CMS Updates Infection Control Guidance Based on CDC Guidelines to Protect Patient & Healthcare Workers

April 10, 2020

As we reported last week, the CDC updated its COVID-19 Infection Control Guidance. This week, on April 8, 2020, CMS announced that it was likewise updating its infection control guidelines for these providers: dialysis facilities, hospitals, Critical Access Hospitals, psychiatric hospitals, Ambulatory Surgical Centers, Community Mental Health Centers, Comprehensive Outpatient Rehabilitation Facilities, Outpatient Physical Therapy or Speech Pathology Services, Rural Health Clinics, Federally Qualified Health Centers, Intermediate Care Facilities for Individuals with Intellectual Disabilities and Psychiatric Residential Treatment Facilities. The CMS guidance documents for each provider type can be located on the CMS Current Emergencies webpage under the heading “Clinical & technical guidance” (click here).

CMS Fields Provider Questions on Telehealth & Specimen Collection in National Call

April 10, 2020

CMS hosted an “Office Hours” call on April 9th for healthcare providers to ask questions of agency officials regarding CMS’s temporary actions during the COVID-19 public health emergency. The two topics receiving the most questions by callers concerned: (a) services provided through telehealth by Rural Health Centers, hospice, home health agencies and physicians outside their office settings; and (b) billing only for the swab-specimen collection by hospitals, urgent care centers and physicians. CMS often answered that it was aware of these areas of concern and was hard at work to supply answers. By the end of the call, CMS announced that it had posted an extensive update to its COVID-19 Interim Rule FAQs addressing several of the callers’ questions. Kathie McDonald-McClure, a member of the Firm’s Health Care Services Team, listened to the call and took notes of the call which may be found here.

CMS Updates Recommendations for Non-Emergent, Elective Medical Services and Treatment During Emergency

April 10, 2020

CMS issued updated recommendations on April 7th for postponing non-essential surgeries and other procedures to conserve critical healthcare resources and limit exposure of patients and staff to COVID-19. Similar to the Kentucky CHFS Order issued on March 23, 2020, CMS recommends limiting medical services that can be deferred, such as non-emergent, elective treatment and preventive medical services for patients of all ages. The CMS guidance includes a 3-tier decision grid: a) Tier 1—Low acuity treatment or service; b) Tier 2—Intermediate acuity treatment or service; and c) Tier 3—High acuity treatment or service.

CMS Addresses Telehealth and Virtual Visits in Dear Clinician Letter

April 10, 2020

CMS posted a letter on April 7th to clinicians outlining a summary of actions CMS has taken to ensure clinicians have maximum flexibility to reduce unnecessary barriers to providing patient care during the unprecedented outbreak of COVID-19. The summary includes information about telehealth and virtual visits, accelerated and advanced payments, and recent waiver information.

Guidance for Processing Attestations from ASCs Temporarily Enrolling as Hospitals

April 10, 2020

CMS announced on April 6th that it had issued specific guidance for processing attestation statements from Medicare-enrolled Ambulatory Surgical Centers (ASCs) temporarily enrolling as hospitals during the emergency. See CMS Memo to State Survey Agency Directors, dated April 3, 2020 (Ref: QSO-20-24-ASC). As previously announced, CMS is giving hospitals the flexibility to expand capacity by utilizing ASCs as hospitals during the COVID-19 public health emergency. (See “Temporary Expansion Location” in the CMS COVID-19 Emergency Declaration Blanket Waivers document.)

CMS Announces Further Expansion of Workforce Flexibilities

April 10, 2020

On April 9th the CMS announced a further expansion of the healthcare workforce flexibilities it had previously announced on March 30 in order to boost frontline medical staffs to fight to save lives during the COVID-19 pandemic. The additional flexibilities include:

  • Doctors directly caring for patients at rural hospitals via phone, radio, online communications, even across state lines.
  • Nurse practitioners performing some medical exams on skilled nursing facility patients, whether COVID-19 related or not.
  • Occupational therapists from home health agencies performing initial assessments on certain homebound patients.
  • Hospice nurses being relieved of hospice aide in-service training tasks.

The previously released COVID-19 Emergency Declaration Blanket Waivers document was updated on April 9, 2020 to include these additional flexibilities.

CMS Issues Guidance on Applying for Accelerated Payments

April 10, 2020

As announced on April 9th in a CMS News Alert, in order to increase cash flow to health care providers impacted by the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) expanded its Accelerated and Advance Payment Program to a broader group of providers. CMS has published a fact sheet with guidance on the accelerated/advance payment process and how to submit a request. The approval process has been streamlined to four to six days (compared to the previous timeframe of three to four weeks) and CMS has approved over 21,000 requests for nearly $51 billion in advance and accelerated payments over the past week.

Health Care Providers to Receive Grant Funding This Week

April 10, 2020

On April 7th the Centers for Medicare and Medicaid Services (CMS) stated in an announcement that $30 billion in grants, which is a portion of the $100 billion of funding provided under the CARES Act to support hospitals, will start to be distributed on Friday of this week. Where the government has the hospitals’ account information on file, these funds will be deposited directly into hospitals’ bank accounts, but some providers may have to register to receive their share or wait a few weeks to receive paper checks. These grants are apportioned to hospitals based on their reported Medicare revenue “with no strings attached,” according to CMS Administrator Seema Verma.

Government to Pay COVID-19 Related Costs for Treating Uninsured Patients at Medicare Rates

April 10, 2020

On April 3rd the Department of Health and Human Services Secretary Alex Azar announced that a portion of the $100 billion of funding for health care providers under the CARES Act will be used to cover providers’ costs of delivering COVID-19 care for the uninsured. Providers will be reimbursed at Medicare rates and are not permitted to balance bill uninsured patients for the cost of their care.

Kentucky Continues to Adapt at the State Level

April 10, 2020

The Cabinet for Health and Family Services (CHFS) has continued to update guidance to Kentucky health care providers:

  • CHFS issued a new memo dated April 9, 2020 saying that all health care providers (not just hospitals, as provided for in its April 6 memo) have a “blanket waiver” and are not required to obtain additional approval from CHFS for a waiver from any requirement in state law or administrative regulation that is more stringent than federal 1135 waivers issued by the Department of Health and Human Services, which were effective March 1, 2020.
  • On April 6, 2020, CHFS issued updated guidance to home health agencies on what constitutes emergent or urgent care for patients requiring in-person services and how to take preventive measures to deliver those services.
  • The Department for Medicaid Services updates its Medicaid COVID-19 FAQs almost daily to give providers the most up-to-date information on the delivery of, and reimbursement for, fee-for-service and managed care Medicaid services, especially adapting for telehealth services.
  • On April 3, 2020, CHFS issued new guidance in accordance with the CDC’s recommendations on when health care professionals can return to work after a potential exposure to a patient with COVID-19.