In addition to a second interim final rule to address the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) also updated the current blanket waivers that are aimed at helping providers respond to the declared public health emergency (PHE). Below are the new waiver items updated by CMS after April 21, 2020.

Telehealth Services

• The waiver expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services.
  • This allows health care professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services.
• This waiver allows the use of audio-only equipment to furnish services described by the codes for audio-only telephone evaluation and management services, and behavioral health counseling and educational services.

Home Health and Hospice

• CMS is waiving the requirement for hospices and home health agencies (HHAs) that a registered nurse make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. Completing these visits is postponed. All postponed onsite assessments must be completed no later than 60 days after the expiration of the PHE.
• CMS is modifying the requirement for Hospice and HHAs that these providers to develop, implement, evaluate, and maintain an effective, ongoing, hospice/HHA-wide, data-driven QAPI program. Specifically, CMS is narrowing the scope of the QAPI program to concentrate on infection control.
• CMS is modifying the requirement that hospices annually assess the skills and competence of all individuals furnishing care and provide in-service training and education programs where required. This does not alter minimum personnel requirements.

Community Mental Health Centers

• CMS is modifying the requirements for CMHC’s QAPI by retaining the overall requirement that CMHC’s maintain an effective, ongoing, data-driven QAPI program but also providing flexibility for CMHCs to use their QAPI resources to focus on challenges and opportunities for improvement related to the PHE by waiving the certain detailed requirements for the QAPI program’s organization and content.
• CMS is waiving the requirement that prohibits CMHCs from providing partial hospitalization services and other CMHC services in an individual’s home so that clients can safely shelter in place during the PHE while continuing to receive needed care and services from the CMHC.
• CMS is waiving the requirement that a CMHC provides at least 40 percent of its items and services to individuals who are not eligible for Medicare benefits.

Physical Environment Requirements for Hospitals and Other Facilities

• CMS is waiving certain physical environment requirements for Hospitals, CAHs, inpatient hospice, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and SNFs/NFs to reduce disruption of patient care and potential exposure/transmission of COVID-19. The physical environment regulations require that facilities and equipment be maintained to ensure an acceptable level of safety and quality.
  • These are being temporarily modified to the extent necessary to permit facilities to adjust scheduled inspection, testing and maintenance frequencies and activities for facility and medical equipment.
• CMS will allow waivers to outside window and outside door requirements to allow hospitals, CAHs, inpatient hospices, SNFs and nursing facilities, and ICF/IIDs to use space not normally used for patient care to be temporarily used for patient care or quarantine.

Ambulatory Surgical Centers

• CMS is waiving the requirement that medical staff privileges must be periodically reappraised, and the scope of procedures performed in the ASC must be periodically reviewed.