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March 31, 2020

Our take: Hospitals just got much more flexibility to respond to COVID-19

Daily Briefing

    CMS over the past few days has issued several new rules and waivers that offer hospitals and providers new flexibilities and quicker payments to help support their response to the United States' COVID-19 epidemic.

    US reports more than 20K new COVID-19 cases in one day

    The moves come as officials in the United States reported about 20,000 new cases of COVID-19, the disease caused by the new coronavirus, in one day. As of Tuesday morning, state and federal officials had reported 163,575 cases of COVID-19 in the country—up from 141,995 cases as of Monday morning. Officials as of Tuesday morning also had reported 3,073 U.S. deaths linked to the virus, up from 2,486 deaths reported as of Monday morning.

    CMS offers providers new flexibilities aimed at boosting US health system's capacity

    CMS on Monday released several new rules and waivers intended to help hospitals and other providers increase their capacity to respond to the COVID-19 epidemic.

    For example, CMS issued new rules intended to increase hospitals' capacity to treat COVID-19 patients by allowing them to receive Medicare payments for treating patients at locations outside of their existing buildings, such as ambulatory surgery centers (ASCs), inpatient rehabilitation hospitals, hotels, dormitories, and other non-traditional facilities. Under the new rules, hospitals and health systems can use hotels and other non-traditional facilities to house and treat patients who need less intensive care, which in turn can allow hospitals and health systems to reserve their inpatient beds for patients with COVID-19.

    CMS also issued new rules that allow hospitals and health systems to contract with ASCs to provide essential surgeries, such as cancer procedures and trauma surgeries, as long as doing so is permitted under the emergency preparedness or pandemic plans in the facilities' respective states. Medicare will pay providers for those services at hospital rates. The rules also permit ASCs to enroll in Medicare and bill as hospitals when providing qualifying essential services.

    Further, CMS issued rules that allow health care systems, hospitals, and communities to establish drive-thru and other off-campus testing and screening sites that are exclusively intended to identify COVID-19 patients. CMS in guidance also detailed circumstances in which hospital EDs can screen and test patients for COVID-19 at off-campus and drive-through testing locations. In addition, Medicare under the new rules will pay laboratory technicians for testing a beneficiary for COVID-19 at the beneficiary's home. CMS said Medicare also will pay hospitals and other entities for testing beneficiaries for COVID-19 at their homes or in other community-based settings.

    CMS also issued new guidance allowing dialysis facilities to establish "special purpose facilities" that provide care only to patients with COVID-19. The move could help protect other dialysis patients, who are immunocompromised, from being exposed to the new coronavirus.

    In addition, CMS issued waivers to allow physician-owned hospitals to increase their numbers of licensed beds and operating and procedure rooms without facing possible sanctions. CMS also released waivers intended to:

    • Allow more health care practitioners, including physician assistants and nurse practitioners, to perform services such as ordering tests and medications as long as the practitioners are allowed to do so under state law;

    • Allow providers to enroll in Medicare temporarily during the COVID-19 emergency;

    • Allow Medicare to cover respiratory-related devices and equipment for any medical reason deemed by clinicians;

    • Allow hospitals and health systems to provide health care workers with new support, including child care, laundry services for personal clothes, and daily meals;

    • Allow Medicare to cover more than 80 additional telehealth services;

    • Allow providers to fulfill many in-person visit requirements via telehealth and to bill for those visits at in-person rates;

    • Give supervising clinicians more flexibility to supervise staff virtually; and

    • Permit broader use of verbal treatment orders.

    CMS Administrator Seema Verma said the "unprecedented temporary relaxation in regulation will help the health care system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly."

    CMS expands accelerated payments

    CMS over the weekend also announced that it is expanding its Accelerated and Advance Payment Program to allow all U.S. health care providers and suppliers to receive Medicare payments more quickly.

    The program typically is available only to providers and suppliers affected by natural disasters, but the agency decided to expand the program to ensure providers and suppliers have the cash flows needed to address the country's COVID-19 epidemic. The expansion allows hospitals, doctors, durable medical equipment suppliers, and other Medicare Part A and Part B providers and suppliers to request accelerated payments.

    To qualify for the payments, a provider or supplier must:

    • Have billed Medicare for claims within 180 days immediately prior to the date of signature on their request form;

    • Not be in bankruptcy;

    • Not be under active medical review or program integrity investigation; and

    • Not have outstanding delinquent Medicare overpayments.

    Under the program's expansion, CMS will allow inpatient acute care hospitals, children's hospitals, and certain cancer hospitals to request advance payments equaling up to 100% of their typical Medicare payment amounts for a six-month period and critical access hospitals to request up to 125% of their typical payment amounts for a six-month period. The agency will require most of the hospitals to repay the balance of accelerated payments up to one year from the payment's date.

    CMS will immediately begin to accept and process requests for accelerated and advance payments. CMS plans to issue the payments within seven days of receiving the requests (King, FierceHealthcare, 3/30; Szabo/Anthony, Kaiser Health News, 3/30; Reed, FierceHealthcare, 3/30; Morse, Healthcare Finance News, 3/30; Weinstock, Modern Healthcare, 3/30; Sanger-Katz, New York Times, 3/30; CMS fact sheet, 3/30; CMS fact sheet, accessed 3/31;  Ellison, Becker's Hospital CFO Report, 3/30).

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