Waiver Tracker
Coronavirus (COVID-19)

Trained healthcare professionals are standing by to answer questions about coronavirus. The call is free. NJ residents should call the 24-Hour Public Hotline, called "The NJ Poison Control and Coronavirus Hotline," at 1-800-962-1253.

The NJ Poison Control Center and 211 have partnered with the State to provide information to the public on COVID-19:

Call: 2-1-1 | Text: NJCOVID to 898-211 | Visit: https://covid19.nj.gov/ for additional information

In a highly regulated field like healthcare, temporary waivers of certain regulations allow healthcare facilities to adjust and respond more quickly during a public health emergency. This Waiver Tracker provides status updates on federal and state waivers sought by NJHA.

Main COVID-19 Page Hospital Visitation Codes Coronavirus Briefings Key for locked members only page.

Updated on Nov. 23, 2020

N.J. Department of Health

Hospitals (General and Specialty), Nursing Homes, Assisted Living/CPCH, Home Health, Hospice

WaiverApplies ToStatus
Allow RMTs and CHHAs to function in CNA Role

Nursing Homes APPROVED

3/28/2020

Confirmed — 11/6/2020
CNA Reciprocity

SNF & Home Health Agency APPROVED

3/27/2020; 3/31/3030

Confirmed — 11/6/2020
Pre-employment Requirements The Department of Health will not require prior Department approval of temporary waivers for the following requirements from licensed facilities:

  • Exceeding licensed bed capacity
  • Bed additions requiring prior CN approval
  • Physical space requirements
  • Staff qualifications requirements
  • Facilities will have to provide a written report to DOH detailing which, if any, actions were implemented, the duration and any adverse outcomes that result
All licensed health care providers licensed under N.J.A.C. 8:36, 39, 43G and 43H Covered under DOH memo

APPROVED

3/26/2020

Confirmed — 11/6/2020
Credentialing Standards N.J.A.C. 8:43G-16.1(b)-(e) permits acute care hospitals to substitute the credentialing standards of their accrediting body instead of the DOH requirements Hospitals APPROVED

3/26/2020

Confirmed — 11/6/2020
Certification – Assisted Living Administrators — Expiration dates between March 1 and May31, 2020 are extended 90 days. CALA will be able to complete CEUs up to the new expiration date of their certification Assisted Living Expired 8/31/2020 but under reconsideration
Certification – Nursing Assistants — all expiration dates between March 1 and May 31, 2020 are extended 90 days Nursing homes, Assisted Living, Hospitals Expired 8/31/2020 but under reconsideration
Certification – Medication Aides — all expiration dates between March 1 and May 31, 2020 are extended 90 days. CMAs will be permitted to complete CEUs up to the new expiration date of their certification Assisted Living Expired 8/31/2020 but under reconsideration
Providing services outside certificate of need or designated area Home Health and Hospice APPROVED

3/13/2020

Confirmed — 11/6/2020
WAIVER/MODIFICATION OF N.J.A.C. 8:39-43.2 - REQUIREMENTS FOR NURSE AIDE CERTIFICATION, adopted by THE COMMISSIONER OF THE DEPARTMENT OF HEALTH

Updated: Extends expiration of certifications for CNAs through August 31. The above-referenced rule is hereby waived/modified subject to the following additional terms and conditions:

  1. During the period of Public Health Emergency declared by Governor Philip D. Murphy in Executive Order No. 103 issued on March 9, 2020, and extended by Executive Order No.119 issued on April 7, 2020, and so long as the Public Health Emergency exists pursuant to a Governor’s Executive Order, the following individuals, although not certified, may be employed as nurse aides: Individuals who complete and pass the 8-hour Temporary Nurse Aide Training Program sponsored by the American Health Care Association and the National Center for Assisted Living program and have demonstrated competency using the program’s skills competency checklist.


All individuals seeking to work as a nurse aide pursuant to this waiver/modification must comply with the requirements for a criminal background check pursuant to N.J.A.C. 8:43I, and the time delineated in N.J.S.A. 26:2H-84(d) (60 days for the Division of State Police in the Department of Law and Public Safety background check and an additional 60 days for the federal authorities’ background check) will be extended for a period of 90 days.

Long-term care facilities, assisted living facilities, assisted living programs and comprehensive personal care homes may temporarily employ individuals who qualify under N.J.A.C. 8:39-43.2(c)(1) and (2). Facilities that hire one or more nurse aides under the modified requirements created by this waiver/modification must:

  1. retain records detailing which, if any, of the above actions were implemented, including a list of the names, Social Security numbers and birth dates of the individuals temporarily hired pursuant to this waiver/modification, the training records and completed competency checklists, the duration of the implementation, and must document and immediately report to the Department any incidents involving the abuse,neglect or misappropriation of property of a resident of the facility, which are attributable to the nurse aides hired under this waiver/modification
  2. within one week of the hiring of one or more nurse aides, provide the Department with the names, Social Security numbers and birth dates of the individuals temporarily hired pursuant to this waiver/modification by sending the information to: Garlina Finn, Education Program Development Specialist Certification Program New Jersey Department of Health P.O. Box 358 Trenton, New Jersey 08625-0358


  1. When the Public Health Emergency is lifted, facilities will be required to return to operation in accordance with all licensure standards. Nurse aides employed pursuant to this waiver/modification will no longer be eligible to work as nurse aides and will have to fulfill the regulatory requirements to become a certified nurse aide.
https://www.state.nj.us/health/legal/covid19/4-15-2020_NurseAideCompetency.pdf
Nursing homes APPROVED

4/15/2020

Updated — 6/8/2020 Confirmed — 11/6/2020
Foreign nurses, graduate nurses, student nurses are able to work as CNAs under certain circumstances Nursing homes, hospitals, assisted living APPROVED

4/29/2020

Confirmed — 11/6/2020
Uncertified aides are permitted to work up to 7 months Nursing homes, hospitals, assisted living APPROVED

4/29/2020

Confirmed — 11/6/2020
CNAs with expired certifications within the last 3 years are permitted to continue working Nursing homes, hospitals, assisted living APPROVED

4/29/2020

Confirmed — 11/6/2020
Waiver/modification of NJAC 8:36-9.1 Qualifications of Personal Care Assistants Assisted living APPROVED

4/15/2020

Confirmed — 11/6/2020
Waiver/modification of NJAC 8:36-9.2© Extends by six months the timeframe for a candidate to take the CMA exam if their original date was march 1 through May 31, 2020 Assisted living APPROVED

4/15/2020

Confirmed — 11/6/2020
Waiver/modification of NJAC 8:39-43.1 Nurse Aide Competency PCAs and Certified medical assistants permitted to function as CAN if they meet certain conditions related to 8-hour training; completing basic orientation; have specific supervision. Temporary certification ends 45 days after end of public health emergency. Nursing Homes APPROVED

4/15/2020

Confirmed — 11/6/2020
Emergency Medical Services Waivers for EMTs, Paramedics, BLS, ALS

Paramedics; Hospitals APPROVED

3/17/2020

Confirmed — 11/6/2020
Notwithstanding (c) above, criminal background clearance notifications issued to a CNA or CNA candidate between November 1, 2019 and March 31, 2020 are valid for a period of 270 days from the date of issuance of the notice of qualification. If full certification is not obtained by the 270th day following the issuance of the notice of qualification, the notice shall expire, and a new criminal history report must be obtained. Hospitals, nursing homes, assisted living APPROVED

8/7/2020

Confirmed — 11/6/2020
Notwithstanding the above provisions, during the duration of the COVID-19 Public Health Emergency;' any certified nurse aide whose certification is scheduled to expire between March 1, 2020 and August 1, 2020 shall be permitted to renew his or certification outside of the two-year window required in subsection (a) above, up to and until September 1,2020. Hospitals, nursing homes, assisted living APPROVED

6/8/2020

Confirmed — 11/6/2020
Paid Dining Assistants

On April 22, 2020, CMS issued a waiver from the requirements of 42 C.F.R. 483.160 for the duration of the federal emergency declared for the COVID-19 pandemic. Under this waiver, a State agency may recognize a one-hour temporary feeding assistant training program that incorporates the topics covered by the 8-hour training course as a substitute for the 8-hour training course required under the rule. The waiver also requires a long term care facility to conduct a competency assessment of the temporary feeding assistant trained under the one-hour program before allowing the feeding assistant to provide dining and feeding assistance to a resident and continues to prohibit a facility from using feeding assistants for complex residents with swallowing difficulties. Pursuant to the CMS waiver, the Department has reviewed and is recognizing a one-hour online training course developed by the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAl) for temporary feeding assistants. This free one-hour online training course is found at: https://educate.ahcancal.org/products/temporary-feeding-assistant
Nursing Homes APPROVED

5/21/2020

Confirmed — 11/6/2020
Blanket Waiver for Home Health Agency Licensing Standards at N.J.A.C. 8:42 and Hospice Agency Licensing Standards at N.J.A.C. 8:42C that are More Stringent than Waivers and Guidance Issued by the Centers for Medicare & Medicaid Services during the Public Health Emergency

4-23-2020 Blanket Waiver for Home Hospice Programs
4-24-2020 Blanket Waiver for Home Health Agency Licensing Standards
Home Health and Hospice Agencies APPROVED

4/23/2020 & 4/24/2020

Confirmed — 11/6/2020
Hospital Nursing Ratios waived on units prescribed by regulation- N.J.A.C. 8:43G-17.1 Hospitals APPROVED

4/7/2020

Confirmed — 11/6/2020
Discharge planning requirements waiver – N.J.A.C. 8:39-5.4 and N.J.A.C. 8:43G-11 Hospitals, Nursing Homes APPROVED

4/7/2020

Confirmed — 11/6/2020

APPROVED

for NF 3/28/2020

Confirmed — 11/6/2020
Mandatory nurse staffing hours – N.J.A.C. 8:39-25.2 Nursing Homes APPROVED

3/28/2020

Confirmed — 11/6/2020
Third Party Inspections Waiver All DOH licensed providers APPROVED

3/26/2020

Confirmed — 11/6/2020
License Renewals All DOH licensed providers APPROVED

3/26/2020

EXPIRED — 11/6/2020
Dialysis Staffing Waiver
In the event CMS issues new superseding guidance, the new guidance shall be followed.
Dialysis Providers APPROVED

4/17/2020

Confirmed — 11/6/2020
Waiver of APN/Anesthesia and Certified Registered Nurse Anesthetists requirements at N.J.A.C. 8:43A Hospitals, ASCs APPROVED

4/17/2020

Confirmed — 11/6/2020
Permits a telemedicine or telehealth examination to substitute for any on-site examination or in-office visit of a resident by an outside healthcare provider that is required under the rules for long-term care facilities, assisted living facilities, assisted living programs, comprehensive personal care homes, dementia care homes and residential health care facilities. Nursing Home, Assisted Living Dementia Care Homes, RHCFs APPROVED

4/17/2020

Confirmed — 11/6/2020
Acute Care Annual Public Meeting may be held remotely if certain requirements are met. Hospitals APPROVED

7/15/2020

EXPIRED — 11/6/2020 for remainder of calendar year

GO TO TOP

NJ Department of Human Services — Waivers & Policy Guidance Related to Medicaid

WaiverApplies ToStatus
COVID-19 Policy Guidance: Fee for Service Billing for Medicaid Certified Nursing Facilities, Special Care Nursing Facilities, and Assisted Living Facilities

Department of Human Services' continued temporary suspension of face-to-face assessments for referrals received by the Division of Aging Services, Office of Community Choice Options (DoAS OCCO). DoAS OCCO continues the suspension of all face-to-face visits to Hospitals – acute, subacute, and psychiatric; Nursing Facilities (NFs); Special Care Nursing Facilities (SCNFs); and Assisted Living facilities (ALs).
SNFs, Assisted Living, SCNFs, Hospitals APPROVED

7/1/2020

Confirmed: 11/15/2020
COVID-19 Policy Guidance: Suspension of Face-to-Face Assessments and Suspension of PASRR Level I and Level II Requirements

Preadmission Screening and Resident Review (PASRR) Level I and Level II requirements for NF and SCNF admissions will be temporarily waived. Face-to-face assessment, reassessment, transfer requests, and I Choose Home/Money Follows the Person activities will be replaced with telephonic processes for the most critical functions to the greatest extent possible. The following processes are in place to facilitate placement in long term care facilities to ensure that these services are available to the individuals who are in need as well as facilitate Medicaid payment for those individuals who are determined financially eligible for NJ Medicaid programs.

EARC Certified Acute Care Hospitals seeking discharge of individuals to a Medicaid certified nursing facility or Ventilator special care nursing facility

Non-EARC Hospitals seeking discharge of individuals to a custodial resident setting including Nursing Facility, Special Care Nursing Facility, Community Residential Services, and Assisted Living. In the event that a discharge to a custodial resident setting is urgent for court orders or medical need, the facility shall outreach the DoAS OCCO office to discuss the individual circumstances and obtain further direction and appropriateness of a submission of a Referral for Onsite OCCO Clinical Assessment via the LTC-4. If OCCO identifies an emergent need for transfer, a transfer approval will be issued via email communication. Clinical eligibility will be established at a later date in accordance with DoAS OCCO policy. Psychiatric and acute psychiatric hospital units shall continue to follow the “NJ FamilyCare Guidance for State Psychiatric Hospital Discharges” guidance dated March 2019 for non-facility discharges.

Medicaid Certified New Jersey Nursing Facilities; Special Care Nursing Facilities; and Assisted Living Facilities
Medicaid Certified NJ NFs, SCNFs, and ALs are expected to comply with all requirements as outlined in N.J.A.C. 8:85 including but not limited to admission criteria and notification, nursing facility level of care eligibility, Medicaid financial eligibility and billing, and transfer requests. In accordance with Medicaid Communication No. 16-09 “Subject: Assisted Living (AL), Nursing Facility (NF), and Special Care Nursing Facility (SCNF) Provider Communication: Clinical Eligibility Standards and Timeframes”, DoAS OCCO has the ability to back-date the clinical eligibility to begin on the 15th day for AL/SCNF or the 31st day for NF after the referral receipt date which allows payment to the provider without penalty as a result of DoAS OCCO failure to conduct the assessment timely. All referrals to DoAS OCCO will continue to be processed, however, the face-to-face assessment will not occur until the restriction is lifted. All referrals, which comply with the requirements outlined in both 8:85 and Medicaid Communication No. 16-09 including the determination of clinical eligibility, will be processed to facilitate appropriate payment to the NF, SCNF, and AL. Facilities will not be penalized via lack of payment due to DoAS OCCO delays in the completion of a face-to-face assessment.

Community Referrals via the County Welfare Agencies (CWAs) and the Aging and Disability Resource Connections (ADRCs)
Individuals referred to DoAS OCCO for individuals residing in a community home (excluding Medicaid Assisted Living facilities – see #3) will be outreached via telephone by DoAS OCCO and be offered a clinical screening to be conducted telephonically. The NJ Screen for Community Services (SCS) will be utilized to presumptively determine clinical eligibility. If clinical eligibility is determined, the information will be entered into the NJ Medicaid Management Information System (NJMMIS). If clinical eligibility is not determined, the individual will be advised of the need for a face-to-face visit which will be scheduled at a later date. Individuals who are not able to have their clinical eligibility determined telephonically will be prioritized upon reinstatement of face-to-face visits. These individuals will also be provided options counseling for unmet needs including a referral to the ADRC, Medical Assistance Customer Center, and other local resources.
SNFs, Assisted Living, SCNFs, Hospitals, Psychiatric Hospitals APPROVED

7/1/2020

Confirmed: 11/15/2020
PACE Operations PACE APPROVED

3/26/2020

Confirmed: 11/15/2020
Adult Medical Day Care

Adult Day Health Care Services and Social Day Services which have suspended operations may continue to serve their current participants. No new participants will be allowed to be served, and no transfers from one center to another will be permitted, until further notice.
Adult Medical Day Care APPROVED

3/30/2020

Confirmed: 11/15/2020
COVID-19 FAQs for Residential Providers - DDD DDD Residential Providers APPROVED

11/12/2020
Surge Planning for Residential Providers – DDD

https://www.nj.gov/humanservices/ddd/documents/covid19-surge-planning-for-residential-providers.pdf

https://www.nj.gov/humanservices/ddd/documents/covid19-surge-planning-use-of-alternate-sites.pdf

Surge Planning Attestation
DDD Residential Providers APPROVED

10/29/2020
Screening Policy – ID & DD Day and Residential Programs ID & DD Day and Residential Programs APPROVED

10/29/2020
Congregate Day Program Reopening Requirements Congregate Day Programs DDD APPROVED

9/3/2020
Guidance on Telehealth for Behavioral Health Providers Behavioral Health Providers APPROVED

4/22/2020

Confirmed: 11/15/2020
Guidance on Telehealth for Partial Hospitalization and Partial Care Providers Partial Hospitalization and Partial Care APPROVED

4/13/2020

Confirmed: 11/15/2020
Transfers to Institutions for Mental Disease and Long-Term Acute Care Facilities IMD & LTCH APPROVED

Confirmed: 11/15/2020

GO TO TOP

NJ Department of Banking & Insurance

WaiverApplies ToStatus
COVID-19 and Health Insurance FAQ Providers; Insurers APPROVED

4/22/2020

Confirmed: 11/15/2020
Telehealth FAQ Providers; Insurers APPROVED

4/22/2020

Confirmed: 11/15/2020
60-DAY GRACE PERIOD FOR HEALTH INSURANCE POLICIES AND CONTRACTS NOT ADDRESSED BY BULLETIN NO. 20-11, 20-12, 20-13 AND 20-14 DUE TO THE DISRUPTION CAUSED BY COVID-19 Accident and Health Insurance Carriers APPROVED

5/28/2020

Confirmed: 11/15/2020
Coverage of COVID-19 Testing

https://www.state.nj.us/dobi/bulletins/blt20_24.pdf

https://www.state.nj.us/dobi/bulletins/blt20_03.pdf

The Department of Banking and Insurance (“Department”) is expanding the requirements in Bulletin 20-03 to require carriers to cover, without cost-sharing, without prior authorization or other medical management requirements, any SARS-COV-2 molecular test authorized pursuant to the DOH standing order. This requirement includes such testing, regardless of site as authorized by the DOH Standing Order, including tests administered at any in or out-of-network community-based, county testing, or private testing site, (including, but not limited to, in and out-of-network hospitals, provider offices, urgent care centers, and pharmacies), and includes items and services furnished to an individual during such visits that result in an order for or administration of a SARS-COV-2 molecular test. Carriers must treat any such test authorized pursuant to the DOH standing order as medically appropriate for the individual. Carriers must not impose cost-sharing for SARSCOV-2 molecular tests provided by in-network or out-of-network laboratories.
Providers; Insurers APPROVED

5/13/2020

Confirmed: 11/15/2020
USE OF TELEMEDICINE AND TELEHEALTH DURING THE COVID-19 PANDEMIC – PERSONAL INJURY PROTECTION COVERAGE Auto Insurers providing medical expense benefits under PIP; Providers APPROVED

4/24/2020

Confirmed: 11/15/2020
USE OF TELEMEDICINE AND TELEHEALTH TO RESPOND TO THE COVID-19 PANDEMIC HEALTH INSURANCE COMPANIES, HEALTH MAINTENANCE ORGANIZATIONS, HEALTH SERVICE CORPORATIONS AND ANY OTHER ENTITY ISSUING HEALTH BENEFITS PLANS IN THIS STATE APPROVED

3/22/2020

Confirmed: 11/15/2020

GO TO TOP

Centers for Medicare & Medicaid Services — Hospitals

WaiverApplies ToStatus
Emergency Medical Treatment & Labor Act (EMTALA). CMS is waiving the enforcement of section 1867(a) of the Act. This will allow hospitals, psychiatric hospitals, and critical access hospitals (CAHs) to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19, so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan. Hospitals; Psychiatric Hospitals APPROVED

Updated 11/4/2020
Verbal Orders. CMS is waiving some requirements to provide additional flexibility related to verbal orders where read-back verification is required, but authentication may occur later than 48 hours. Specifically, the following requirements are waived:

  • §482.23(c)(3)(i) -If verbal orders are used for the use of drugs and biologicals (except immunizations), they are to be used infrequently.
  • §482.24(c)(2) -All orders, including verbal orders, must be dated, timed, and authenticated promptly by the ordering practitioner or by another practitioner who is responsible for the care of the patient.
  • §482.24(c)(3) -Hospitals may use pre-printed and electronic standing orders, order sets, and protocols for patient orders. This would include all subparts at §482.24(c)(3).
  • §485.635(d)(3) -Although the regulation requires that medication administration be based on a written, signed order, this does not preclude the CAH from using verbal orders. A practitioner responsible for the care of the patient must authenticate the order in writing as soon as possible after the fact.
Hospitals APPROVED

Updated 11/4/2020
Signature Requirements: CMS is not enforcing signature and proof of delivery requirements for Part B drugs and Durable Medical Equipment when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19. Hospitals APPROVED

Updated 11/4/2020
Reporting Requirements. CMS is waiving the requirements which require that hospitals report patients in an intensive care unit whose death is caused by their disease, but who required soft wrist restraints to prevent pulling tubes/IVs, no later than the close of business on the next business day. Any death where the restraint may have contributed must still be reported within standard time limits (i.e., close of business on the next business day following knowledge of the patient’s death). Hospitals APPROVED

Updated 11/4/2020
Patient Rights. CMS is waiving requirements under 42 CFR §482.13 only for hospitals that are considered to be impacted by a widespread outbreak of COVID-19. Hospitals that are located in a state which has widespread confirmed cases (i.e., 51 or more confirmed cases*) as updated on the CDC website, CDC States Reporting Cases of COVID-19, at ttps://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html, would not be required to meet the following requirements:

  • §482.13(d)(2) -With respect to timeframes in providing a copy of a medical record.
  • §482.13(h) -Related to patient visitation, including the requirement to have written policies and procedures on visitation of patients who are in COVID-19 isolation and quarantine processes.
  • §482.13(e)(1)(ii) -Regarding seclusion.
Hospitals APPROVED

Updated 11/4/2020
Telehealth

Hospital Outpatient Services Accompanying Professional Services Furnished Via Telehealth:

When a physician or non-physician practitioner who typically furnishes professional services in the hospital outpatient department furnishes telehealth services during theCOVID-19 PHE, they bill with a hospital outpatient place of service since that is likely where the services would have been furnished if not for the COVID-19 PHE. The physician or practitioner is paid for the service under the PFS at the facility rate, which does not include payment for resources such as clinical staff, supplies, or office overhead since those things are usually supplied by the hospital outpatient department. During the COVID-19 PHE, if the beneficiary’s home or temporary expansion site is considered to be a provider-based department of the hospital, and the beneficiary is registered as an outpatient of the hospital for purposes of receiving telehealth services billed by the physician or practitioner, the hospital may bill under the PFS for the originating site facility fee associated with the telehealth service.

CMS is waiving the provisions related to telemedicine at 42 CFR §482.12(a) (8)– (9)for hospitals, making it easier for telemedicine services to be furnished to the hospital’s patients through an agreement with an off-site hospital.
Hospitals APPROVED

Updated 11/4/2020
Hospitals Able to Provide Care in Temporary Expansion Sites: Hospitals can provide hospital services in other healthcare facilities and sites that would not otherwise be considered to be part of a healthcare facility; or can set up temporary expansion sites to help address the urgent need to increase capacity to care for patients. For the duration of the COVID-19 PHE, CMS is allowing hospitals to screen patients at offsite locations, and furnish inpatient and outpatient services at temporary expansion sites. Hospitals APPROVED

Updated 11/4/2020
Ambulatory Surgical Centers Temporary Enrollment as Hospitals. ASCs that wish to enroll to receive temporary billing privileges as a hospital should call the COVID-19 Provider Enrollment Hotline to reach the contractor that serves their jurisdiction, and then will complete and sign an attestation form specific to the COVID-19 PHE. See https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf for additional information. ASCs APPROVED

Updated 11/4/2020
Sterile Compounding. CMS is waiving requirements at 42CFR §482.25(b)(1) and §485.635(a)(3) in order to allow used face masks to be removed and retained in the compounding area to be re-donned and reused during the same work shift in the compounding area only. CMS will not review the use and storage of face masks under these requirements. Hospitals APPROVED

Updated 11/4/2020
Detailed Information Sharing for Discharge Planning for Hospitals and CAHs. CMS is waiving the requirement 42 CFR §482.43(a)(8), §482.61(e), and §485.642(a)(8) to provide detailed information regarding discharge planning, described below:

  • The hospital, psychiatric hospital, and CAH must assist patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) quality measures and resource use measures. The hospital must ensure that the post-acute care data on quality measures and resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences.
  • CMS is maintaining the discharge planning requirements that ensure a patient is discharged to an appropriate setting with the necessary medical information and goals of care as described in 42 CFR §482.43(a)(1)-(7) and (b).
Hospitals APPROVED

Updated 11/4/2020
Limiting Detailed Discharge Planning for Hospitals. CMS is waiving all the requirements and subparts at 42 CFR §482.43(c) related to post-acute care services as follows:

  • §482.43(c)(1): Include in the discharge plan a list of HHAs, SNFs, IRFs, or LTCHs that are available to the patient.
  • §482.43(c)(2): Inform the patient or the patient’s representative of their freedom to choose among participating Medicare providers and suppliers of post-discharge services.
  • §482.43(c)(3): Identify in the discharge plan any HHA or SNF to which the patient is referred in which the hospital has a disclosable financial interest, as specified by the Secretary, and any HHA or SNF that has a disclosable financial interest in a hospital under Medicare.
Hospitals APPROVED

Updated 11/4/2020
Physical Environment. CMS is waiving certain physical environment requirements at 42 CFR §482.41 and 42 CFR §485.623 to allow for increased flexibilities for surge capacity and patient quarantine at hospitals, psychiatric hospitals, and critical access hospitals (CAH). CMS will permit facility and non-facility space that is not normally used for patient care to be utilized for patient care or quarantine, provided the location is approved by the state and is consistent with the state’s emergency preparedness or pandemic plan. States are still subject to obligations under the integration mandate of the Americans with Disabilities Act, to avoid subjecting persons with disabilities to unjustified institutionalization or segregation. Hospitals APPROVED

Updated 11/4/2020
Specific Life Safety Code (LSC) for Hospitals: CMS is modifying these requirements as follows:

Alcohol-based Hand-Rub (ABHR) Dispensers: We are waiving the prescriptive requirements for the placement of alcohol-based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control. However, ABHRs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers. This includes restricting access by certain patient/resident population to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area. Refer to: 2012 LSC, sections 18/19.3.2.6. In addition, facilities should continue to protect ABHR dispensers against inappropriate use as required by 42 CFR §482.41(b)(7) for hospitals and §485.623(c)(5) for CAHs.

Fire Drills: Due to the inadvisability of quarterly fire drills that move and mass staff together, we will instead permit a documented orientation training program related to the current fire plan, which considers current facility conditions. The training will instruct employees, including existing, new or temporary employees, on their current duties, life safety procedures and the fire protection devices in their assigned area. Refer to: 2012 LSC, sections 18/19.7.1.6.

Temporary Construction: CMS is waiving requirements that would otherwise not permit temporary walls and barriers between patients. Refer to: 2012 LSC, sections18/19.3.3.2.

Hospitals APPROVED

Updated 11/4/2020
Hospital Outpatient: Use of Provider-Based Departments as Temporary Expansion Sites: CMS is waiving certain requirements at 42 CFR §482.41 and §485.623 and the provider-based department requirements at 42 CFR §413.65 to allow hospitals to expand capacity by create new or relocating existing provider-based departments. CMS has made several changes to support hospitals so they can more effectively respond to the COVID-19 PHE. Hospitals APPROVED

Updated 11/4/2020
Hospital-Only Remote Outpatient Therapy and Education Services: Hospitals may provide behavioral health and education services furnished by hospital-employed counselors or other professionals that cannot bill Medicare directly for their professional services. This includes partial hospitalization services. These services may be furnished to a beneficiary in their home when the beneficiary is registered as an outpatient of the hospital and the hospital considers the beneficiary’s home to be a provider-based department of the hospital. Hospitals APPROVED

Updated 11/4/2020
Expanded Ability for Hospitals to Offer Long-term Care Services (“Swing-Beds”) for Patients Who do not Require Acute Care but do Meet the Skilled Nursing Facility (SNF) Level of Care Criteria as Set Forth at 42 CFR 409.31. CMS is waiving the requirements at 42 CFR 482.58, to allow hospitals to establish SNF swing beds payable under the SNF prospective payment system (PPS) to provide additional options for hospitals with patients who no longer require acute care but are unable to find placement in a SNF. Hospitals APPROVED

Updated 11/4/2020
Housing Acute Care Patients in Excluded Distinct Part Units: CMS is waiving requirements to allow acute care hospitals to house acute care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute care inpatients. The Inpatient Prospective Payment System (IPPS) hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the disaster or emergency. Hospitals APPROVED

Updated 11/4/2020
Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital: CMS is waiving requirements to allow acute care hospitals with excluded distinct part inpatient psychiatric units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct part psychiatric unit to an acute care bed and unit. This waiver may be utilized where the hospital’s acute care beds are appropriate for psychiatric patients and the staff and environment are conducive to safe care. For psychiatric patients, this includes assessment of the acute care bed and unit location to ensure those patients at risk of harm to self and others are safely cared for. Hospitals APPROVED

Updated 11/4/2020
Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital: CMS is waiving requirements to allow acute care hospitals with excluded distinct part inpatient Rehabilitation units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct part rehabilitation unit to an acute care bed and unit. This waiver may be utilized where the hospital’s acute care beds are appropriate for providing care to rehabilitation patients and such patients continue to receive intensive rehabilitation services. Hospitals APPROVED

Updated 11/4/2020
Flexibility for Inpatient Rehabilitation Facilities Regarding the “60 Percent Rule". CMS is allowing IRFs to exclude patients from the freestanding hospital’s or excluded distinct part unit’s inpatient population for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such. Inpatient Rehabilitation Hospitals APPROVED

Updated 11/4/2020
Inpatient Rehabilitation Facility – Intensity of Therapy Requirement (“3-Hour Rule”). The Secretary has waived 42 CFR§412.622(a)(3)(ii) which provides that payment generally requires that patients of an inpatient rehabilitation facility receive at least 15 hours of therapy per week. This waiver clarifies information provided in “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” (CMS-1744-IFC). (85 Federal Register19252, 19287, April 6, 2020). The information in that rulemaking (CMS-1744-IFC) about Inpatient Rehabilitation Facilities was contemplated prior to the passage of the CARES Act. Inpatient Rehabilitation Hospitals APPROVED

Updated 11/4/2020
Long Term Care Hospitals -Site Neutral Payment Rate Provisions. The Secretary has waived section 1886(m)(6) of the Social Security Act relating to certain site neutral payment rate provisions for long-term care hospitals (LTCHs).

  • Section 3711(b)(1) of the CARES Act waives the payment adjustment under section 1886(m)(6)(C)(ii) of the Act for LTCHs that do not have a discharge payment percentage (DPP) for the period that is at least 50 percent during the COVID-19 public health emergency period. Under this provision, for the purposes of calculating an LTCH’s DPP, all admissions during the COVID-19 public health emergency period will be counted in the numerator of the calculation, that is, LTCH cases that were admitted during the COVID-19 public health emergency period will be counted as discharges paid the LTCH PPS standard Federal payment rate.
  • Section 3711(b)(2) of the CARES Act provides a waiver of the application of the site neutral payment rate under section 1886(m)(6)(A)(i) of the Act for those LTCH admissions that are in response to the public health emergency and occur during the COVID-19 public health emergency period. Under this provision, all LTCH cases admitted during the COVID-19 public health emergency period will be paid the relatively higher LTCH PPS standard Federal rate. A new LTCH PPS Pricer software package will be released in April 2020 to include this temporary payment policy effective for claims with an admission date occurring on or after January 27, 2020 and continuing through the duration of the COVID-19 public health emergency period. Claims received on or after April 21, 2020, will be processed in accordance with this waiver. Claims received April 20, 2020, and earlier will be reprocessed.
Long Term Care Hospitals APPROVED

Updated 11/4/2020
Supporting Care for Patients in Long-Term Care Acute Hospitals (LTCHs). CMS has determined it is appropriate to issue a blanket waiver to long-term care hospitals (LTCHs) where an LTCH admits or discharges patients in order to meet the demands of the emergency from the 25-day average length of stay requirement at § 412.23(e)(2), which allows these hospitals to participate in the LTCH PPS. Hospitals should add the “DR” condition code to applicable claims. Long Term Care Hospitals; Acute Care Hospitals APPROVED

Updated 11/4/2020
Medicare Graduate Medical Education (GME) Affiliation Agreement

CMS is waiving the July 1 submission deadline under 42 CFR 413.79(f)(1) for new Medicare GME affiliation agreements and the June 30 deadline under the May 12, 1998 Health Care Financing Administration Final Rule (63 FR 26318, 26339, 26341) for amendments of existing Medicare GME affiliation agreements. CMS is allowing hospitals to submit new and/or amended Medicare GME affiliation agreements as applicable to CMS and the MACs by January 1, 2021. As under existing procedures, hospitals should email new and/or amended agreements to CMS at Medicare_GME_Affiliation_Agreement@cms.hhs.gov, and indicate in the subject line whether the affiliation agreement is a new one or an amended one.
Hospitals APPROVED

Updated 11/4/2020
Postponement of Application Deadline to the Medicare Geographic Classification Review Board

CMS is postponing the September 1 deadline until 15 days after the public display date of the FY 2021 IPPS/LTCH final rule by the Office of the Federal Register.
Hospitals APPROVED

Updated 9/29/2020

EXPIRED
Medical Staff. CMS is waiving requirements under 42 CFR §482.22(a)(1)-(4) to allow for physicians whose privileges will expire to continue practicing at the hospital and for new physicians to be able to practice before full medical staff/governing body review and approval CMS is waiving §482.22(a) (1)-(4) regarding details of the credentialing and privileging process. Hospitals APPROVED

Updated 11/4/2020
Physician Services. CMS is waiving requirements under 42 CFR §482.12(c)(1)–(2)and§482.12(c)(4), which requires that Medicare patients be under the care of a physician. This waiver may be implemented so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan. This allows hospitals to use other practitioners to the fullest extent possible. Hospitals APPROVED

Updated 11/4/2020
Anesthesia Services. CMS is waiving requirements under 42 CFR §482.52(a)(5), §485.639(c) (2), and §416.42 (b)(2) that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician CRNA supervision will be at the discretion of the hospital and state law. Hospitals; ASCs APPROVED

Updated 11/4/2020
Nursing Services. CMS is waiving the requirements at 42 CFR §482.23(b)(4), which requires the nursing staff to develop and keep current a nursing care plan for each patient, and§482.23(b)(7), which requires the hospital to have policies and procedures in place establishing which outpatient departments are not required to have a registered nurse present. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Hospitals APPROVED

Updated 11/4/2020
Respiratory Care Services. CMS is waiving the requirements at 42 CFR §482.57(b)(1) that require hospitals to designate in writing the personnel qualified to perform specific respiratory care procedures and the amount of supervision required for personnel to carry out specific procedures. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Hospitals APPROVED

Updated 11/4/2020
Medical Records. CMS is waiving requirements under 42 CFR §482.24(a) through (c), which cover the subjects of the organization and staffing of the medical records department, requirements for the form and content of the medical record, and record retention requirements, and these flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. CMS is waiving §482.24(c)(4)(viii) related to medical records to allow flexibility in completion of medical records within 30 days following discharge from a hospital. Hospitals APPROVED

Updated 11/4/2020
Flexibility in Patient Self Determination Act Requirements (Advance Directives). CMS is waiving the requirements which require hospitals to provide information about their advance directive policies to patients. Hospitals APPROVED

Updated 11/4/2020
Utilization Review. CMS is waiving the entire utilization review condition of participation Utilization Review (UR) at §482.30, which requires that a hospital must have a UR plan with a UR committee that provides for a review of services furnished to Medicare and Medicaid beneficiaries to evaluate the medical necessity of the admission, duration of stay, and services provided. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Hospitals APPROVED

Updated 11/4/2020
Written Policies and Procedures for Appraisal of Emergencies at Off Campus Hospital Departments. CMS is waiving 42 CFR §482.12(f)(3), emergency services, with respect to surge facilities only, such that written policies and procedures for staff to use when evaluating emergencies are not required for surge facilities. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Surge Hospitals APPROVED

Updated 11/4/2020
Emergency Preparedness Policies and Procedures. CMS is waiving 42 CFR §482.15(b) and §485.625(b), which requires the hospital to develop and implement emergency preparedness policies and procedures, and §482.15(c)(1)–(5) and §485.625(c)(1)–(5) which requires that the emergency preparedness communication plans for hospitals to contain specified elements with respect to the surge site. The requirement under the communication plan requires hospitals to have specific contact information for staff, entities providing services under arrangement, patients’ physicians, other hospitals and volunteers. This would not be an expectation for the surge site. Surge Hospitals APPROVED

Updated 11/4/2020
Quality Assessment and Performance Improvement Program. CMS is waiving 42CFR§482.21(a)–(d) and (f), and §485.641(a), (b), and (d), which provide details on the scope of the program, the incorporation, and setting priorities for the program’s performance improvement activities, and integrated Quality Assurance & Performance Improvement programs. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. We expect any improvements to the plan to focus on the Public Health Emergency (PHE). While this waiver decreases burden associated with the development of a QAPI program, the requirement to maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement program will remain. Hospitals APPROVED

Updated 11/4/2020
Food and Dietetic Services. CMS is waiving the requirement at paragraph 42 CFR §482.28(b) (3), which requires providers to have a current therapeutic diet manual approved by the dietitian and medical staff readily available to all medical, nursing, and food service personnel. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Surge Hospitals APPROVED

Updated 11/4/2020
Hospital Value-Based Purchasing (VBP) Program’s Extraordinary Circumstances Exceptions (ECE) policy: CMS has the ability to grant exceptions to hospitals located in entire regions or locales without an ECE request form where we determine that the extraordinary circumstance has affected the entire region or locale. CMS is granting an exception for certain HVBP reporting requirements in light of the COVID PHE as specified in the March 27, 2020 guidance memo:

https://www.cms.gov/files/document/guidance-memo-exceptions-and-extensionsquality-reporting-and-value-based-purchasing-programs.pdf
Hospitals APPROVED

Updated 11/4/2020
Application of Teaching Physician Regulations: Under current rules, Medicare payment is made for services furnished by a teaching physician involving residents only if the physician is physically present for the key portion of the service or procedure or the entire procedure, where applicable. During the COVID-19 PHE, teaching physicians may use audio/video real time communications technology to interact with the resident through virtual means, which would meet the requirement that they be present for the key portion of the service, including when the teaching physician involves the resident in furnishing Medicare Telehealth services. Teaching physicians involving residents in providing care at primary care centers can provide the necessary direction, management and review for the resident’s services using audio/video real time communications technology. Residents furnishing services at primary care centers may furnish an expanded set of services to beneficiaries, including levels 4-5 of an office/outpatient evaluation and management (E/M) visit, telephone E/M, care management, and communication technology-based services. These flexibilities do not apply in the case of surgical, high risk, interventional, or other complex procedures, services performed through an endoscope, and anesthesia services. This allows teaching hospitals to maximize their workforce to safely take care of patients. Teaching Hospitals APPROVED

Updated 11/4/2020
Resident Moonlighting: Under current rules, Medicare considers the services of residents that are not related to their approved graduate medical education programs and performed in the outpatient department or the emergency department of a hospital as separately billable physicians’ services. During the COVID-19 PHE, Medicare also considers the services of residents that are not related to their approved GME programs and furnished to inpatients of a hospital in which they have their training program as separately billable physicians’ services Teaching Hospitals APPROVED

Updated 11/4/2020
Counting of Resident Time at Alternate Locations: Existing regulations have specific rules on when a hospital may count a resident for purposes of Medicare direct graduate medical education (DGME) payments or indirect medical education (IME) payments. Normally, if the resident is performing activities with the scope of his/her approved program in his/her own home, or a patient’s home, the hospital may not count the resident. During the PHE, a hospital that is paying the resident’s salary and fringe benefits for the time that the resident is at home or in a patient’s home, but performing duties within the scope of the approved residency program and meets appropriate physician supervision requirements can claim that resident for IME and DGME purposes. This allows medical residents to perform their duties in alternate locations, including their own home or a patient’s home, so long as such activities meet appropriate physician supervision requirements. Teaching Hospitals APPROVED

Updated 11/4/2020
Graduate Medical Education (GME) Residents Training in Other Hospitals: During the COVID-19 PHE, a teaching hospital that sends residents to other hospitals will be able to continue to claim those residents in the teaching hospital’s IME and DGME FTE resident counts, if certain requirements are met. Those requirements include that 1) the teaching hospital sends the resident to the other hospital in response to the COVID-19 pandemic; 2) the time spent by the resident training at the other hospital is in lieu of time that would have been spent training at the sending hospital; and 3) the time that the resident spent training immediately prior to and/or subsequent to the time frame that the COVID-19 PHE was in effect was included in the FTE count for the sending hospital. Moreover, the presence of residents in non-teaching hospitals will not trigger establishment of IME and/or DGME FTE resident caps at those non-teaching hospitals. Specifically, for DGME, the presence of residents in non-teaching hospitals will not trigger establishment of PRAs at those non-teaching hospitals. Teaching Hospitals APPROVED

Updated 11/4/2020
IME Payments Held Harmless for Temporary Increase in Beds: During the COVID-19 PHE, CMS will hold teaching hospitals harmless from a reduction in IME payments due to beds temporarily added during the COVID-19 PHE by not considering such beds when determining IME payment. Teaching Hospitals APPROVED

Updated 11/4/2020
Inpatient Psychiatric Facilities (IPFs) Teaching Status Adjustment Payments: To ensure that teaching IPFs can alleviate bed capacity issues by taking patients from the inpatient acute care hospitals without being penalized by lower teaching status adjustments, we are freezing the IPFs’ teaching status adjustment payments at their values prior to the PHE. For the duration of the COVID-19 PHE, a teaching IPF’s teaching status adjustment payments will be the same as they were on the day before the COVID-19 PHE was declared. Inpatient Psychiatric Hospitals APPROVED

Updated 11/4/2020
“Stark Law” Waivers: The physician self-referral law (also known as the “Stark Law”) prohibits a physician from making referrals for certain healthcare services payable by Medicare if the physician (or an immediate family member) has a financial relationship with the entity performing the service. There are statutory and regulatory exceptions, but in short, a physician cannot refer a patient to any entity with which he or she has a financial relationship. On March 30, 2020, CMS issued blanket waivers of certain provisions of the Stark Law regulations. These blanket waivers apply to financial relationships and referrals that are related to the COVID-19 emergency. The remuneration and referrals described in the blanket waivers must be solely related to COVID-19 Purposes, as defined in the blanket waiver document. Under the waivers, CMS will permit certain referrals and the submission of related claims that would otherwise violate the Stark Law. These flexibilities include:

  • Hospitals and other health care providers can pay above or below fair market value for the personal services of a physician (or an immediate family member of a physician), and parties may pay below fair market value to rent equipment or purchase items or services. For example, a physician practice may be willing to rent or sell needed equipment to a hospital at a price that is below what the practice could charge another party. Or, a hospital may provide space on hospital grounds at no charge to a physician who is willing to treat patients who seek care at the hospital but are not appropriate for emergency department or inpatient care.
  • Health care providers can support each other financially to ensure continuity of health care operations. For example, a physician owner of a hospital may make a personal loan to the hospital without charging interest at a fair market rate so that the hospital can make payroll or pay its vendors. o Hospitals can provide benefits to their medical staffs, such as multiple daily meals, laundry service to launder soiled personal clothing, or child care services while the physicians are at the hospital and engaging in activities that benefit the hospital and its patients
  • Health care providers may offer certain items and services that are solely related to COVID-19 Purposes (as defined in the waivers), even when the provision of the items or services would exceed the annual non-monetary compensation cap. For example, a home health agency may provide continuing medical education to physicians in the community on the latest care protocols for homebound patients with COVID-19, or a hospital may provide isolation shelter or meals to the family of a physician who was exposed to the novel coronavirus while working in the hospital’s emergency department
  • Physician-owned hospitals can temporarily increase the number of their licensed beds, operating rooms, and procedure rooms, even though such expansion would otherwise be prohibited under the Stark Law. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surge during the COVID-19 pandemic in the United States. o Some of the restrictions regarding when a group practice can furnish medically necessary designated health services (DHS) in a patient’s home are loosened. For example, any physician in the group may order medically necessary DHS that is furnished to a patient by one of the group’s technicians or nurses in the patient’s home contemporaneously with a physician service that is furnished via telehealth by the physician who ordered the DHS. o Group practices can furnish medically necessary MRIs, CT scans or clinical laboratory services from locations like mobile vans in parking lots that the group practice rents on a part-time basis
Hospitals; Physicians APPROVED

Updated 11/4/2020
Comprehensive Care for Joint Replacement (CJR) Model

Extension of Comprehensive Care for Joint Replacement (CJR) Model Year 5: In the IFC issued October 28, 2020, CMS extended Performance Year (PY) 5 of the Comprehensive Care for Joint Replacement (CJR) model an additional 6 months, so PY 5 now ends September 30, 2021. To accommodate the extension of PY 5, CMS will perform a 12-month reconciliation period and a 9- month reconciliation period in PY 5. Further the adjustment to the extreme and uncontrollable circumstances policy for COVID-19, previously established in Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency IFC, will now expire on March 31, 2021 or the end of the PHE, whichever occurs first. After that, the extreme and uncontrollable circumstances policy for COVID-19 will be episode-based, where, beginning after the PHE or on April 1, 2020 (whichever occurs first) and through the end of the PHE, actual episode payments are capped at the quality adjusted target price for an episode with actual episode payments that include a claim with a COVID-19 diagnosis code. Lastly, to ensure that the model continues to include the same inpatient Lower Extremity Joint Replacement (LEJR) procedures, despite the adoption of new MS-DRGs 521 and 522 to describe those procedures, CMS made a technical change, retroactive to October 1, 2020, to include these new DRGs in the model. Questions about the CJR model can be submitted via email at CJRSupport@cms.hhs.gov.
CJR Hospitals APPROVED

Updated 9/29/2020

EXPIRED
Enhanced Medicare Payments for New COVID-19 Treatments: Hospital Inpatient Stays: In order to mitigate potential financial disincentives for hospitals to provide new COVID-19 treatments hospital during the COVID-19 PHE, the Medicare program will provide an enhanced payment for eligible inpatient cases that involve use of certain new products authorized or approved to treat COVID-19. The enhanced payment will be equal to the lesser of: (1) 65 percent of the operating outlier threshold for the claim; or (2) 65 percent of the cost of a COVID-19 stay beyond the operating Medicare payment (including the 20 percent add-on payment under section 3710 of the CARES Act) for eligible cases. Hospitals APPROVED

Updated 11/4/2020

GO TO TOP

Centers for Medicare & Medicaid Services — Skilled Nursing Facilities, Nursing Homes

WaiverApplies ToStatus
Physical Environment: Provided that the State has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements under 42 CFR §483.90 to allow for a non-SNF/NF building to be temporarily certified as and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID-19 is available while protecting other vulnerable adults. CMS will waive certain conditions of participation and certification requirements for opening a SNF/NF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location. To assist with isolation needs, CMS is also temporarily allowing for rooms in a long-term care facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this purpose include activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long as residents can be kept safe, comfortable, and other applicable requirements for participation are met. This can be done so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department. SNFs; Temporary SNFS APPROVED

Updated 11/4/2020
3-Day Prior Hospitalization: Using the waiver authority under Section 1812(f) of the Social Security Act, CMS is temporarily waiving the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay. This waiver provides temporary emergency coverage of SNF services without a qualifying hospital stay. SNFs APPROVED

Updated 11/4/2020
Renewed SNF Coverage without 60-day wellness period
For certain beneficiaries who exhausted their SNF benefits, the waiver authorizes renewed SNF coverage without first having to start and complete a 60-day “wellness period” (that is, the 60-day period of non-inpatient status that is normally required in order to end the current benefit period and renew SNF benefits). This waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the 60-day “wellness period” that would have occurred under normal circumstances. By contrast, if the patient has a continued skilled care need (such as a feeding tube) that is unrelated to the COVID-19 emergency, then the beneficiary cannot renew his or her SNF benefits under the Section 1812(f) waiver, as it is this continued skilled care in the SNF rather than the emergency that is preventing the beneficiary from beginning the 60-day “wellness period.”
SNFs APPROVED

Updated 11/4/2020
Reporting Minimum Data Set: CMS is waiving 42 CFR §483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission. SNFs APPROVED

Updated 11/4/2020
Waive Pre-Admission Screening and Annual Resident Review (PASRR): CMS is allowing states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should receive the assessment as soon as resources become available. SNFs APPROVED

Updated 11/4/2020
Resident Groups: CMS is waiving the requirements at §483.10(f)(5) to allow for residents to have the right to participate in-person in resident groups. This waiver would only permit the facility to restrict having in-person meetings during the national emergency given the recommendations of social distancing and limiting gatherings of more than ten people. Refraining from in-person gatherings will help prevent the spread of COVID-19. SNFs APPROVED

Updated 11/4/2020
Quality Assurance and Performance Improvement (QAPI). CMS is modifying certain requirements in 42 CFR §483.75, which requires long-term care facilities to develop, implement, evaluate, and maintain an effective, comprehensive, data-driven QAPI program. Specifically, CMS is modifying §483.75(b)–(d) and (e)(3) to the extent necessary to narrow the scope of the QAPI program to focus on adverse events and infection control. SNFs APPROVED

Updated 11/4/2020
Nurse Aide In-Service Training: CMS is modifying the nurse aide training requirements at §483.95(g)(1) for SNFs and NFs, which requires the nursing assistant to receive at least 12 hours of inservice training annually. In accordance with section 1135(b)(5) of the Act, we are postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. SNFs APPROVED

Updated 11/4/2020
Detailed Information Sharing for Discharge Planning. CMS is waiving the discharge planning requirement in §483.21(c)(1)(viii), which requires LTC facilities to assist residents and their representatives in selecting a post-acute care provider using data, such as standardized patient assessment data, quality measures and resource use. This temporary waiver is to provide facilities the ability to expedite discharge and movement of residents among care settings. CMS is maintaining all other discharge planning requirements, such as but not limited to, ensuring that the discharge needs of each resident are identified and result in the development of a discharge plan for each resident; and involving the interdisciplinary team, as defined at 42 CFR §483.21(b)(2)(ii), in the ongoing process of developing the discharge plan address the resident's goals of care and treatment preferences. SNFs APPROVED

Updated 11/4/2020
Clinical Records. Pursuant to section 1135(b)(5) of the Act, CMS is modifying the requirement at 42 CFR §483.10(g)(2)(ii) which requires long-term care (LTC) facilities to provide a resident a copy of their records within two working days (when requested by the resident). Specifically, CMS is modifying the timeframe requirements to allow LTC facilities ten working days to provide a resident’s record rather than two working days. SNFs APPROVED

Updated 11/4/2020
Transfers of COVID-19 Patients: A long term care (LTC) facility can temporarily transfer its COVID-19 positive resident(s) to another facility, such as a COVID-19 isolation and treatment location, with the provision of services “under arrangements.” The transferring LTC facility need not issue a formal discharge in this situation, as it is still considered the provider and should bill Medicare normally for each day of care. The transferring LTC facility is then responsible for reimbursing the other provider that accepted its resident(s) during the emergency period. This is consistent with recent CDC guidance, and helps residents with COVID-19 by placing them into facilities that are prepared to care for them. It also helps residents without COVID-19 by placing them in facilities without other COVID19 residents, thus helping to protect them from being infected. If the LTC facility does not intend to provide services under arrangement, the COVID-19 isolation and treatment facility is the responsible entity for Medicare billing purposes. The SNF should follow the procedures described in 40.3.4 of the Medicare Claims Processing Manual (https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/clm104c06.pdf) to submit a discharge bill to Medicare. The COVID-19 isolation and treatment facility should then bill Medicare appropriately for the type of care it is providing for the beneficiary. If the COVID-19 isolation and treatment facility is not yet an enrolled provider, the facility should enroll through the provider enrollment hotline for the Medicare Administrative Contractor that services their geographic area to establish temporary Medicare billing privileges. SNFs APPROVED

Updated 11/4/2020
Resident Transfer and Discharge: CMS is waiving requirements in 42 CFR 483.10(c)(5); 483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), (c)(9), and (d); and § 483.21(a)(1)(i), (a)(2)(i), and (b) (2)(i) (with some exceptions noted below) to allow a long term care facility to transfer or discharge residents to another LTC facility solely for the following cohorting purposes:

  1. Transferring residents with symptoms of a respiratory infection or confirmed diagnosis of COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents;
  2. Transferring residents without symptoms of a respiratory infection or confirmed to not have COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents to prevent them from acquiring COVID-19, as well as providing treatment or therapy for other conditions as required by the resident’s plan of care; or
  3. Transferring residents without symptoms of a respiratory infection to another facility that agrees to accept each specific resident to observe for any signs or symptoms of a respiratory infection over 14 days.


Exceptions:
  • These requirements are only waived in cases where the transferring facility receives confirmation that the receiving facility agrees to accept the resident to be transferred or discharged. Confirmation may be in writing or verbal. If verbal, the transferring facility needs to document the date, time, and person that the receiving facility communicated agreement.
  • In § 483.10, we are only waiving the requirement, under § 483.10(c)(5), that a facility provide advance notification of options relating to the transfer or discharge to another facility. Otherwise, all requirements related to § 483.10 continue to apply. Similarly, in § 483.15, we are only waiving the requirement, under § 483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), and (d), for the written notice of transfer or discharge to be provided before the transfer or discharge. This notice must be provided as soon as practicable.
  • In § 483.21, we are only waiving the timeframes for certain care planning requirements for residents who are transferred or discharged for the purposes explained in 1–3 above. Receiving facilities should complete the required care plans as soon as practicable, and we expect receiving facilities to review and use the care plans for residents from the transferring facility, and adjust as necessary to protect the health and safety of the residents they apply to.
  • These requirements are also waived when the transferring residents to another facility, such as a COVID-19 isolation and treatment location, with the provision of services “under arrangements,” as long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department. In these cases, the transferring LTC facility need not issue a formal discharge, as it is still considered the resident’s provider and should bill Medicare normally for each day of care. The transferring LTC facility is then responsible for reimbursing the other provider that accepted its resident(s) during the emergency period.


If the LTC facility does not intend to provide services under arrangement, the COVID-19 isolation and treatment facility is the responsible entity for Medicare billing purposes. The LTC facility should follow the procedures described in 40.3.4 of the Medicare Claims Processing Manual (https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/clm104c06.pdf) to submit a discharge bill to Medicare. The COVID-19 isolation and treatment facility should then bill Medicare appropriately for the type of care it is providing for the beneficiary. If the COVID-19 isolation and treatment facility is not yet an enrolled provider, the facility should enroll through the provider enrollment hotline for the Medicare.
SNFs APPROVED

Updated 11/4/2020
Resident Roommates and Grouping: CMS is waiving the requirements in 42 CFR 483.10(e)(5), (6), and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19, and separating them from residents who are asymptomatic or tested negative for COVID19. This action waives a facility’s requirements, under 42 CFR 483.10, to provide for a resident to share a room with his or her roommate of choice in certain circumstances, to provide notice and rationale for changing a resident’s room, and to provide for a resident’s refusal a transfer to another room in the facility. SNFs APPROVED

Updated 11/4/2020
Inspection, Testing & Maintenance (ITM) under the Physical Environment Conditions of Participation: CMS is waiving certain physical environment requirements §483.90, §483.90(a)(1)(i) and (b) for 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. CMS will permit facilities to adjust scheduled inspection, testing and maintenance (ITM) frequencies and activities for facility and medical equipment.

The following LSC and HCFC ITM are considered critical are not included in this waiver:
  • Sprinkler system monthly electric motor-driven and weekly diesel engine-driven fire pump testing.
  • Portable fire extinguisher monthly inspection.
  • Elevators with firefighters’ emergency operations monthly testing.
  • Emergency generator 30 continuous minute monthly testing and associated transfer switch monthly testing.
  • Means of egress daily inspection in areas that have undergone construction, repair, alterations or additions to ensure its ability to be used instantly in case of emergency.
SNFs APPROVED

Updated 11/4/2020
Waiver of §483.90(a)(7) that requires SNFs to have an outside window or outside door in every sleeping room. CMS will permit a waiver of these outside window and outside door requirements to permit these providers to utilize facility and non-facility space that is not normally used for patient care to be utilized for temporary patient care or quarantine. SNFs APPROVED

Updated 11/4/2020
Specific Life Safety Code (LSC) for Multiple Providers. CMS is waiving and modifying particular waivers under §483.90(a) for SNF/NFs. Specifically, CMS is modifying these requirements as follows:

  • Alcohol-based Hand-Rub (ABHR) Dispensers: We are waiving the prescriptive requirements for the placement of alcohol based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control. However, ABHRs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers. This includes restricting access by certain patient/resident population to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area. Refer to: 2012 LSC, sections 18/19.3.2.6. In addition, facilities should continue to protect ABHR dispensers against inappropriate use as required by 42 CFR §483.470(j)(5)(ii) for ICF/IIDs and §483.90(a)(4) for SNF/NFs.
  • Fire Drills: Due to the inadvisability of quarterly fire drills that move and mass staff together, we will instead permit a documented orientation training program related to the current fire plan, which considers current facility conditions. The training will instruct employees, including existing, new or temporary employees, on their current 10 duties, life safety procedures and the fire protection devices in their assigned area. Refer to: 2012 LSC, sections 18/19.7.1.6.
  • Temporary Construction: CMS is waiving requirements that would otherwise not permit temporary walls and barriers between patients. Refer to: 2012 LSC, sections 18/19.3.3.2.
SNFs APPROVED

Updated 11/4/2020
Physician Delegation of Tasks in SNFs: 42 CFR 483.30(e)(4). CMS is waiving the requirement in § 483.30(e)(4) that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally. This waiver gives physicians the ability to delegate any tasks to a physician assistant, nurse practitioner, or clinical nurse specialist who meets the applicable definition in 42 CFR 491.2 or, in the case of a clinical nurse specialist, is licensed as such by the State and is acting within the scope of practice laws as defined by State law. We are temporarily modifying this regulation to specify that any task delegated under this waiver must continue to be under the supervision of the physician. This waiver does not include the provision of § 483.30(e)(4) that prohibits a physician from delegating a task when the delegation is prohibited under State law or by the facility’s own policy. SNFs APPROVED

Updated 11/4/2020
Physician Visits: 42 CFR 483.30(c)(3). CMS is waiving the requirement at § 483.30(c)(3) that all required physician visits (not already exempted in § 483.30(c)(4) and (f)) must be made by the physician personally. We are modifying this provision to permit physicians to delegate any required physician visit to a nurse practitioner (NPs), physician assistant, or clinical nurse specialist who is not an employee of the facility, who is working in collaboration with a physician, and who is licensed by the State and performing within the state’s scope of practice laws.

CMS is not waiving the requirements for the frequency of required physician visits at § 483.30(c)(1). CMS has only modified the requirement to allow for the requirement to be met by an NP, physician assistant, or clinical nurse specialist, and via telehealth or other remote communication options, as appropriate. In addition, CMS is not waiving requirements for physician supervision in § 483.30(a)(1), and the requirement at § 483.30(d)(3) for the facility to provide or arrange for the provision of physician services 24 hours a day, in case of an emergency. It is important that the physician be available for consultation regarding a resident’s care.
SNFs APPROVED

Updated 11/4/2020
Physician visits in skilled nursing facilities/nursing facilities: CMS is waiving the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform in person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options. SNFs APPROVED

Updated 11/4/2020
Training and Certification of Nurse Aides: CMS is waiving the requirements at 42 CFR §483.35(d), (except for 42 CFR §483.35(d)(1)(i)), which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements under §483.35(d). To ensure the health and safety of nursing home residents, CMS is not waiving §483.35(d)(1)(i), which requires facilities to not use any individual working as a nurse aide for more than four months, on a full-time basis, unless that individual is competent to provide nursing and nursing related services. CMS is not waiving §483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care. SNFs APPROVED

Updated 11/4/2020
Paid Feeding Assistants: CMS is modifying the requirements at 42 CFR §§ 483.60(h)(1)(i) and 483.160(a) regarding required training of paid feeding assistants. Specifically, CMS is modifying the minimum timeframe requirements in these sections, which require this training to be a minimum of 8 hours. CMS is modifying to allow that the training can be a minimum of 1 hour in length. CMS is not waiving any other requirements under 42 CFR §483.60(h) related to paid feeding assistants or the required training content at 42 CFR §483.160(a)(1)-(8), which contains infection control training and other elements. Additionally, CMS is also not waiving or modifying the requirements at 42 CFR §483.60(h)(2)(i), which requires that a feeding assistant must work under the supervision of a registered nurse (RN) or licensed practical nurse (LPN). SNFs APPROVED

Updated 11/4/2020

GO TO TOP

Centers for Medicare & Medicaid Services — Home Health & Hospice

WaiverApplies ToStatus
Medicare Telehealth

Home Health Agencies (HHAs) can provide more services to beneficiaries using telecommunications technology within the 30-day period of care, so long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care. Telecommunications technology can include, for example: remote patient monitoring; telephone calls (audio only and TTY); and 2-way audio-video technology that allows for real-time interaction between the clinician and patient. However, only in-person visits can be reported on the home health claim.

Hospice providers can provide services to a Medicare patient receiving routine home care through telecommunications technology (e.g., remote patient monitoring; telephone calls (audio only and TTY); and 2-way audio-video technology), if it is feasible and appropriate to do so. Only in-person visits are to be recorded on the hospice claim.
HH Agencies; Hospices APPROVED

Updated 11/4/2020
Telehealth Face-to-Face Encounter Requirement

The required face-to-face encounter for home health can be conducted via telehealth (i.e., 2-way audio-video telecommunications technology that allows for real-time interaction between the physician/allowed practitioner and the patient).

Face-to-face encounters for purposes of patient recertification for the Medicare hospice benefit can now be conducted via telehealth (i.e., 2-way audio-video telecommunications technology that allows for real-time interaction between the hospice physician/hospice nurse practitioner and the patient).
HH Agencies; Hospices APPROVED

Updated 11/4/2020
Homebound Definition: A beneficiary is considered homebound when their physician advises them not to leave the home because of a confirmed or suspected COVID-19 3 11/4/20 diagnosis or if the patient has a condition that makes them more susceptible to contract COVID-19. As a result, if a beneficiary is homebound due to COVID-19 and needs skilled services, an HHA can provide those services under the Medicare Home Health benefit. HH Agencies APPROVED

Updated 11/4/2020
Detailed Information Sharing for Discharge Planning. CMS is waiving the requirements of 42 CFR §484.58(a) to provide detailed information regarding discharge planning, to patients and their caregivers, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, (another) home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) quality measures and resource use measures. HH Agencies APPROVED

Updated 11/4/2020
Plans of Care and Certifying/Recertifying Patient Eligibility: In addition to a physician, section 3708 of the CARES Act allows a Medicare-eligible home health patient to be under the care of a nurse practitioner, clinical nurse specialist, or a physician assistant who is working in accordance with State law. These physicians/practitioners can: (1) order home health services; (2) establish and periodically review a plan of care for home health services (e.g., sign the plan of care), (3) certify and re-certify that the patient is eligible for Medicare home health services. These changes, effective March 1, 2020, provide the flexibility needed for more timely initiation of services for home health patients, while allowing providers and patients to practice social distancing. Specifically, for Medicare, these changes are effective for Medicare claims with a “claim through date” on or after March 1, 2020. HH Agencies APPROVED

Updated 11/4/2020
Clinical Records: In accordance with section 1135(b)(5) of the Act, CMS is extending the deadline for completion of the requirement at 42 CFR §484.110(e), which requires HHAs to provide a patient a copy of their medical record at no cost during the next visit or within four business days (when requested by the patient). Specifically, CMS will allow HHAs ten business days to provide a patient’s clinical record, instead of four. HH Agencies APPROVED

Updated 11/4/2020
Training and Assessment of Aides: CMS is waiving the requirement at 42 CFR §418.76(h)(2) for Hospice and 42 CFR §484.80(h)(1)(iii) for HHAs, which require a registered nurse, or in the case of an HHA a registered nurse or other appropriate skilled professional (physical therapist/occupational therapist, speech language pathologist) to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. In accordance with section 1135(b)(5) of the Act, CMS is postponing completion of these visits. All postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the PHE. HH Agencies APPROVED

Updated 11/4/2020
12-hour annual in-service training requirement for home health aides: CMS is modifying the requirement at 42 C.F.R. §484.80(d) that home health agencies must assure that each home health aide receives 12 hours of in-service training in a 12-month period. In accordance with section 1135(b)(5) of the Act, CMS is postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. HH Agencies APPROVED

Updated 11/4/2020
Quality Assurance and Performance Improvement (QAPI): CMS is modifying the requirement at 42 CFR §418.58 for Hospice and §484.65 for HHAs, which requires these providers to develop, implement, evaluate, and maintain an effective, ongoing, hospice/HHA-wide, data-driven QAPI program. Specifically, CMS is modifying the requirements at §418.58(a)–(d) and §484.65(a)–(d) to narrow the scope of the QAPI program to concentrate on infection control issues, while retaining the requirement that remaining activities should continue to focus on adverse events. The requirement that HHAs and hospices maintain an effective, ongoing, agency-wide, data driven quality assessment and performance improvement program will remain. HH Agencies; Hospices APPROVED

Updated 11/4/2020
Waive Onsite Visits for HHA Aide Supervision: CMS is waiving the requirements at at 42 CFR 42 CFR 418.76(h), for Hospice and at 42 CFR §484.80(h) for HHAs, which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time. This waiver is also temporarily suspending the 2-week aide supervision by a registered nurse for home health agencies requirement at §484.80(h)(1), but virtual supervision is encouraged during the period of the waiver. HH Agencies; Hospices APPROVED

Updated 11/4/2020
OASIS Reporting: CMS is providing relief to HHAs on the timeframes related to OASIS transmission through the following 1) extending the 5-day completion requirement for the comprehensive assessment to 30 days; and 2) waiving the 30-day OASIS submission requirement. Delayed submission is permitted during the PHE. CMS is now allowing 30 days for the completion of the comprehensive assessment. HHAs must submit OASIS data prior to submitting their final claim in order to receive Medicare payment. HH Agencies APPROVED

Updated 11/4/2020
Home Health Quality Reporting Program: HHAs are exempted from the Home Health Quality Reporting Program reporting requirements. The time period covered by this exemption is October 1, 2019 through June 30, 2020. HHAs that do not submit data for those quarters will not have their annual market basket percentage increase reduced by two percentage points. CMS is also delaying the compliance dates for collecting and reporting the Transfer of Health Information quality measures and certain standardized patient assessment data elements (SPADEs) adopted for the HH Quality Reporting Program. HHAs will be required to begin collecting the Transfer of Health Information 5 11/4/20 quality measures and certain SPADEs on January 1st of the year that is at least one calendar year after the end of the public health emergency. HH Agencies APPROVED

Updated 11/4/2020
Allow Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessment for all Patients: CMS is waiving the requirements in 42 CFR § 484.55(a)(2) and § 484.55(b)(3) that rehabilitation skilled professionals may only perform the initial and comprehensive assessment when only therapy services are ordered. This temporary blanket modification allows any rehabilitation professional (OT, PT, or SLP) to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. The existing regulations at § 484.55(a) and (b)(2) would continue to apply; rehabilitation skilled professionals would not be permitted to perform assessments in nursing only cases. We would continue to expect HHAs to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. Therapists must act within their state scope of practice laws when performing initial and comprehensive assessments, and access a registered nurse or other professional to complete sections of the assessment that are beyond their scope of practice. HH Agencies APPROVED

Updated 11/4/2020
Requests for Anticipated Payments (RAPs): MACs can extend the auto-cancellation date of RAPs during emergencies. RAPs are a pre-payment for home health services. HH Agencies APPROVED

Updated 11/4/2020
Ordering Medicaid Home Health Services and Equipment: Medicaid home health regulations now allow non-physician practitioners to order medical equipment, supplies and appliances, home health nursing and aide services, and physical therapy, occupational therapy or speech pathology and audiology services, in accordance with state scope of practice laws. HH Agencies APPROVED

Updated 11/4/2020
Certification for Payment of Medicare Home Health Services: As required under section 3708 of the CARES Act, CMS is allowing nurse practitioners, clinical nurse specialists and physician assistants to certify the need for home health services as defined under 42 CFR § 424.507(b)(1) payment requirements for covered Part A or Part B home health services. HH Agencies APPROVED

Updated 11/4/2020
Annual Training. CMS is modifying the requirement at 42 CFR §418.100(g)(3), which requires hospices to annually assess the skills and competence of all individuals furnishing care and provide in-service training and education programs where required. Pursuant to section 1135(b)(5) of the Act, we are postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. This does not alter the minimum personnel requirements at 42 CFR §418.114. Selected hospice staff must complete training and have their competency evaluated in accordance with unwaived provisions of 42 CFR Part 418. Hospices APPROVED

Updated 11/4/2020
Waive requirement for hospices to use volunteers: CMS is waiving the requirement at 42 CFR §418.78(e) that hospices are required to use volunteers (including at least 5% of patient care hours). It is anticipated that hospice volunteer availability and use will be reduced related to COVID-19 surge and anticipated quarantine. Hospices APPROVED

Updated 11/4/2020
Comprehensive Assessments: CMS is waiving certain requirements for Hospice 42 CFR §418.54 related to update of the comprehensive assessments of patients. This waiver applies the timeframes for updates to the comprehensive assessment (§418.54(d)). Hospices must continue to complete the required assessments and updates, however, the timeframes for updating the assessment may be extended from 15 to 21 days. Hospices APPROVED

Updated 11/4/2020
Waive Non-Core Services: CMS is waiving the requirement for hospices to provide certain non-core hospice services during the national emergency, including the requirements at 42 CFR §418.72 for physical therapy, occupational therapy, and speech-language pathology. Hospices APPROVED

Updated 11/4/2020
Specific Life Safety Code (LSC) for Hospice: CMS is waiving and modifying particular waivers under 42 CFR §418.110(d) for inpatient hospice. Specifically, CMS is modifying these requirements as follows:

  • Alcohol-based Hand-Rub (ABHR) Dispensers: We are waiving the prescriptive requirements for the placement of alcohol based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control. However, ABHRs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers. This includes restricting access by certain patient/resident population to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area.
  • Fire Drills: Due to the inadvisability of quarterly fire drills that move and mass staff together, we will instead permit a documented orientation training program related to the current fire plan, which considers current facility conditions. The training will instruct employees, including existing, new or temporary employees, on their current duties, life safety procedures and the fire protection devices in their assigned area. Refer to: 2012 LSC, sections 18/19.7.1.6.
  • Temporary Construction: CMS is waiving requirements that would otherwise not permit temporary walls and barriers between patients. Refer to: 2012 LSC, sections 18/19.3.3.2.
Inpatient Hospices APPROVED

Updated 11/4/2020

GO TO TOP

Centers for Medicare & Medicaid Services — Medicare Appeals in FFS, Medicare Advantage & Part D

WaiverApplies ToStatus
CMS is allowing Medicare Administrative Contractors (MACs) and Qualified Independent Contractor (QICs) in the FFS program 42 CFR 405.942 and 42 CFR 405.962 and MA and Part D plans, as well as the Part C and Part D Independent Review Entity (IREs), 42 CFR 562, 42 CFR 423.562, 42 CFR 422.582 and 42 CFR 423.582 to allow extensions to file an appeal;
CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 and the Part C and Part D IREs to waive requirements for timeliness for requests for additional information to adjudicate appeals; MA plans may extend the timeframe to adjudicate organization determinations and reconsiderations for medical items and services (but not Part B drugs) by up to 14 calendar days if: the enrollee requests the extension; the extension is justified and in the enrollee's interest due to the need for additional medical evidence from a noncontract provider that may change an MA organization's decision to deny an item or service; or, the extension is justified due to extraordinary, exigent, or other non-routine circumstances and is in the enrollee's interest 42 CFR § 422.568(b)(1)(i), § 422.572(b)(1) and § 422.590(f)(1);
CMS is allowing MACs and QICs in the FFS program 42 C.F.R 405.910 and MA and Part D plans, as well as the Part C and Part D IREs to process an appeal even with incomplete Appointment of Representation forms 42 CFR § 422.561, 42 CFR § 423.560. However, any communications will only be sent to the beneficiary;
CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 and MA and Part D plans, as well as the Part C and Part D IREs to process requests for appeal that don’t meet the required elements using information that is available 42 CFR § 422.562, 42 CFR § 423.562.
CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 and MA and Part D plans, as well as the Part C and Part D IREs, 42 CFR 422.562, 42 CFR 423.562 to utilize all flexibilities available in the appeal process as if good cause requirements are satisfied.

GO TO TOP

U.S. Department of Labor, Occupational Health & Safety Administration

WaiverApplies ToStatus
https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit

https://www.osha.gov/memos/2020-04-03/enforcement-guidance-respiratory-protection-and-n95-shortage-due-coronavirus

This memorandum provides temporary enforcement guidance to Compliance Safety and Health Officers for enforcing the Respiratory Protection standard, 29 CFR § 1910.134, with regard to supply shortages of N95 filtering facepiece respirators due to the COVID-19 outbreak. The Respiratory Protection standard has specific requirements, including a written program, medical evaluation, fit-testing, and training, that employers must follow to ensure workers are provided and are properly using appropriate respiratory protection when necessary to protect their health. OSHA is providing this temporary guidance for 29 CFR § 1910.134, regarding required annual fit-testing (paragraph (f)(2)), which is to take effect from the date of this memorandum and remain in effect until further notice.

Appropriate respiratory protection is required for all healthcare personnel providing direct care of these patients. For additional guidance, see COVID-19 Hospital Preparedness Assessment Tool, https://www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.html.

OSHA recommends HCP employers follow existing CDC guidelines, including taking measures to conserve supplies of these respirators while safeguarding HCP.

  • One such measure is that healthcare employers may provide HCP with another respirator of equal or higher protection, such as N99 or N100 filtering facepieces, reusable elastomeric respirators with appropriate filters or cartridges, or powered air purifying respirators (PAPR).
  • Another measure is that healthcare employers may change the method of fit testing from a destructive method (i.e., quantitative) to a non-destructive method (i.e., qualitative). For filtering facepiece respirators, qualitative and quantitative fit-testing methods are both effective at determining whether the respirator fits properly. See 29 CFR § 1910.134, Appendix A, Fit Testing Procedures.2 The fitted respirator can then be safely used for work tasks that require respiratory protection. For additional guidance, see Strategies for Optimizing the Supply of N95 Respirators.3


OSHA field offices shall exercise enforcement discretion concerning the annual fit testing requirement, 29 CFR § 1910.134(f)(2), as long as employers:

  • Make a good-faith effort to comply with 29 CFR § 1910.134;
  • Use only NIOSH-certified respirators;
  • Implement CDC and OSHA strategies for optimizing the supply of N95 filtering facepiece respirators and prioritizing their use, as discussed above;
  • Perform initial fit tests for each HCP with the same model, style, and size respirator that the worker will be required to wear for protection against COVID-19 (initial fit testing is essential to determine if the respirator properly fits the worker and is capable of providing the expected level of protection);
  • Inform workers that the employer is temporarily suspending the annual fit testing of N95 filtering facepiece respirators to preserve and prioritize the supply of respirators for use in situations where they are required to be worn;
  • Explain to workers the importance of performing a user seal check (i.e., a fit check) at each donning to make sure they are getting an adequate seal from their respirator, in accordance with the procedures outlined in 29 CFR § 1910.134, Appendix B-1, User Seal Check Procedures.4 See also, OSHA tutorial videos (English, Spanish).5
  • Conduct a fit test if they observe visual changes in the employee’s physical condition that could affect respirator fit (e.g., facial scarring, dental changes, cosmetic surgery, or obvious changes in body weight) and explain to workers that, if their face shape has changed since their last fit test, they may no longer be getting a good facial seal with the respirator and, thus, are not being adequately protected; and,
  • Remind workers that they should inform their supervisor or their respirator program administrator if the integrity and/or fit of their N95 filtering facepiece respirator is compromised.


To emphasize, this is an enforcement discretion policy, beginning from the date of this memorandum, and applicable where respirators are needed to protect HCP during the COVID-19 outbreak. This temporary enforcement discretion policy will no longer apply upon notification.

All employers:
  • Extended use or reuse of N95s:
    In the event extended use or reuse of N95 FFRs becomes necessary, the same worker is permitted to extend use of or reuse the respirator, as long as the respirator maintains its structural and functional integrity and the filter material is not physically damaged, soiled, or contaminated (e.g., with blood, oil, paint).[7] Employers must address in their written RPPs the circumstances under which a disposable respirator will be considered contaminated and not available for extended use or reuse. Extended use is preferred over reuse due to contact transmission risk associated with donning/doffing during reuse. When respirators are being re-used, employers should pay particular attention to workers’ proper storage of the FFRs in between periods of reuse.
    • Users should perform a user seal check each time they don a respirator and should not use a respirator on which they cannot perform a successful user seal check. See 29 CFR § 1910.134, Appendix B-1, User Seal Check Procedures.[8]
    • Employers should train workers to understand that if the structural and functional integrity of any part of the respirator is compromised, it should be discarded, and that if a successful user seal check cannot be performed, another respirator should be tried to achieve a successful user seal check.
    • If reuse of respirators is necessary, an appropriate sequence for donning/doffing procedures should be used to prevent contamination, and training needs to address appropriate donning/doffing procedures. See www.cdc.gov/niosh/npptl/pdfs/PPE-Sequence-508.pdf.
  •  Use of expired N95s:
    In the event that N95s are not available and the employer has shown a good faith effort to acquire the respirators or to use alternative options, as outlined below, CSHOs should exercise enforcement discretion for the use of N95 FFRs beyond the manufacturer’s recommended shelf life, including surgical N95s.[9]
    • Employers may use only previously NIOSH-certified expired N95 FFRs found at www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html.Workers should be notified that they are using expired N95s.
    • Purchasers and users of personal protective equipment should not co-mingle products that are past their manufacturer’s recommended shelf life (i.e., expired) with items that are within their shelf life.
    • Employers should visually inspect, or ensure that workers visually inspect, the N95 FFRs to determine if the structural and functional integrity of the respirator has been compromised. Over time, components such as the straps, nose bridge, and nose foam material may degrade, which can affect the quality of the fit and seal.
    • Where an employer has expired N95s available from their own stored cache (i.e., not from the U.S. Strategic National Stockpile), the employer should seek assistance from the respirator manufacturer or independent lab regarding testing of those stored respirators prior to use.


Healthcare employers only:
  • Expired N95s generally must not be used when HCP:
    • Perform surgical procedures on patients infected with, or potentially infected with, SARS-CoV-2, or perform or are present for procedures expected to generate aerosols or procedures where respiratory secretions are likely to be poorly controlled (e.g., cardiopulmonary resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction).
      • o In accordance with CDC guidance for optimizing the supply of respirators, employers should prioritize the use of N95 respirators by activity type. When HCP perform or are present for aerosol-generating procedures or procedures where respiratory secretions are likely to be poorly controlled, use respirators (including N95 FFRs; other FFRs; non-disposable, elastomeric respirators; and PAPRs) that are still within their manufacturer’s recommended shelf life, if available, before using respirators that are beyond their manufacturer’s recommended shelf life. See www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/contingency-capacity-strategies.html. The CDC guidance also addresses scenarios in which other crisis standards of care may need to be considered, but this enforcement guidance is not intended to cover those scenarios.
All providers, health care workers APPROVED

11/15/2020
Temporary Enforcement Guidance – Tight-Fitting Powered Air Purifying Respirators (PAPRs) Used During the Coronavirus Disease 2019 (COVID-19) Pandemic

This memorandum outlines a new enforcement discretion policy to permit the use of NIOSH-approved tight-fitting PAPRs, because of their positive-pressure design, for protection against SARS-CoV-2 when initial and/or annual fit-testing is infeasible due to respirator and fit-testing supply shortages. This guidance applies only to fit-testing of NIOSH-approved tight-fitting PAPRs used as a contingency capacity strategy2 when performing job tasks with high or very high occupational exposure risk to SARS-CoV-2.3 It does not apply to:

  • PAPRs that have not been approved by NIOSH;
  • PAPRs used by any workers with low or medium exposure risk to SARS-CoV-2;
  • PAPRs used by any workers for protection against airborne hazards other than SARS-CoV-2 (e.g., chemical hazards); and
  • Loose-fitting hooded PAPRs that do not require fit-testing.


In light of the continuing essential need for adequate supplies of respirators and fit-testing supplies, OSHA is issuing this additional memorandum, which will take effect immediately and remain in effect until further notice. This guidance is intended to be time-limited to the current public health crisis with the novel coronavirus pandemic.
All health care providers APPROVED

10/2/2020
Respiratory Protection in Long Term Care SNFs, Assisted Living APPROVED

10/30/2020
Decontamination of Respirators in Healthcare

If respiratory protection must be used, and acceptable alternatives are not available for use in accordance with OSHA’s previous COVID-19 enforcement memoranda, NIOSH has identified limited available research that suggests the following methods offer the most promise for decontaminating FFRs:

  • Vaporous hydrogen peroxide;[9]
  • Ultraviolet germicidal irradiation; and/or
  • Moist heat (e.g., using water heated in an oven).


If such methods are not available, the above-referenced NIOSH-evaluated research showed the following methods could also be suitable decontamination options:

  • Microwave-generated steam; and/or
  • Liquid hydrogen peroxide.


Based on the above-referenced NIOSH-evaluated research, employers should not use the following methods unless objective data that sufficiently demonstrate the safety and effectiveness of such methods become available:
  • Autoclaving;
  • Dry heat;
  • Isopropyl alcohol;
  • Soap;
  • Dry microwave irradiation;
  • Chlorine bleach; and/or
  • Disinfectant wipes, regardless of impregnation (i.e., chemical saturation); and/or
  • Ethylene oxide (EtO).[10]


All employers should:
  • Make a good-faith effort to provide and ensure workers use the most appropriate respiratory protection available for the hazards against which workers need to be protected. Efforts should be consistent with flexibilities outlined in OSHA's previous COVID-19 enforcement memoranda.
  • When respirators must be decontaminated to facilitate their reuse in ways consistent with OSHA's previous COVID-19 enforcement memoranda and the U.S. Centers for Disease Control and Prevention (CDC) Strategies for Optimizing the Supply of N95 Respirators, ensure that decontamination is accomplished according to the methods described above and detailed in CDC's Decontamination and Reuse of Filtering Facepiece Respirators using Contingency and Crisis Capacity Strategies
  • Ensure users perform a user seal check each time they don a respirator. Employers should not permit use of a respirator on which the user cannot perform a successful user seal check. See 29 CFR § 1910.134, Appendix B-1, User Seal Check Procedures.[11]
  • Train employees to follow appropriate precautionary measures prior to using a decontaminated filtering facepiece respirator (FFR). See www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html.
  • Train employees using decontaminated respirators to understand that if the structural and functional integrity of any part of the respirator is compromised, it should not be used by that individual as respiratory protection. The inability to achieve a successful user seal check could be an indicator that the integrity of the respirator is compromised.
  • Visually inspect, or ensure that workers visually inspect, the FFRs to determine if the structural and functional integrity of the respirator has been compromised. Over time or as a result of the decontamination process, components such as the straps, nose bridge, and nose foam material may degrade, which can affect the quality of the fit and seal.
  • Train employees on the procedures for the sequence of donning/doffing to prevent self-contamination. See www.cdc.gov/niosh/npptl/pdfs/PPE-Sequence-508.pdf.
  • If no manufacturer or third-party guidance or procedures are available to support the specific decontamination method(s) employed, avoid the use of decontaminated FFRs when healthcare personnel perform surgical procedures on patients infected with, or potentially infected with, SARS-CoV-2 or perform or are present for procedures expected to generate aerosols or procedures where respiratory secretions are likely to be poorly controlled (e.g., cardiopulmonary resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction). If decontamination methods degrade FFR performance, including filtration and fit, or otherwise affect structural integrity, the decontaminated FFR may not provide the level of protection needed or expected during aerosol-generating procedures.
All health care providers APPROVED

4/24/2020

Confirmed: 11/15/2020
OSHA COVID-19 Citations

https://www.osha.gov/SLTC/covid-19/covid-citations-lessons.pdf
https://www.osha.gov/SLTC/covid-19/covid-citations-guidance.pdf

The following are examples, to date, of requirements that employers have most frequently failed to follow:

  • Provide a medical evaluation before a worker is fit-tested or uses a respirator.
  • Perform an appropriate fit test for workers using tight fitting respirators.
  • Assess the workplace to determine if COVID-19 hazards are present, or likely to be present, which will require the use of a respirator and/or other personal protective equipment (PPE).
  • Establish, implement, and update a written respiratory protection program with required worksite-specific procedures.
  • Provide an appropriate respirator and/or other PPE to each employee when necessary to protect the health of the employees (ensuring the respirator and/or PPE used is the correct type and size).
  • Train workers to safely use respirators and/or other PPE in the workplace, and retrain workers about changes in the workplace that might make previous training obsolete.
  • Store respirators and other PPE properly in a way to protect them from damage, contamination, and, where applicable, deformation of the facepiece and exhalation valve.  For any fatality that occurs within 30 days of a work-related incident, report the fatality to OSHA within eight hours of finding out about it.
  • Keep required records of work-related fatalities, injuries, and illness


All providers APPROVED

11/6/2020
Handling COVID-19-related complaints, referrals, and severe illness reports (Interim Enforcement Response Plan)

This guidance is intended to be time-limited to the current COVID-19 public health crisis.

As workplaces reopen, OSHA will continue to ensure safe and healthy conditions for America's working men and women pursuant to the following framework:

  • In geographic areas where community spread of COVID-19 has significantly decreased, OSHA will return to the inspection planning policy that OSHA relied on prior to the start of the COVID-19 health crises, as outlined in the OSHA Field Operations Manual (FOM), CPL 02-00-164, Chapter 2, when prioritizing reported events for inspections, except that:
    • OSHA will continue to prioritize COVID-19 cases;
    • OSHA will utilize non-formal phone/fax investigations or rapid response investigations in circumstances where OSHA has historically performed such inspections (e.g., to address formal complaints) when necessary to assure effective and efficient use of resources to address COVID-19-related events; and
    • In all instances, the Area Director (AD) will ensure that CSHOs utilize the appropriate precautions and personal protective equipment (PPE) when performing inspections related to COVID-19.
  • In geographic areas experiencing either sustained elevated community transmission or a resurgence in community transmission of COVID-19, ADs will exercise their discretion, including consideration of available resources, to:
    • Continue prioritizing COVID-19 fatalities and imminent danger exposures for inspection. Particular attention for on-site inspections will be given to high-risk workplaces, such as hospitals and other healthcare providers treating patients with COVID-19, as well as workplaces, with high numbers of complaints or known COVID-19 cases.
      • Where resources are insufficient to allow for on-site inspections, the inspections for these types of reported events will be initiated remotely with an expectation that an on-site component will be performed if/when resources become available to do so.
      • Where limitations on resources are such that neither an on-site nor remote inspection is possible, OSHA will investigate these types of reported events using a rapid response investigation (RRI) to identify any hazards, provide abatement assistance, and confirm abatement.
      • OSHA will develop a program to conduct monitoring inspections from a randomized sampling of fatality or imminent danger cases where inspections were not conducted due to resource limitations.
    • Utilize non-formal phone/fax investigation instead of an on-site inspection in industries where doing so can address the relevant hazard(s); and
    • Ensure that CSHOs utilize the appropriate precautions and PPE to protect against potential exposures to COVID-19.


Attached to this Updated Interim Enforcement Response Plan are specific enforcement procedures (Attachment 1); a sample employer letter for COVID-19 activities (Attachment 2); a sample hazard alert letter (Attachment 3); a sample alleged violation description for a citation under the general duty clause, Section 5(a)(1), of the Occupational Safety and Health (OSH) Act (Attachment 4); and additional references, including OSHA's prior COVID-19-related enforcement memoranda (Attachment 5).
All health care providers APPROVED

5/26/2020

Confirmed: 11/15/2020

GO TO TOP

U.S. Drug Enforcement Agency — Guidance and Policy COVID-19

WaiverApplies ToStatus
Administration of REMS-designated controlled substances to patients in the parking lot at the HCPs' DEA-registered locations

The Controlled Substances Act (CSA) and its implementing regulations require a separate registration for each principal place of business or professional practice where controlled substances are manufactured, distributed, or dispensed, as set forth in 21 U.S.C. 822(e) and 21 C.F.R. 1301.12(a). The term "dispense," as defined in 21 U.S.C. 802(10), means to "deliver a controlled substance to an ultimate user or research subject by, or pursuant to the lawful order of, a practitioner, including the prescribing and administering of a controlled substance…." Neither the CSA nor DEA regulations specifically address whether healthcare providers may dispense controlled substances to patients in the parking lots of their DEA-registered locations. Nevertheless, DEA is exercising its authorities to provide flexibilities in the dispensing of controlled substances so as to permit the dispensing of controlled substances in provider parking lots under certain conditions. For the duration of the nationwide public health emergency declared by the Secretary of Health and Human Services on January 31, 2020, as a result of COVID-19 (unless this allowance is first modified or withdrawn by DEA), DEA will consider it permissible under the CSA for healthcare providers to provide medically supervised treatment using controlled substances, including REMS-designated controlled substances, in the parking lots of their DEA-registered healthcare facilities, so long as a provider's parking lot is located immediately adjacent to the provider's DEA-registered facility. This activity, however, must be carried out in compliance with all other applicable federal, state, and tribal laws and regulations. EO-DEA213, DEA-DC-043, July 28, 2020
HCPs APPROVED

Updated 11/15/2020
DEA Policy: Use of Telephone Evaluations to Initiate Buprenorphine Prescribing (Effective March 31, 2020)

On March 16, 2020, the Secretary, with the concurrence of the Acting DEA Administrator, designated that the telemedicine allowance under section 802(54)(D) applies to all schedule II-V controlled substances in all areas of the United States. Accordingly, as of March 16, 2020, and continuing for as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners in all areas of the United States may issue prescriptions for all schedule II-V controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:

The term "practitioner" in this context includes a physician, dentist, veterinarian, or other person licensed, registered, or otherwise permitted, by the United States or the jurisdiction in which s/he practices to prescribe controlled substances in the course of his/her professional practice (21 U.S.C. 802(21)).

Important note: If the prescribing practitioner has previously conducted an in-person medical evaluation of the patient, the practitioner may issue a prescription for a controlled substance after having communicated with the patient via telemedicine, or any other means, regardless of whether a public health emergency has been declared by the Secretary of Health and Human Services, so long as the prescription is issued for a legitimate medical purpose and the practitioner is acting in the usual course of his/her professional practice. In addition, for the prescription to be valid, the practitioner must comply with applicable Federal and State laws.

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and
  • The practitioner is acting in accordance with applicable Federal and State laws.
HCPs APPROVED

Updated 11/15/2020
Medication Assisted Treatment (MAT)

DEA Policy: Use of Unregistered Off-Site Locations in MAT (Effective April 7, 2020)

DEA Policy: Use of Unregistered Off-Site Locations in MAT (Buprenorphine) (Effective April 28, 2020)

DEA Policy: Use of Telephone Evaluations to Initiate Buprenorphine Prescribing (Effective March 31, 2020)

DEA Guidance: Exemption Allowing Alternate Delivery Methods for OTPs (Effective March 16, 2020)

Substance Abuse and Mental Health Services Administration (SAMHSA): OTP Update Page

SAMHSA: COVID-19 Guidance for Opioid Treatment Programs

DEA Guidance: Q&A Methadone Shortages

DEA Guidance: Distributor shipments to NTP's signed delivery exception (Effective April 11, 2020)
HCPs APPROVED

Updated 11/15/2020
Records and Reports

DEA Guidance: Q&A Conducting Biennial Inventories During the COVID-19 Health Emergency

DEA Policy: Exception to Regulations to Email or Fax DEA Form 222s (Effective March 26, 2020)

DEA Guidance: Q&A concerning physically signing manifests as proof of delivery.

DEA Guidance: Q&A Concerning Deliveries of Controlled Substances to Safe Zone.

DEA Guidance: Q&A Concerning Faxing and Scanning DEA Form 222s.

DEA Guidance: Q&A Concerning Emergency Alternate Delivery Sites.

DEA Guidance: Q&A Concerning Registration of and delivery to Emergency "Pop-Up" Hospitals.

DEA Guidance: Q&A Concerning Customers Picking Up Controlled Substance Orders From the Distributor.

DEA Guidance: DEA Practitioners 5% Rule Exception (Effective April 13, 2020)
HCPs; Hospitals APPROVED

Updated 11/15/2020
Electronic Prescribing of Controlled Substance (EPCS)

DEA Policy: Questions and Answers for Prescribing Practitioners (EPCS)

DEA Guidance: Use of Mobile Devices in the Issuance of EPCS (Effective August 16, 2018)

DEA Guidance: Q&A Remote Identity Proofing EPCS at hospital/clinics
HCPs APPROVED

Updated 11/15/2020
Registration

Registration of Emergency Temporary Sites: If you need to set up an emergency or temporary off-site location and use controlled substances, please contact DEA at Natural.Disaster@usdoj.gov. DEA will issue you a temporary registration number for each designated alternate location. This will enable the drug supply chain to continue uninterrupted and maintain patient access to needed controlled substances.

DEA Policy: Exception to Separate Registration Requirements Across State Lines (Effective March 25, 2020)

DEA Guidance: Q&A Concerning Emergency Alternate Delivery Sites.

DEA Guidance: Q&A Concerning Registration of and delivery to Emergency "Pop-Up" Hospitals.

DEA Guidance: Q&A Concerning Customers Picking Up Controlled Substance Orders From the Distributor.

DEA Guidance: Satellite Hospital/Clinic Registration Exception (Effective April 11, 2020)

DEA Guidance: DEA Practitioners 5% Rule Exception (Effective April 13, 2020)
HCPs APPROVED

Updated 11/15/2020
Prescriptions

DEA Policy: COVID-19 Prescribing Guidance (For assistance contact Local DEA Field Office) (Effective March 31, 2020)

DEA Policy: Registrant Guidance on Controlled Substance Prescription Refills (Effective March 21, 2020)

DEA Policy: Exception to Separate Registration Requirements Across State Lines (Effective March 25, 2020)

DEA Policy: Exception to Regulations Emergency Oral CII Prescription (Effective March 25, 2020)

DEA Guidance: Q&A Remote Identity Proofing EPCS at hospital/clinics.
HCPs APPROVED

Updated 11/15/2020

GO TO TOP

Division of Consumer Affairs

WaiverApplies ToStatus
Emergency Graduate Licensure

https://www.njconsumeraffairs.gov/COVID19/Documents/DCA-AO-2020-05_DCA-W-2020-09.pdf

https://www.njconsumeraffairs.gov/COVID19/Documents/DCA-AO-2020-12_DCA-W-2020-11.pdf
Graduate Nurses, PAs, Pharmacists, RTs

Mental Health Practitioners
APPROVED

5/5/2020

Confirmed — 11/6/2020

APPROVED

7/13/2020

Confirmed — 11/6/2020
Temporary Emergency Foreign Physician Licensure Program

https://www.njconsumeraffairs.gov/COVID19/Documents/DCA-AO-2020-02.pdf
Physicians Hospitals APPROVED

4/17/2020

Confirmed — 11/6/2020
Suspension of Certain Restrictions on the Scope of Practice for Advanced Practice Nurses (APNs) and Physician Assistants (PAs) APNs/PAs APPROVED

4/3/2020

Confirmed — 11/6/2020
In Home Plan of Care Evaluations by Nursing Supervisors Health Care Service Firms APPROVED

3/31/2020

Confirmed — 11/6/2020
Reciprocity of Licensure for licensed, certified health care professionals from other states All licensees under DCA APPROVED

3/26/2020

Confirmed — 11/6/2020
Telehealth – waiver of parameters that are barriers to telehealth APPROVED

3/20/2020

Confirmed — 11/6/2020
Temporary reactivation of expired licenses within 5 years All licensees under DCA APPROVED

4/3/2020

Confirmed — 11/6/2020
Prescription Management Program Enrollment Physicians APPROVED

4/3/2020

Confirmed — 11/6/2020
Pharmacists Collecting COVID-19 Specimens Pharmacists APPROVED

5/13/2020

Confirmed — 11/6/2020
Elective Surgeries Office Practices APPROVED

5/18/2020

Confirmed — 11/6/2020
Temporary Certification of Alcohol and Drug Counselor Interns Office Practices APPROVED

7/15/2020

Confirmed — 11/6/2020
Waiver of On-Site Supervision – AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS, OCCUPATIONAL THERAPISTS, AND PHYSICAL THERAPISTS Audiologists, SLP, OT, PT APPROVED

7/29/2020

Confirmed — 11/6/2020
Allow healthcare practitioners to utilize telemedicine encounters to meet CDS prescribing requirements. Prescribers APPROVED

8/11/2020

Confirmed — 11/6/2020
Allow pharmacy interns and pharmacy externs to administer influenza vaccines to patients over age 7 and under age 18 (with prescription requirements for children between ages 7 and 9), and administer all authorized vaccines, including for influenza, to eligible patients who are 18 and older. Pharmacy Interns and Externs APPROVED

10/26/2020

Confirmed — 11/6/2020
Temporary waiver for 16 professional boards of rules requiring continuing education to be completed in person. 16 licensee types APPROVED

4/13/2020

Confirmed — 11/6/2020
Establishes standards for the reopening of registered professional nurse (RN) and licensed practice nurse (LPN) programs, certified homemaker-home health aide (CHHA) training programs RN, LPN, CHHA training programs APPROVED

9/1/2020

Confirmed — 11/6/2020
Pharmacists may now dispense up to a 30-day supply of Schedule II CDS upon the oral order of a prescriber. In addition, consistent with waivers issued by the United States Drug Enforcement Administration, follow up paper prescriptions may be submitted within 15 days, and may be submitted via facsimile. This waiver does NOT apply to "initial" opioid prescriptions for pain; it is only applicable for patients being treated for "chronic" pain. Pharmacists APPROVED

9/1/2020

Confirmed — 11/6/2020
Telehealth Guidance Manual Updated 10/30/2020

GO TO TOP

Food & Drug Administration — Emergency Use Authorizations

General Information:

WaiverApplies ToStatus
Testing

As of Oct. 22, 2020, 283 tests are authorized by the FDA under Emergency Use Authorizations (EUAs); these include 221 molecular tests, 56 antibody tests and 6 antigen tests

APPROVED

10/22/2020
Medical Devices

All medical device EUAs

Emergency use of the COViage Hemodynamic Instability and Respiratory Decompensation Prediction System (COViage) 1 to be used by healthcare providers (HCP) in the hospital setting for adult patients2 with confirmed COVID-193 for the computation of proprietary patient status indices referred to as Respiratory Decompensation Status4 and Hemodynamic Instability Status5 (collectively referred to as “risk level determinations”) as an adjunct to patient monitoring during the Coronavirus Disease 2019 (COVID-19) outbreak

Revocation of the Emergency Use Authorization (EUA) issued May 13, 2020, for emergency use of infusion pumps and infusion pump accessories for use by healthcare providers (HCPs) to treat conditions caused by the Coronavirus Disease 2019 (COVID-19) with the controlled infusion of medications, total parenteral nutrition (TPN), and/or other fluids. Based on information and experience since issuance of the umbrella EUA, FDA has determined that circumstances support revocation of the umbrella EUA. Individual EUAs will allow for tailored indications and scopes of authorization, including but not limited to those for different environments of use, routes of administration, and patient populations
APPROVED

Updated 8/25/2020



9/21/2020
Therapeutics

All therapeutic EUAs
APPROVED

Updated 9/24/2020
PPE

Non-NIOSH-Approved Disposable Filtering Facepiece Respirators manufactured in China

FAQ for Non-NIOSH-Approved Disposable Filtering Facepiece Respirators manufactured in China

Authorized Respirators

No longer Authorized Respirators
APPROVED

11/10/2020



Reissued 9/21/2020
Antibody Detection Kit

Qualitative detection of total neutralizing antibodies to SARSCoV-2 in human serum and K2-EDTA plasma. Intended for use as an aid in identifying individuals with an adaptive immune response to SARS-CoV-2, indicating recent or prior infection. Emergency use of this test is limited to authorized laboratories.

Qualitative detection of immunoglobulin G (IgG) antibodies to SARS-CoV-2 in human serum and plasma (dipotassium EDTA and lithium heparin) using the Quansys Q-View Imager LS or Quansys Q-View Imager Pro and Q-view Software. Intended for use as an aid in identifying individuals with an adaptive immune response to SARS-CoV-2, indicating recent or prior infection. Emergency use of this test is limited to authorized laboratories
APPROVED

11/6/2020



10/28/2020
Revocation of Hydroxychloroquine EUA APPROVED

6/19/2020
Drugs & Biologicals

FAQ on Remdesivir

Remdesivir Fact Sheet

Remdesivir EUA letter update

bamlanivimab — treatment of mild to moderate coronavirus disease 2019
APPROVED

10/23/2020

10/22/2020

10/22/2020

11/9/2020
Convalescent Plasma APPROVED

8/23/2020
Emergency Use Authorization for Vaccines Explained

GO TO TOP

Internal Revenue Service — Community Health Needs Assessment

WaiverApplies ToStatus
Extension on CHNA Requirements

https://www.irs.gov/pub/irs-drop/n-20-56.pdf

https://www.irs.gov/newsroom/irs-provides-additional-relief-for-tax-exempt-hospitals-deadline-for-completing-certain-needs-assessment-requirements-moved-to-dec-31

Because of the burdens the COVID-19 pandemic has placed on hospitals, the Internal Revenue Service today provided additional relief to hospital organizations that must meet the Community Health Needs Assessments (CHNA) requirements extends the deadline for conducting a CHNA and adopting an implementation strategy to meet the community health needs identified through the CHNA to December 31, 2020.
Hospitals APPROVED

Issued 7/14/2020

EXPIRES: 12/31/2020

GO TO TOP

AmeriHealth

WaiverApplies ToStatus
Providers may use telemedicine services to perform preventive well visits

AmeriHealth New Jersey will cover COVID-19 testing as follows:

  • Diagnostic tests: Covered without member cost-sharing* (i.e., copayment, deductible, and coinsurance) and without an order or prescription by a licensed or qualified health care professional, when performed at any site, including a physician's office, urgent care center, hospital or hospital emergency room, pharmacy or during a home health visit or drive-through testing center visit.
  • Antibody tests: Covered without member cost-sharing* when performed at a physician's office, urgent care center, hospital or hospital emergency room, pharmacy or during a home health visit or drive-through testing center visit, when ordered or authorized by a licensed or qualified health care professional.
Effective March 6, 2020, until 90 days after the end of both the state of emergency and the public health emergency.
AmeriHealth is waiving the requirement that a member must be homebound to receive COVID-19 specimen collection at home

Effective March 6, 2020, until 90 days after the end of both the state of emergency and the public health emergency.
AmeriHealth will cover the treatment of COVID-19 as follows

  • AmeriHealth will waive cost-sharing for in-network, inpatient, acute care treatment of members diagnosed with COVID-19, whether for medical or behavioral health.
  • AmeriHealth will waive cost-sharing for emergency department visits associated with admissions for in-network, in-patient, acute care treatment of COVID-19 whether for medical or behavioral health.


For services not related to COVID-19, we will continue to apply the appropriate member cost-sharing.
Effective March 30, 2020, through December 31, 2020.

GO TO TOP

Aetna

WaiverApplies ToStatus
  • Extended all member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services.
  • Will waiver cost-sharing for any in-network covered telemedicine visit – regardless of diagnosis
Ongoing until 90 days following PHE

GO TO TOP

Clover Health

WaiverApplies ToStatus
Clover zero cost share telehealth

  • Clover will continue to reimburse providers for the telehealth services that are outlined by CMS in its List of Telehealth Services.
  • Providers should use the place of service (POS) that would have been used if the patient had been seen face-to-face instead of just defaulting to POS 02.
  • Providers should also include modifier 95 on telehealth claims.
  • For audio-only visits (non-video), providers should bill Clover following the updated CMS coding guidelines by billing the appropriate audio codes 99441-99443 or 98966-98968.
  • Clover still does not require pre-established patient relationships or telehealth origination sites at this time.
  • Clover continues to honor the $0 copay and $0 cost-share for members receiving telehealth services.

GO TO TOP

UnitedHealthCare

WaiverApplies ToStatus
Telehealth Policies:

  • Audio-only coverage
  • Cost share waived for covered behavioral health visits
  • Cost share waived for COVID-19-related covered visits
  • Cost share waived for non-COVID-19-related covered visits
  • Coverage for PT/OT/ST
  • Covered telehealth services reimbursed at in-person rates


https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2020/covid19/telehealth-provisions-northeast.pdf
Ongoing (90 days after the end of the state’s emergency declaration)

GO TO TOP