April 15, 2020
As part of its continued efforts to ease burdens on healthcare providers during the 2019 novel coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services (CMS) released a slew of additional waivers on March 30, 2020. Among other waivers, covered in separate alerts based on provider type, the following waivers are aimed at expanding the healthcare workforce and easing documentation requirements for physicians and other clinicians so they can focus on putting “patients over paperwork” during this critical time.
Expanding the Healthcare Workforce
Below is a list of the most notable measures that CMS is implementing to rapidly expand the healthcare workforce participating in the fight against COVID-19.
Provider Enrollment. CMS is easing Medicare enrollment requirements for physicians, non-physician practitioners (NPPs) and other providers and suppliers who are establishing new isolation facilities to furnish care to patients with COVID-19. As covered in more detail in a separate McGuireWoods alert, CMS has established toll-free hotlines at each of the Medicare Administrative Contractors (MACs) to allow physicians, NPPs and Part A certified providers and suppliers establishing isolation facilities during the public health emergency to initiate temporary Medicare billing privileges.
Practitioner Locations. CMS is temporarily waiving requirements that practitioners be licensed in both the state where they are enrolled in Medicare as well as in the state where they are actually providing services. These waivers apply to physicians and NPPs who meet the following four conditions:
The qualified practitioner should seek the licensure waiver by contacting the provider enrollment hotline for the MAC that services his or her geographic area. This federal waiver does not waive state or local licensure requirements.
CoP Waivers. CMS is waiving a condition of participation (CoP) for hospitals participating in the Medicare program which requires that a Medicare patient be under the care of a physician, as set forth in 42 CFR § 482.12(c)(1-2) and (4). This waiver allows hospitals to use NPPs more fully. To the extent national coverage determinations (NCDs) and local coverage determinations (LCDs) require a specific practitioner type or physician specialty to furnish or supervise a service, during this public health emergency, the chief medical officer or equivalent of a hospital will have the authority to make those staffing decisions, giving hospitals more flexibility to provide services to patients.
Physician Supervision.
Permitting Non-Physician Practitioners and Other Clinicians to Work to the Fullest Extent of Their Licenses.
Putting “Patients over Paperwork”
Stark Law Waivers. CMS released sweeping blanket waivers to the Stark Law in an effort to minimize regulatory burdens on hospitals and physicians. For more detail regarding the Stark Law waivers, see this separate McGuireWoods alert.
Clinical Judgment Deference . To increase clinician flexibility when treating patients during the COVID-19 public health emergency, CMS is waiving the NCDs and LCDs requiring that patients have specific diagnoses or clinical characteristics in order to be prescribed respiratory devices and equipment. Instead, clinicians may use their discretion to determine which patients should receive such equipment.
Hospital Medical Records. CMS is waiving the CoP requirements regarding adequate staffing of a hospital’s medical records department, requirements for the form and retention of the medical record, and requirements for the content of the medical record. Of particular note is the waiver of the requirements that (i) records include the results of all consultative evaluations of patients, and (ii) records be completed within 30 days of a patient’s discharge.
Signature Requirements. CMS is waiving signature and proof of delivery requirements for Part B drugs and durable medical equipment when a signature cannot be obtained due to the current crisis. Suppliers should document in the medical record the appropriate date of delivery and that a signature could not be obtained because of COVID-19.
MIPS Reporting. As discussed in an earlier McGuireWoods alert, CMS is revising certain portions of the Merit-based Incentive Payment System (MIPS) in the Quality Payment Program. First, clinicians who have been adversely affected by the COVID-19 public health emergency may submit an application and request reweighting of the MIPS performance categories for the 2019 performance year. This change allows clinicians impacted by the COVID-19 outbreak, and who may be unable to submit their MIPS data during the current submission period, to request reweighting and potentially receive a neutral MIPS payment adjustment for the 2021 payment year. Additionally, CMS is adding one new “improvement activity” for the CY 2020 performance year that, if selected, would provide high-weighted credit for clinicians within the MIPS Improvement Activities performance category. Clinicians will receive credit for this improvement activity by participating in a clinical trial utilizing a drug or biological product to treat a patient with COVID-19 and then reporting their findings to a clinical data repository or clinical data registry.
Please contact the authors for additional information on any of the waivers listed above. McGuireWoods has published additional thought leadership on how companies across industries can address crucial coronavirus-related business and legal issues. The firm’s COVID-19 response team stands ready to help clients navigate urgent and evolving legal and business issues arising from the COVID-19 pandemic.
COVID-19: Healthcare Video AlertsIn a series of video alerts, McGuireWoods’ healthcare lawyers address issues providers face and overcoming COVID-19 challenges. |