In early April 2020, the Centers for Medicare and Medicaid Services (CMS) acted at the direction of President Donald Trump and suspended a handful of rules so hospitals, clinics, and other healthcare facilities can have the staff they need to fight the COVID-pandemic.
The guidances are aimed at reducing supervision and certification requirements, which will help practitioners to be hired quickly and perform work as allowed by their license. These changes are effective immediately and address supervision, licensure and certification, and other limitations in healthcare settings including Critical Access Hospitals, Rural Health Clinics, Federally Qualified Health Centers, Skilled Nursing Facilities, Home Health Agencies, and Hospice. These more recent actions expand on prior temporary regulatory waivers intended to help the American healthcare system respond to COVID-19.
“It’s all hands on deck during this crisis,” said CMS Administrator Seema Verma. “All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic.”
New Waivers Issued
In early April, CMS enabled a handful of new regulatory waivers, all with the eye of ensuring medical equipment, supplies, and providers, are providing all Americans the best care they can. As a result of CMS’s action:
- Doctors can now directly care for patients at rural hospitals (including across state lines if necessary) via phone, radio, or online communication, without having to be physically present. The remote physicians will provide staff at those facilities additional flexibility to meet the needs of their patients.
- Nurse practitioners (in addition to physicians) can now perform some medical exams on Medicare patients at skilled nursing facilities.
- Occupational therapists from home health agencies can now perform initial assessments on certain homebound patients. This allows home health services to start sooner and enables home-health nurses to do more direct patient care.
- Hospice nurses will be relieved of hospice aide in-service training tasks so they can spend more time with patients.
Prior Regulatory Waivers
These new changes expand upon the temporary regulatory waivers and new rules issued on March 30, 2020. Those changes supplemented the work of FEMA, as well as state and local public health authorities, by empowering hospitals and healthcare systems to rapidly expand treatment capacity and separate infected from uninfected patients. The waivers and flexibilities offered by CMS allowed patients to be triaged to a variety of community-based locales, including ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories. This helped hospital staffs to focus on the most critical COVID-19 patients, maintain infection control protocols, and conserve personal protective equipment (PPE).
During the COVID-19 pandemic, CMS has also temporarily:
- Authorized physicians whose privileges expire to continue practicing at a hospital and allowed new physicians to begin working prior to full hospital medical staff/governing body review and approval.
- Lifted regulatory requirements regarding hospital personnel qualified to perform specific respiratory care procedures, allowing these professionals to operate to the fullest extent of their license.
- Waived federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants so they can work at rural hospitals as long as they meet state licensure requirements.
- Allowed physicians and non-physician practitioners to use telehealth technology to care for patients at long-term care facilities.
- Waived certain training and certification requirements for nurse’s aides at long term care facilities (to help address potential staffing shortages during the pandemic).
- Waived paperwork requirements so that hospital doctors can use more verbal instead of written medical orders.
For a complete list of workforce flexibilities permitted by CMS in recent weeks, click here.