Coronavirus Update: March 31, 2020

Yesterday the federal Centers for Medicare & Medicaid Services (CMS) published a major update of Medicare and Medicaid regulations that included blanket waivers of a large number of Medicare and Medicaid regulations and requirements.  The following is a summary of the major aspects of this new regulation.

New Policies and Waivers From Medicare and Medicaid Regulations and Requirements

CMS has introduced dozens of changes that involve waivers from current regulations and requirements.  A comprehensive, 26-page CMS document describing these changes can be found here and below are the highlights organized into four broad categories:

• increasing hospital capacity (what CMS calls “hospitals without walls”)
• expanding the health care workforce
• increasing the use of telehealth in Medicare
• reducing paperwork

Increasing Hospital Capacity

• CMS is waiving the enforcement of section 1867(a) of EMTALA to permit hospitals to screen patients at off-site locations to help prevent the spread of COVID-19.
• CMS is waiving certain requirements under the Medicare conditions of participation allow for flexibilities during hospital and psychiatric hospital surges, permitting non-hospital buildings/space to be used for patient care and quarantine sites.
• For the duration of the public health emergency, CMS is waiving certain requirements under the

Coronavirus Update: March 30, 2020.  The following is the latest information from the administration and federal regulators as of 4:15 today.

The White House

• Vice President Pence has written to all hospitals asking them to provide to the Department of Health and Human Services daily statistics on all of their in-house COVID-19 testing and results.
• The White House has published its executive order on exercising the president’s authority under the Defense Production Act on matters involving health and medical resources.

Centers for Medicare & Medicaid Services

• CMS has posted a fact sheet explaining to health care provider how to apply for stimulus bill-authorized accelerated and advance Medicare payments during the COVID-19 crisis.  See a more detailed memo about this process.
• CMS has published a toolkit for long-term-care facilities to help them make better use of telehealth services during the COVID-19 national emergency.
• CMS’s Office of Civil Rights has published a bulletin addressing civil rights, HIPAA, and COVID-19.  The bulletin answers questions and points users to other resources.

Department of Health and Human Services

The HHS Office of Inspector General (OIG) published a statement regarding the discretion the OIG will employ when investigating any conduct during this …

The following is the latest information from Congress, federal regulators, and others as of 4:00 p.m. on Friday, March 27.

Congress

The House of Representatives passed the $2 trillion Coronavirus Aid, Relief, and Economic Security Act passed by the Senate late Wednesday.  It now goes to the president for his signature and he has indicated he will sign it.

The Administration

President Trump

President Trump sent a letter to governors thanking them for their efforts in fighting the COVID-19 emergency, outlining upcoming federal efforts, and expressing hope for the future.

Department of Health and Human Services

•  The Department of Health and Human Services has provided guidance to states asking them to take immediate action to waive restrictions on licensure, scope of practice, certification, and recertification/relicensure consistent with changes announced in federal programs.  See that guidance here.
• Secretary Azar sent a letter to governors requesting immediate action on a number of measures to help “extend the capacity of the health care workforce to address the pandemic.”
• The department’s Office of Family Assistance Services has posted an FAQ about TANF (the Temporary Assistance for Needy Families) program and COVID-19.

Centers for Medicare & Medicaid Services

CMS has issued guidance …

MedPAC has recommended to Congress changes in Medicare payment rates in the coming year.

In its annual report to Congress, the Medicare Payment Advisory Commission recommended the following rate changes:

acute-care hospitals – a two percent rate increase and a suggestion that the difference between this two percent increase and the payment increase specified by law be used to increase the rewards hospitals may earn under Medicare’s hospital value incentive program.  As a result, the value incentive program would offer a possible 0.8 percent in bonus payments, and with the recommended elimination of the 0.5 percent penalty for which hospitals are at risk, hospitals could average net increases of 3.3 percent.

• ambulatory surgical centers – no rate increase and a requirement that such facilities report cost data
• physicians – rates updated as already provided for by law
• long-term acute-care hospitals – a two percent increase
• inpatient rehabilitation facilities – a five percent rate reduction
• skilled nursing facilities – no rate increase
• dialysis facilities – rates updated as already provided for by law
• hospice services – no rate increase and the aggregate hospice cap should be wage-adjusted and reduced 20 percent
• home health agencies – a seven percent rate reduction

While …

CMS updates COVID-19 guidelines, regulations, the waiving of regulations, and more daily on the “Current Emergencies” page of the CMS website.  Find it here.

In addition, the Centers for Disease Control and Prevention (CDC) regularly posts COVIS-19 updates of its own.  Find them here.…