The Centers for Medicare & Medicaid Services (CMS) temporarily suspended a number of rules to boost frontline medical staff at healthcare facilities during the COVID-19 pandemic. The new waivers expand on the workforce flexibilities announced by CMS on March 30, 2020 (previously covered by the HL Pulse here). The new waivers include:
Physicians in Critical Access Hospitals (CAHs): CMS is waiving the requirement for CAHs that a doctor of medicine or osteopathy be physically present for medical direction, consultation, and supervision for services in the CAH. However, CMS is retaining the requirement that a physician be available through direct radio, telephone, or electronic communication for consultations, assistance with emergencies, and patient referrals.
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): CMS is waiving the requirement that a nurse practitioner, physician assistant, or certified midwife be available at least 50% of the time the RHC and FQHC operates. CMS is retaining the requirement that a physician, nurse practitioner, physician assistant, certified nurse midwife, clinical social worker, or clinical psychologist to be available at all times the clinic or center operates. CMS is also eliminating the requirement that physicians must provide medical direction and supervision of nurse practitioners, to the extent permitted by state law. Physicians will continue to be responsible for providing medical direction and supervision for the remaining health care staff. The modification is intended to allow RHCs and FQHCs to use nurse practitioners to the fullest extent possible.
Long-Term Care Facilities and Skilled Nursing Facilities: CMS is allowing nursing homes to admit new residents who have not received Level 1 or Level 2 Preadmission Screening. CMS is also waiving requirements that prevent physicians from delegating tasks when regulations specify it must be performed by a physician. However, tasks delegated under this wavier must continue to be under the supervision of a physician. CMS is also waiving the requirement that all required physician visits must be made by the physician personally, allowing delegation to nurse practitioners, physician assistants, or clinical nurse specialists.
Home Health Agencies Occupational Therapists: CMS is allowing occupational therapists to perform the initial and comprehensive assessment for all patients receiving therapy services to the extent permitted under state law. Therapists must act within their state scope of practice laws, and access a registered nurse of other professional to complete components the assessment beyond their scope of practice.
Hospice Aide Competency Testing: CMS is temporarily allowing hospices to utilize pseudo patients instead of actual patients in the competency testing of hospice aides. CMS is also waiving the requirement that hospice aides receive 12 hours of in-service training in a 12 month period.
The complete updated list of workforce flexibilities CMS has permitted may be found here.
Norton Rose Fulbright attorneys will continue to provide relevant updates for healthcare providers on the Health Law Pulse during the COVID-19 public health crisis.