March 16, 2020

Coronavirus is a 'national emergency': Our 4 key takeaways for hospitals

Daily Briefing

    President Trump on Friday declared the new coronavirus pandemic a national emergency and asked U.S. hospitals to activate their emergency preparedness plans.

    According to STAT News, the announcement marks the first time the United States has declared a national emergency in response to an infectious disease outbreak since the 2009 H1N1 influenza pandemic. As of Monday morning, state and federal officials had reported 3,602 cases of COVID-19, the disease caused by the new coronavirus, in the United States and 66 deaths tied to the virus.

    March 19 webinar: COVID-19 and the U.S. health care delivery system

    What the declaration means for providers

    The emergency declaration along with HHS Secretary Alex Azar's prior declaration of a public health emergency frees up to $50 billion in federal disaster relief funding to combat the spread of the new coronavirus and COVID-19.

    The emergency declaration instructs state governments to set up emergency operations centers and instructs U.S. hospitals to activate emergency preparedness contingency plans. On Saturday, U.S. Surgeon General Jerome Adams called on hospitals to delay elective procedures under the declaration to ensure hospitals have the bed capacity to treat an anticipated influx of patients affected by the new coronavirus.

    In addition, the emergency declaration gives Azar the authority to temporarily waive or modify certain Medicare, Medicaid, and CHIP regulations that can hinder health professionals' ability to treat patients.

    CMS in a fact sheet released late Friday clarified that it would issue several blanket 1135 waivers under the declaration. For instance, CMS said it has made blanket waivers available for:

    • The 3-day inpatient hospital stay requirements for Medicare skilled nursing facility (SNF) coverage for beneficiaries who have been dislocated because of the new coronavirus or need SNF care because of the virus. According to Inside Health Policy, certain ACOs organizations already can waive this requirement, and nursing homes and advocates have been pushing for CMS and Congress to eliminate the requirement;

    • Regulations that limit critical access hospitals to 25-bed capacities and lengths of stay to no more than 96 hours;

    • Acute care hospital requirements that bar acute care inpatients from being housed and treated in excluded distinct part units. Acute care hospitals that bill under Medicare's Inpatient Prospective Payment System should note in the patient's medical record they are being housed in the excluded unit for capacity issues related to the new coronavirus. CMS also waived requirements to allow acute care hospitals with excluded distinct part inpatient psychiatric units and/or excluded distinct part inpatient rehabilitation units to relocate those patient to an acute care bed and unit. CMS also waived the inpatient rehabilitation facility (IRF) 60% rule at IRFs and facilities attempting to be classified as IRFs;

    • Provider locations to temporarily waive Medicare payment rules that require "out-of-state providers be licensed in the state where they are providing services when they are licensed in another state." However, the waiver does not appear to override state permissibility rules set by state boards of medicine;

    • Provider Medicare enrollment application fees, criminal background checks, and site visit requirements; and

    • Certain Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) regulations to make it easier for contractors to replace lost, destroyed, damaged, or otherwise unusable products.

    CMS also will establish a toll-free hotline for non-certified Medicare Part B suppliers and providers to enroll and get temporary Medicare billing privileges.

    In addition, CMS said states and U.S. territories can request 1135 waivers for certain Medicaid and CHIP requirements, including:

    • Prior authorization requirements in fee-for-service programs;
    • Provider licensing location requirements; and
    • Provider enrollment and revalidation requirements.

    Trump pledges to improve testing kit availability

    Trump during his Friday announcement also vowed to "vastly increase and accelerate" the availability and production of coronavirus testing kits. Providers and hospitals for weeks have been battling a shortage of test kits that public health experts said have hampered the United States' ability to control the virus' spread.

    Trump said his administration will work with private-sector companies to address the testing kit shortage and noted that his administration is working with pharmacies and retailers to establish drive-thru testing locations.

    HHS on Friday announced that it will help fund and provide advanced development support for two new COVID-19 diagnostic tests that may detect the disease within an hour of being administered (Facher, STAT News, 3/13; Cohrs, Modern Healthcare, 3/13; Stein, Inside Health Policy, 3/13 [subscription required]; New York Times, 3/15; Luthi, Politico, 3/14; AHA News, 3/13; Smith et al., New York Times, 3/16; CMS fact sheet, 3/13).

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