patient care.
  • Hospice nurses will be relieved of hospice aide in-service training tasks so they can spend more time with patients.

The new changes take effect immediately and apply to a range of other healthcare settings, including Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Home Health Agencies (HHAs). They follow several similar moves; in recent weeks, for example, CMS also has temporarily:

  • Permitted physicians whose privileges are about to expire to continue practicing in the hospital setting, and allowed new physicians to begin working prior to full hospital medical staff/governing body review and approval;
  • Lifted regulatory requirements regarding hospital personnel qualified to perform specific respiratory care procedures;
  • Waived federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants so they can work at rural hospitals as long as they meet state licensure requirements;
  • Allowed physicians and non-physician practitioners to use telehealth technology to care for patients at long-term care facilities, rather than having to treat patients in person;
  • Waived certain training and certification requirements for nurse’s aides at long-term care facilities, to help address potential staffing shortages; and
  • Waived paperwork requirements so that hospital doctors can use more verbal rather than written medical orders.

For a complete list of workforce flexibilities that CMS has permitted, go online to https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

For a fact sheet detailing additional information on the waivers announced today and previously, go to: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

Programming Note: For the very latest regulatory news and information concerning COVID-19 listen to Monitor Mondays this coming Monday at 10 a.m. EST.

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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