On the evening of March 30th, the Centers for Medicare and Medicaid Services (CMS) announced a series of additional blanket waivers under section 1877(g) and section 1135 of the Social Security Act and an interim final rule (IFC) aimed at addressing the ongoing COVID-19 public health emergency.  

Below are many of the new flexibilities and capabilities included in the waivers and rule:  

Increasing Hospital Capacity

• Allow ambulatory surgery centers to contract with local healthcare systems to provide hospital services or surgery centers may enroll and bill as hospitals during the emergency declaration  
• Permit non-hospital buildings and spaces to be used for patient care and quarantine sites, if locations are approved by states 
• Allowing COVID-19 tests to be performed on people at home and in other community-based settings outside of hospitals 
  • Medicare will pay for laboratory technicians to travel to a beneficiary’s home to collect a specimen for COVID-19 testing 
• Allow hospitals to conduct testing and screening for COVID-19 at drive through and off-campus test sites 
• Ambulances may transport patients to additional locations when other transportation is not medically appropriate. These locations include community mental health centers, FQHCs, physician offices, urgent care facilities, ASCs, and locations providing dialysis when an ESRD facility is not available.  
• Physician-owned hospitals can temporarily increase the number of licensed beds, operating rooms, and procedure rooms 
• Hospitals may bill for services provided “outside their four walls,” including via telehealth and alternate treatment and testing sites 

Expanding the Healthcare Workforce

• Allow increase of hospital workforce by streamlining hiring from the local community, including private practice clinicians, and individuals licensed from other states without violated Medicare rules 
• Expanding services that may be provided by physician assistants and nurse practitioners 
• Waiving requirement that a certified registered nurse anesthetist (CRNA) be under the supervision of a physician, allowing CRNAs to function to the extent allowed by a state 
• Providing a blanket waiver to allow hospitals to provide benefits and support to medical staff, such as multiple daily meals, laundry service for personal clothing, and child care services 
• Health care providers, including clinicians, hospitals, institutional providers, and suppliers, will be allowed to temporarily enroll in Medicare 

Reducing Burden

• Eliminate paperwork requirements, covering respiratory-related devices and equipment for any medical reason determined by a clinician (Medicare previously only covered these in specified circumstances) 
• Hospitals will not be required to have written policies on processes and visitation of COVID-19 patients in isolation 
• Hospitals will be provided with additional time to provide a patient a copy of their medical record 
• CMS is extending certain reporting requirements and suspending documentation requests for providers, facilities, Medicare Advantage plans, Part D prescription drug plans, and states 

Use of Telehealth, Alternate Settings

• An additional 80 services may now be furnished via telehealth, including through apps with audio and video capabilities.  
• Providers will be allowed to evaluate beneficiaries through phones with audio only 
• Telehealth visits may be billed at the same rate as in-person visits and services may be provided to both new and established patients 
• Face-to-face requirements of national coverage determinations (NCDs) and local coverage determinations (LCDs) will be waived during the public health emergency  
• Physicians may supervise clinical staff using virtual technologies when appropriate 
• For beneficiaries whom a physician determines should not leave home from medical contraindication or suspected/confirmed COVID-19, the beneficiary will be considered homebound and quality for the Medicare Home Health Benefit, allowing certain services to be provided at home.  

• To allow for care to be provided in “unexpected settings” including at home, CMS is waiving the clinical indications for certain NCDs and LCDs, including for respiratory, home anticoagulation management, and infusion pumps.