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Hospitals can bill for treatment outside their four walls in new regulatory flexibility

CMS is also allowing ERs to use drive-through testing and telehealth, and for tests to be done at home for stay-at-home residents.

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services is temporarily removing regulatory requirements to give hospitals a greater ability to treat an influx of patients with COVID-19 while they also treat those needing other care.

The changes apply immediately for the duration of the emergency declaration.


Under the new hospitals without walls strategy, hospitals will be able to create new treatment sites in areas such as dormitories, gymnasiums, ambulatory surgery centers, inpatient rehabilitation hospitals, hotels and dormitories.

This will allow hospitals to treat patients without COVID-19 at one site and isolate and treat COVID-19 patients needing acute care in their main facility.

Services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries can be provided at these non-hospital sites.

Hospitals can bill for the services provided outside of their four walls. Ambulatory surgical centers will receive reimbursement at the hospital rate.

Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration.

Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms and procedure rooms. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surge.

Ambulances will be able to transport between various sites, such as doctors' offices, urgent care facilities, community mental health centers, federally qualified health centers, ambulatory surgery centers and any locations furnishing dialysis services when an ESRD facility is not available.


CMS will allow hospital emergency departments to test and screen patients for COVID-19 at drive-through and off-campus test sites.

CMS will also allow hospitals, laboratories and other entities to perform tests for COVID-19 on people at home. Medicare will pay for lab companies to collect samples in people's homes and nursing homes.

Over 150 nursing homes have been infected by the coronavirus, Administrator Seema Verma said.


Building on prior action to expand reimbursement for telehealth services, CMS will now allow for more than 80 additional services to be furnished via telehealth.

Individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.

Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, all of which must be provided by a clinician who is allowed to provide telehealth.

Hospitals can use telehealth to triage patients. Emergency room doctors will be paid for virtual ER visits. Emergency departments can use telehealth services to quickly assess patients to determine the most appropriate site of care, thus freeing emergency space for those that need it most, CMS said.

Providers can bill for telehealth visits at the same rate as in-person visits.

Telehealth is also available for hospice and home health for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.

Clinicians can provide remote patient-monitoring services to patients who have only one disease. For example, remote patient-monitoring can be used to monitor a patient's oxygen saturation levels using pulse oximetry.

In addition, CMS is allowing physicians to supervise their clinical staff using virtual technologies when appropriate.


New rules allow hospitals to support physician practices by transferring critical equipment, including items used for telehealth, as well as providing meals and childcare for their healthcare workers.

Local private practice clinicians and their trained staff may be available for temporary employment, since nonessential medical and surgical services are postponed during the public health emergency.

CMS's temporary requirements allow hospitals and healthcare systems to increase their workforce capacity by removing barriers for physicians, nurses and other clinicians to be readily hired from the local community, as well as those licensed from other states, without violating Medicare rules.

These healthcare workers can then perform the functions they are qualified and licensed for while awaiting completion of federal paperwork requirements.

CMS is issuing waivers so that hospitals can use other practitioners, such as physician assistants and nurse practitioners, to the fullest extent possible, in accordance with a state's emergency preparedness or pandemic plan. These clinicians can perform services such as ordering tests and medications that may have previously required a physician's order where this is permitted under state law.

CMS is waiving the requirements that a certified registered nurse anesthetist is under the supervision of a physician. This will allow CRNAs to function to the fullest extent allowed by the state, and free up physicians from the supervisory requirement.

CMS also is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staff, such as multiple daily meals, laundry service for personal clothing and childcare services while the physicians and other staff are at the hospital.

CMS will also allow healthcare providers to enroll in Medicare temporarily to provide care during the public health emergency.


CMS is temporarily eliminating paperwork requirements. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need. Previously, Medicare only covered them under certain circumstances. 

During the public health emergency, hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation. Hospitals will also have more time to provide patients a copy of their medical record.

CMS is providing temporary relief from many audit and reporting requirements by extending reporting deadlines and suspending documentation requests.


These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts.

CMS recently approved hundreds of waiver requests from healthcare providers, state governments and state hospital associations in the following states: Ohio, Tennessee, Virginia, Missouri, Michigan, New Hampshire, Oregon, California, Washington, Illinois, Iowa, South Dakota, Texas, New Jersey and North Carolina.

Today's blanket waivers require no application process for providers to begin using the flexibilities immediately.

Administrator Verma added that she applauds the March 23 pledge by America's Health Insurance Plans to match CMS's waivers for Medicare beneficiaries in areas where inpatient capacity is under strain.


"Every day, heroic nurses, doctors, and other healthcare workers are dedicating long hours to their patients. This means sacrificing time with their families and risking their very lives to care for coronavirus patients," said CMS Administrator Seema Verma. "Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible. 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."

Twitter: @SusanJMorse
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