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 Want to Help? Daily Briefings Key for locked members only page.

Updated on June 15, 2020

Healthcare Personnel

N.J. Department of Health

Submission DateWaiverApplies ToStatus
3/16/2020 Licensed Nursing Home Administrator Licensure Renewal N.J.A.C. 8:34

§ 8:34-6.2 Renewal of license
  • All licenses issued under this chapter shall expire on the date established by the Board and shall become invalid if not renewed
  • The Department shall issue a renewed license to a licensed administrator every three years upon the Board's review and determination that the applicant has submitted the following to the Board:
    • A completed license renewal application;
    • A criminal history record background check with fingerprints pursuant to with the applicant bearing all costs of administering and processing the background check;
    • Payment of the required license renewal fee as determined by the Board in accordance with N.J.A.C. 8:34-9.1(a); and
    • Written documentation of the applicant's completion of 60 hours of continuing education approved by the Board in accordance with N.J.A.C. 8:34-7.2(a)
  • At the discretion of the Board, the Department may renew a license up to 60 days after the date of its expiration upon the applicant's payment of a late fee, as set forth at N.J.A.C. 8:34-9.1(a)4, in addition to the renewal fee
LNHAs in SNFs and AL APPROVED

4/10/2020
3/31/2020 Personal Care Assistants
NJHA respectfully requests that individuals certified as personal care assistants by the State of NJ be permitted to work in nursing homes licensed pursuant to N.J.A.C. 8:39

Licensed Nursing Home Administrators — Reciprocity and Licensure Renewal
NJHA respectfully requests an extension of 180 days to the renewal deadline for licensed nursing home administrators (N.J.A.C. 8:34-6.2) so that LNHAs will have adequate time to complete their CEU requirements. All programs scheduled beginning in March were cancelled or postponed, and therefore, not all LNHAs will have completed their CEU requirement for renewal. Failure to be able to renew will jeopardize the livelihoods of dozens of LNHAs

Further, NJHA respectfully requests a waiver of the reciprocity requirements at N.J.A.C. 8:34-6.8 so that nursing homes can bring out-of-state LNHAs to support operations in our nursing homes. We believe this should be implemented in alignment with the expedited reciprocity process that has been established by the Division of Consumer Affairs for licensed and certified clinicians. This will ensure that out-of-state LNHAs can demonstrate that they have an active license in good standing from their home state.
SNF APPROVED

Licensure renewal extension to 7/31/2020 approved 3/31/2020
Allow RMTs and CHHAs to function in CNA Role SNF APPROVED

3/28/2020
3/16/2020 CNA and CHHA Reciprocity SNF and Home Health Agency APPROVED

for CNA — 3/27/2020
3/16/2020 Pre-employment Requirements
The Department of Health will not require prior Department approval of temporary waivers for the following requirements from licensed facilities:
  1. Exceeding licensed bed capacity
  2. Bed additions requiring prior CN approval
  3. Physical space requirements
  4. 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
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
Certification – Assisted Living Administrators — Expiration dates between March 1 and May 31, 2020 are extended 90 days. CALA will be able to complete CEUs up to the new expiration date of their certification Assisted Living APPROVED

3/26/2020
Certification – Nursing Assistants — all expiration dates between March 1 and May 31, 2020 are extended 90 days Nursing Homes, Assisted Living, Hospitals APPROVED

3/26/2020
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 APPROVED

3/26/2020
Exceeding Licensed Bed Capacity and Physical Space Requirements — DOH memo March 13, 2020 All licensed health care providers licensed under N.J.A.C. 8:36, 39, 43G and 43H APPROVED

3/13/2020
Bed Additions Requiring Prior CN Approval — DOH memo March 13, 2020 All licensed health care providers licensed under N.J.A.C. 8:36, 39, 43G and 43H APPROVED

3/13/2020
Mandatory Overtime All licensed health care providers PENDING
3/28/2020 Allow Certified Medical Assistants to Function as CNAs PENDING

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Department of Health

Submission DateWaiverApplies ToStatus
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:
    1. 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.
    2. 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.
    3. 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
    4. 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.
Nursing Homes Updated 6/8/2020

APPROVED

4/15/2020
Waiver/modification of NJAC 8:36-9.1
Qualifications of Personal Care Assistants
Assisted Living, CPCH, ALP APPROVED

4/15/2020
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, CPCH APPROVED

4/15/2020
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
3/16/2020 Scope of practice for EMTs
  1. Notwithstanding the provisions of N.J.SA 26:2K-18, hospitals are authorized to utilize New Jersey certified mobile intensive care paramedics in the hospital setting to perform functions and duties within their scope of practice to enhance and supplement their existing medical staff
  2. Advanced life support provider hospitals must continue to maintain advanced life support coverage in their designated certificate of need areas and may not take mobile intensive care units offline in order to use those paramedics in the hospital setting, unless otherwise directed or authorized by the Department of Health
Paramedics; Hospitals APPROVED

3/17/2020
BLS Crewmember requirements APPROVED

3/13/2020
MICU Crewmember requirements APPROVED

3/13/2020
Out of State BLS requirements APPROVED

3/13/2020
STCU Crewmember requirements APPROVED

3/13/2020
Unlicensed Vehicle for Transport APPROVED

3/13/2020
EMT-Paramedic certification shall be valid for a period of not less than 24, nor more than 30, months. Expiration of all certifications shall occur on either June 30 or December 31, depending on the date of initial certification. Certifications shall be vaild until 12:00 midnight of the expiration date listed on the card. No grace periods or extensions shall be granted.

This waiver is subject to the following terms and conditions:
  1. The June 30, 2020 expiration date of all valid NJ EMT-Paramedic certifications shall be extended until August 31, 2020
  2. The June 30, 2020 expiration date of all valid Mobile Intensive Care Nurses and Air Medical crewmembers shall be extended until August 31, 2020
  3. Providers shall be able to complete recertification for current credentials including August 31, 2020
All ALS Certified Providers APPROVED

3/12/2020

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Division of Consumer Affairs

Submission DateWaiverApplies ToStatus
Emergency Graduate Licensure Graduate Nurses APPROVED

5/17/2020
Temporary Emergency Foreign Physician Licensure Program Physicians Hospitals APPROVED

4/17/2020
Suspension of Certain Restrictions on the Scope of Practice for Advanced Practice Nurses (APNs) and Physician Assistants (PAs)
Governor Murphy issued Executive Order No. 112 on April 1, 2020 subsequently followed by the Division of Consumer Affairs' corresponding  Administrative Order on April 3, 2020. These Orders suspend certain restrictions on the scope of practice for Advanced Practice Nurses (APNs) and Physician Assistants (PAs) during the state of emergency and public health emergency declared on March 9, 2020.

Acting Director Paul R. Rodríguez’s letter to APNs, PAs, and physicians containing important information about the suspension of these restrictions.
APNs/Pas APPROVED

4/15/2020
3/16/2020 The Division hereby waives provisions in N.J.A.C. 13:45B-14.9(g) to the extent that the rule requires on-site, in home plan-of-care evaluations by nursing supervisors Health Care Service Firms APPROVED

3/31/2020
Reciprocal Licensure for licensed, certified health care professionals from other states:

Press Release: AG Grewal: NJ Temporarily Waives Rules for Out-of-State Healthcare Providers to Offer Services to NJ Residents During COVID-19 Emergency

Accelerated Temporary Licensure
Accelerated temporary licensure by reciprocity is available for the following Boards:
  • Acupuncture Examining Board
  • Alcohol and Drug Counselor Committee (licensed clinical alcohol and drug counselors)
  • Athletic Training Advisory Committee
  • Audiology and Speech-Language Pathology Advisory Committee
  • New Jersey State Board of Dentistry (licensed dentists)
  • Genetic Counseling Advisory Committee
  • Hearing Aid Dispensers Examining Committee
  • State Board of Marriage and Family Therapy Examiners (licensed marriage and family therapists)
  • State Board of Medical Examiners
  • New Jersey Board of Nursing (APNS, RNs, LPNs, and HHAs)
  • Occupational Therapy Advisory Council (licensed occupational therapists)
  • State Board of Examiners of Ophthalmic Dispensers and Ophthalmic Technicians
  • New Jersey State Board of Optometrists
  • Perfusionists Advisory Committee
  • Board of Pharmacy
  • State Board of Physical Therapy Examiners (licensed physical therapists)
  • Physician Assistant Advisory Committee
  • State Board of Polysomnography (licensed polysomnographic technologists)
  • Professional Counselor Examiners Committee (licensed professional counselors)
  • Certified Psychoanalysts Advisory Committee
  • State Board of Psychological Examiners
  • State Board of Respiratory Care
  • State Board of Social Work Examiners
APPROVED

3/26/2020
Request for exception to AO 2020-01 for nursing home medical directors and physicians related to prescribing hydroxychloroquine SNF medical directors and physicians APPROVED
3/16/2020 Scope of practice for registered medical technicians
Pharmacy techs be allowed to receive new verbal prescriptions (DCA, State Board of Pharmacy, NJAC 13:39-6.15). In the event of limited pharmacy staffing, this would allow patients to receive needed medications
Reg. Med Tech

Pharmacies, pharmacy techs
PENDING
Certified Anesthesiology Assistants - Request temporary certification for CAAs who are certified and in good standing in other states Hospitals PENDING

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U.S. Drug Enforcement Agency

Submission DateWaiverApplies ToStatus
Permitting telemedicine prescribing of CDS Prescribers with DEA # APPROVED

3/20/2020

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U.S. Department of Labor

Submission DateWaiverApplies ToStatus
This memorandum provides interim guidance to Compliance Safety and Health Officers (CSHOs) for enforcing the Respiratory Protection standard, 29 CFR § 1910.134, and certain other health standards, with regard to supply shortages of disposable N95 filtering facepiece respirators. Specifically, it outlines enforcement discretion to permit the extended use and reuse of respirators, as well as the use of respirators that are beyond their manufacturer’s recommended shelf life (sometimes referred to as “expired”). This guidance applies in all industries, including workplaces in which:
  • Healthcare personnel (HCP) are exposed to patients with suspected or confirmed coronavirus disease 2019 (COVID-19) and other sources of SARS-CoV-2 (the virus that causes COVID-19)
  • Protection of workers exposed to other respiratory hazards is impacted by the shortage resulting from the response to the COVID-19 pandemic. Such workplace respiratory hazards may be covered by one or more substance-specific health standards


Our previous memorandum, Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak, issued on March 14, 2020, provided temporary guidance for 29 CFR § 1910.134, regarding required annual fit testing of HCP.[1] This memorandum provides additional guidance on enforcing OSHA’s respirator standard for all workers, including HCP. In light of the essential need for adequate supplies of respirators, this memorandum 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. Please frequently check OSHA’s webpage for updates.

View full memo.
All healthcare workers APPROVED

4/3/2020

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Conditions of Participation/Licensure

N.J. Department of Health

Submission DateWaiverApplies ToStatus
DOH has provided flexibilities for ALS and BLS crews to triage patients to home, rather than requiring a transport to a hospital.

https://www.state.nj.us/health/ems/documents/reg-enforcement/waivers/Final%20BLS%20Triage%20to%20Home.pdf
ALS and BLS Crews APPROVED

4/15/2020
Hospital Nursing Ratios — waive ratios on units that are prescribed by regulation Hospitals APPROVED

4/10/2020
Discharge Planning Requirements — State only N.J.A.C. 8:39-5.4 SNF APPROVED

3/28/2020
Mandatory nurse staffing hours and type — N.J.A.C. 8:39-25.2 SNF APPROVED

3/28/2020
Third Party Inspections — routine physical plant and life safety inspections performed by third party. Does not include needed repairs to ensure safe and effective functioning of physical plant All DOH licensed entities APPROVED

3/26/2020
License Renewals — If DOH is unable to issue or process renewals this waives requirement to have renewed license by expiration date. All licenses that are expiring from March 26 through April 30 are extended until May 31, 2020 All DOH licensed entities APPROVED

3/26/2020
Home Health CN — waive CN boundaries for service area & Hospice Provider Services out of Service Area Home Health Agencies APPROVED

3/13/2020
3/25/2020 Observation Stays — NJ Department of Health suspend its memo dated October 10, 2014 with respect to Observation Services, a copy of which is attached, for the duration of the public health emergency PENDING
3/16/2020 Out of Network Disclosure Requirement Hospitals, ASC, Physician PENDING
§ 8:43G-12.7 Emergency department patient services
  • If it is determined that an emergency medical condition exists, the patient must be evaluated by a physician and provided with such medical treatment as is necessary to assure that the condition has been stabilized, except as provided in (e) below.
  • (e) If a patient has an emergency medical condition which has not been stabilized, the hospital shall not transfer the patient unless:
    1. The patient (or a legally responsible person acting on the patient's behalf), after being informed of the hospital's obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility; or
    2. A physician has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the patient and, in the case of labor, to the unborn child, from effecting the transfer. This certification shall include a summary of the risks and benefits upon which the certification is based.
Hospitals PENDING

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Department of Health

Submission DateWaiverApplies ToStatus
Temporary Rule WAIVER/MODIFICATION OF N.J.A.C. 8:43A-24.7(c)-(d) - DIALYSIS STAFFING, adopted by THE COMMISSIONER OF THE DEPARTMENT OF HEALTH
  1. Notwithstanding the above provisions, during the period of the COVID-19 Public HealthEmergency, ambulatory care facilities providing outpatient dialysis services shall comply with the staff requirements set forth in 42 C.F.R. 494.180(b). Specifically, the facilities shall develop and adhere to a staffing plan that is consistent with the following:
    1. An adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient/staff ratio is appropriate to the level of dialysis care given and meets the needs of patients; and the registered nurse, social worker and dietitian members of the interdisciplinary team are available to meet patient clinical needs;
    2. A registered nurse, who is responsible for the nursing care provided, is present in the facility at all times that in-center dialysis patients are being treated.


In the event that CMS issues new superseding guidance for these regulations, the new guidance issued by CMS shall be followed.
Dialysis Providers APPROVED

4/17/2020
Waiver of APN/Anesthesia and Certified Registered Nurse Anesthesists
(CRNA) requirements at N.J.A.C. 8:43A that during the Public Health Emergency

In order to ameliorate staffing issues, the Department of Health is issuing the following waivers pursuant to the authority under N.J.A.C. 8:43A-2.9(a) and N.J.A.C. 8:43G-2.8(a) for the term of the Public Health Emergency:
  1. The requirements for a joint protocol and the supervision standards for a CRNA in N.J.A.C. 8:43G-6.3(a)3 and (h)3 is hereby waived; and
  2. The requirement for supervision by an anesthesiologist for a CRNA at N.J.A.C. 8:43A-12.5(a)2i, 3i and (d)2i in ambulatory surgery centers is hereby waived
Hospitals, ASC APPROVED

4/17/2020
Request for waiver for 2020 annual public meeting for acute care hospitals Acute Care Hospitals PENDING

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Centers for Medicare & Medicaid

Submission DateWaiverApplies ToStatus
CMS Extends Submission Deadline for GME Affiliation Agreements
In a new release today the Centers for Medicare and Medicaid Services waived 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. That is, during the COVID-19 PHE, instead of requiring that new Medicare GME affiliation agreements be submitted to CMS and the MACs by July 1, 2020 (for the academic year starting July 1, 2020), and that amendments to Medicare GME affiliation agreements be submitted to CMS and the MACS by June 30, 2020 (for academic year ending June 30, 2020), CMS is allowing hospitals to submit new and/or amended Medicare GME affiliation agreements as applicable to CMS and the MACs by October 1, 2020. 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.
Teaching Hospitals APPROVED

6/12/2020
Option for hospital to establish SNF beds: The Centers for Medicare and Medicaid Services issued a new waiver under its 1135 authority of requirements that allows hospitals to establish SNF swing beds payable under the SNF Medicare prospective payment system. This waiver of 42 CFR 482.58 gives hospitals options when they are unable to find placement in a SNF. In order to qualify for this waiver, hospitals must:

  • Not use SNF swing beds for acute level care.
  • Comply with all other hospital conditions of participation and those SNF provisions set out at 42 CFR 482.58(b) to the extent not waived.
  • Be consistent with the state’s emergency preparedness or pandemic plan.


Hospitals must call the CMS Medicare Administrative Contractor (MAC) enrollment hotline to add swing bed services. The hospital must attest to CMS that:

  • They have made a good faith effort to exhaust all other options;
  • There are no skilled nursing facilities within the hospital’s catchment area that under normal circumstances would have accepted SNF transfers, but are currently not willing to accept or able to take patients because of the COVID-19 public health emergency (PHE);
  • The hospital meets all waiver eligibility requirements; and
  • They have a plan to discharge patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.


This waiver applies to all Medicare enrolled hospitals, except psychiatric and long term care hospitals that need to provide post-hospital SNF level swing-bed services for non-acute care patients in hospitals, so long as the waiver is not inconsistent with the state’s emergency preparedness or pandemic plan.
Hospitals APPROVED

5/11/2020
Paid Feeding Assistants: CMS is modifying the requirements at 42 CFR §§ 483.60(h)(1)(i) and 483.160(a) regarding the minimum 8-hour timeframe requirements. 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 19 5/11/2020 1 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). Skilled Nursing Facilities APPROVED

5/11/2020
Home Health — Allow Occupational Therapists (OTs), Physical Therapists (PTs), and Speech Language Pathologists (SLPs) to Perform Initial and Comprehensive Assessment for all Patients. 42 CFR § 484.55(a)(2) and § 484.55(b)(3) This 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 home health 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 § 20 5/11/2020 1 484.55(a) and (b)(2) would continue to apply; rehabilitation skilled professionals would not be permitted to perform assessments in nursing- only cases. Therapists must act within their state scope of practice laws. Home Health Agencies APPROVED

5/11/2020
Expanding Availability of Renal Dialysis Services to ESRD Patients. CMS is waiving requirements related to Nursing Home residents: requirements at 42 CFR §494.180(d) require dialysis facilities to provide services directly on its main premises or on other premises that are contiguous with the main premises. CMS is waiving this requirement to allow dialysis facilities to provide service to its patients who reside in the nursing homes, long-term care facilities, assisted living facilities and similar types of facilities, as licensed by the state (if applicable). CMS continues to require that services provided to these patients or residents are under the direction of the same governing body and professional staff as the resident’s usual Medicare-certified dialysis facility. Further, in order to ensure that care is safe, effective and is provided by trained and qualified personnel, CMS requires that the dialysis facility staff: 1) furnish all dialysis care and services; 2) provide all equipment and supplies necessary; 3) maintain equipment and supplies in off-premises location; 4) and complete all equipment maintenance, cleaning and disinfection using appropriate infection control procedures and manufacturer’s instructions for use Renal dialysis and SNF APPROVED

5/11/2020
Specific Life Safety Code (LSC) for Multiple Providers — CMS is waiving and modifying particular waivers under 42 CFR §482.41(b) for hospitals; §418.110(d) for inpatient hospice; §483.470(j) for ICF/IIDs and §483.90(a) for SNF/NFs.

  • 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; §485.623(c)(5) for CAHs; §418.110(d)(4) for inpatient hospice; §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 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.
Hospitals, Inpatient Hospice, ICF/IID APPROVED

5/11/2020
CMS is delaying the compliance date by which IRFs, LTCH, and HHAs must collect and report data on two Transfer of Health (TOH) Information quality measures and certain Standardized Patient Assessment Data Elements (SPADEs) adopted for the IRF QRP, LTCH QRP, and HH QRP. Rehabilitation hospitals, long term care hospitals and home health agencies APPROVED

5/8/2020
Modification to Medicare Rules and Medicaid Concerning Certification and Provision of Home Health Services
CMS is revising §§ 409.41 through 409.48; 424.22; 424.507(b)(1); § 440.70(a)(2) and (3), and (b)(1), (2) and (4); and several sections of 42 CFR part 484 to include physician assistants, nurse practitioners, and clinical nurse specialists as individuals who can certify the need for home health services and order services. These changes are permanent, and applicable to services provided on or after March 1, 2020.
Home Health Agencies APPROVED

5/8/2020
IRF 3-hour rule
CMS has amended requirements at §§ 412.29(d), (e), (h), and (i) and 412.622(a)(3), (4), and (5) to add an exception for care furnished to patients admitted to freestanding IRF hospitals (identified as those facilities with the last 4 digits of their Medicare provider numbers between 3025 through 3099) solely to relieve acute care hospital capacity during the COVID-19 PHE.

For the purposes of exercising these IRF flexibilities that are intended to provide broad flexibility for freestanding IRF hospitals to provide surge capacity in support of acute care hospitals in their state or community, CMS considers surge to be alleviated with regard to exercising these flexibilities when the state (or region, as applicable) in which the freestanding IRF is located is in phase 2 or phase 3 or reopening under federal guidelines. For billing purposes, freestanding IRF hospitals must append the “DS” modifier to the end of the IRF’s unique patient identifier number (used to identify the patient’s medical record in the IRF) to identify patients who are being treated in a freestanding IRF hospital solely to alleviate inpatient bed capacity in a state that is experiencing a surge during the PHE for the COVID-19 pandemic.
Freestanding Rehabilitation Hospitals APPROVED

5/8/2020
Medicaid home health
CMS amended the Medicaid home health regulations to allow other licensed practitioners to order all components of home health services in accordance with state scope of practice laws. CMS also amended the home health regulation at § 440.70(a)(3) to allow other licensed practitioners, to order medical equipment, supplies and appliances in addition to physicians, when practicing in accordance with state laws. For other services covered under the Medicaid home health benefit, CMS is applying the new list of practitioners set forth in section 3708 of the CARES Act to who can order those services, specifically, part-time or intermittent nursing services, home health aide services, and if included in the state’s home health benefit, therapy services. CMS also amended regulations to remove the requirement that the NPPs have to communicate the clinical finding of the face-to-face encounter to the ordering physician. With expanding authority to order home health services, the CARES Act also provides that such practitioners are now capable of independently performing the face-to-face encounter for the patient for whom they are the ordering practitioner, in accordance with state law. If state law does not allow such flexibility, the NPP is required to work in collaboration with a physician.
Home Health Agencies APPROVED

5/8/2020 & 3/31/2020
Updated mandatory assessment instruments
CMS has delayed the release of updated versions of the IRF Patient Assessment Instrument (IRF-PAI), LTCH Continuity Assessment Record and Evaluation Data Set (LTCH CARE Data Set), and HHA’s Outcome and Assessment Information Set (OASIS) Instrument to reduce the burden that these providers would otherwise incur as a result of being required to incorporate the updated versions into their operations before October 1, 2020 (for IRFs and LTCHs) or January 1, 2021 (for HHAs).

Specifically, CMS will require IRFs to use IRF-PAI V4.0 and LTCHs to use LTCH CARE Data Set V5.0 to begin collecting data on the two TOH Information Measures beginning with discharges on October 1st of the year that is at least 1 full fiscal year after the end of the COVID-19 PHE. For example, if the COVID-19 PHE ends on September 20, 2020, IRFs and LTCHs will be required to begin collecting data on these measures beginning with patients discharged on October 1, 2021. We will also require IRFs and LTCHs to begin collecting data on the SPADEs for admissions and discharges (except for the hearing, vision, race, and ethnicity SPADEs, which would be collected for admissions only) on October 1st of the year that is at least 1 full fiscal year after the end of the COVID-19 PHE.

HHAs will be required to use OASIS-E to begin collecting data on the two TOH Information Measures beginning with discharges and transfers on January 1st of the year that is at least 1 full calendar year after the end of the COVID-19 PHE. For example, if the COVID-19 PHE ends on September 20, 2020, HHAs will be required to begin collecting data on those measures beginning with patients discharged or transferred on January 1, 2022. We will also require HHAs to begin collecting data on the SPADEs beginning with the start of care, resumption of care, and discharges (except for the hearing, vision, race, and ethnicity SPADEs, which would be collected at the start of care only) on January 1st of the year that is at least 1 full calendar year after the end of the COVID-19 PHE.

SNFs will be required to begin collecting data on the two TOH Information Measures beginning with discharges on October 1st of the year that is at least 2 full fiscal years after the end of the COVID-19 PHE. For example, if the COVID-19 PHE ends on September, 20, 2020, SNFs will be required to begin collecting data on these measures beginning with patients discharged on October 1, 2022. SNFs will begin collecting data on the SPADEs beginning with admissions and discharges (except for the hearing, vision, race, and ethnicity SPADEs, which would be collected for admissions only) on October 1st of the year that is at least 2 full fiscal years after the end of the COVID-19 PHE. This delay is longer than the delay adopted for IRFs, LTCHs and HHAs because it will give CMS time to work with stakeholders to ensure that their concerns are addressed while also allowing SNFs a reasonable amount of time to complete required training, train their staffs, and work with their vendors to make necessary programming updates.
Rehabilitation hospitals, long term care hospitals, home health agencies and skilled nursing facilities APPROVED

5/8/2020
Paid Feeding Assistant Waiver of minimum 8 hour training and instead provide Just in time training; continue compliance with not assigning complex patients to dining assistant SNFs APPROVED

4/24/2020
Inpatient Rehabilitation Facility – Intensity of Therapy Requirement (“3-Hour Rule”). As required by section 3711(a) of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, during the COVID-19 public health emergency, 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 Register 19252, 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. IRF APPROVED

4/15/2020
Long Term Care Hospitals - Site Neutral Payment Rate Provisions. Also as required by section 3711(b) of the CARES Act, during the Public Health Emergency (PHE) due to COVID-19, 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). o 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. o 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. LTCHs should add the “DR” condition code to applicable claims. LTCH APPROVED

4/15/2020
Bed Increases and Swing Beds. Enable hospitals to increase its number of certified beds, as necessary to respond to the public health emergency, and enable hospitals that do not have either a hospital-based skilled nursing facility to use their acute care beds to provide SNF level care if the public health emergency should require it. Hospitals APPROVED

4/10/2020
Utilization Review. CMS is waiving certain requirements under 42 CFR §482.1(a)(3) and 42 CFR §482.30 which address the statutory basis for hospitals and includes the requirement that hospitals participating in Medicare and Medicaid must have a utilization review plan that meets specified requirements.
  • 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. Removing these administrative requirements will allow hospitals to focus more resources on providing direct patient care.
Hospitals APPROVED

4/9/2020
Written Policies and Proceduresfor 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. This removes the burden on facilities to develop and establish additional policies and procedures at their surge facilities or surge sites related to the assessment, initial treatment and referral of patients. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan.
  • Emergency Preparedness Policies and Procedures. CMS is waiving 42 CFR §482.15(b) and §485.625(b), which requires the hospital and CAH 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 and CAHs to contain specified elements with respect to the surge site. The requirement under the communication plan requires hospitals and CAHs to have specific contact information for staff, entities providing services under arrangement, patients’ physicians, other hospitals and CAHs, and volunteers. This would not be an expectation for the surge site. This waiver applies to both hospitals and CAHs, and removes the burden on facilities to establish these policies and procedures for their surge facilities or surge sites.
Hospitals APPROVED

4/9/2020
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) to allow a long term care (LTC) 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; 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.
SNF APPROVED

4/9/2020
Physician Services. CMS is providing relief to long-term care facilities related to provision of physician services through the following actions:
  • Physician Delegation of Tasks in SNFs. 42 C.F.R. 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 C.F.R. 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.
  • Physician Visits. 42 C.F.R. 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.These actions will assist in potential staffing shortages, maximize the use of medical personnel, and protect the health and safety of residents during the PHE. We note that we are not waiving the requirements for the frequency of required physician visits at § 483.30(c)(1). As set out above, we have 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, we note that we are not waiving our 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.
SNF APPROVED

4/9/2020
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 are not waived. 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. SNF APPROVED

4/9/2020
Allow occupational therapists (OTs) to perform initial and comprehensive assessment for all patients. 42 C.F.R. 484.55(a)(2) and 484.55(b)(3). CMS is waiving the requirement that OTs may only perform the initial and comprehensive assessment if occupational therapy is the service that establishes eligibility for the patient to be receiving home health care. This temporary blanket modification allows OTs 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 occupational therapy is the service that establishes eligibility. The existing regulations at § 484.55(a) and (b)(2) would continue to apply that OTs and other therapists 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. Expanding the category of therapists who may perform initial and comprehensive assessments to include OTs provides HHAs with additional flexibility that may decrease patient wait times for the initiation of home health services. Home Health APPROVED

4/9/2020
Comprehensive Assessments. CMS is waiving certain requirements at 42 CFR §418.54 related to updating comprehensive assessments of patients. This waiver applies the timeframes for updates to the comprehensive assessment found at §418.54(d). Hospices must continue to complete the required assessments and updates, however, the timeframes 16 for updating the assessment may be extended from 15 to 21 days. Hospice APPROVED

4/9/2020
Hospice aide competency testing allow use of pseudo patients. 42 C.F.R. 418.76(c)(1). CMS is temporarily modifying the requirement in § 418.76(c)(1) that a hospice aide must be evaluated by observing an aide’s performance of certain tasks with a patient. This modification allows hospices to utilize pseudo patients such as a person trained to participate in a role-play situation or a computer-based mannequin device, instead of actual patients, in the competency testing of hospice aides for those tasks that must be observed being performed on a patient. This increases the speed of performing competency testing and allows new aides to begin serving patients more quickly without affecting patient health and safety during the public health emergency (PHE). Hospice APPROVED

4/9/2020
12-hour annual in-service training requirement for hospice aides. 42 C.F.R. 418.76(d). CMS is waiving the requirement that hospices must assure that each hospice aide receives 12 hours of in-service training in a 12-month period. This allows aides and the registered nurses (RNs) who teach in-service training to spend more time delivering direct patient care. Hospice APPROVED

4/9/2020
Current regulations allow a HIPAA business associate to use and disclose protected health information for public health and health oversight purposes only if expressly permitted by its business associate agreement with a HIPAA covered entity.

To facilitate uses and disclosures for public health and health oversight activities during this nationwide public health emergency, effective immediately, OCR will exercise its enforcement discretion and will not impose penalties against a business associate or covered entity under the Privacy Rule provisions 45 CFR 164.502(a)(3), 45 CFR 164.502(e)(2), 45 CFR 164.504(e)(1) and (5) if, and only if:
  • The business associate makes a good faith use or disclosure of the covered entity’s PHI for public health activities consistent with 45 CFR 164.512(b), or health oversight activities consistent with 45 CFR 164.512(d); and
  • The business associate informs the covered entity within ten (10) calendar days after the use or disclosure occurs (or commences, with respect to uses or disclosures that will repeat over time)


Examples of such good faith uses or disclosures covered by this Notification include uses and disclosures for or to:
  • The Centers for Disease Control and Prevention (CDC), or a similar public health authority at the state level, for the purpose of preventing or controlling the spread of COVID-19, consistent with 45 CFR 164.512(b)
  • The Centers for Medicare and Medicaid Services (CMS), or a similar health oversight agency at the state level, for the purpose of overseeing and providing assistance for the health care system as it relates to the COVID-19 response, consistent with 45 CFR 164.512(d)


This enforcement discretion does not extend to other requirements or prohibitions under the Privacy Rule, nor to any obligations under the HIPAA Security and Breach Notification Rules applicable to business associates and covered entities. For example, business associates remain liable for complying with the Security Rule’s requirements to implement safeguards to maintain the confidentiality, integrity, and availability of electronic PHI (ePHI), including by ensuring secure transmission of ePHI to the public health authority or health oversight agency.
All providers APPROVED

4/2/2020
Hospital VBP
CMS has excepted hospitals from the requirement to report HAI measure data, HCAHPS survey data, and claims-based data for Q1 and Q2 2020 discharges because the data collected during that period may be greatly impacted by the hospital’s response to COVID-19. CMS will not use discharge data from these quarters for measure calculations For the Q4 2019 HAI and HCAHPS data, the exception is being granted because the April and May 2020 data submission deadlines for those data fall during the COVID-19 PHE.
Hospitals APPROVED

3/31/2020
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 COVID-19. 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. This aligns with CDC guidance to preferably place residents in locations designed to care for COVID-19 residents, to prevent the transmission of COVID-19 to other residents. SNF APPROVED

3/30/2020
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) to allow a long term care (LTC) 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; 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 are not waived.
  • 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 the 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 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 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.


We remind LTC facilities that they are responsible for ensuring that any transfers (either within a facility, or to another facility) are conducted in a safe and orderly manner, and that each resident’s health and safety is protected. We also remind states that under 42 CFR 488.426(a)(1), in an emergency, the State has the authority to transfer Medicaid and Medicare residents to another facility
SNF APPROVED

3/30/2020
Expanding availability of ESRD to Nursing Home Residents
CMS is waiving the following requirements related to Nursing Home residents:

Home Residents:
  • Furnishing dialysis services on the main premises: ESRD requirements at 42 CFR §494.180(d) require dialysis facilities to provide services directly on its main premises or on other premises that are contiguous with the main premises. CMS is waiving this requirement to allow dialysis facilities to provide service to its patients in the nursing home or skilled nursing facility. CMS continues to require that services provided to these nursing home residents are under the direction of the same governing body and professional staff as the resident’s usual Medicare-certified dialysis facility. Further, in order to ensure that care is safe, effective and is provided by trained and qualified personnel, CMS requires that the dialysis facility staff: furnish all dialysis care and services, provide all equipment and supplies necessary, maintain equipment and supplies in the nursing home, and complete all equipment maintenance, cleaning and disinfection using appropriate infection control procedures and manufacturer’s instructions for use.
  • Clarification for billing procedures. Typically, ESRD beneficiaries are transported from a SNF/NF to an ESRD facility to receive renal dialysis services. In an effort to keep patients in their SNF/NF and decrease their risk of being exposed to COVID-19, ESRD facilities may temporarily furnish renal dialysis services to ESRD beneficiaries in the SNF/NF instead of the offsite ESRD facility. The in-center dialysis center should bill Medicare using Condition Code 71 (Full care unit. Billing for a patient who received staff-assisted dialysis services in a hospital or renal dialysis facility). The in-center dialysis center should also apply condition code DR to claims if all the treatments billed on the claim meet this condition or modifier CR on the line level to identify individual treatments meeting this condition. The ESRD provider would need to have their trained personnel administer the treatment in the SNF/ NF. In addition, the provider must follow the CFCs. In particular, under the CFCs is the requirement that to use a dialysis machine, the FDA-approved labeling must be adhered to § 494.100 and it must be maintained and operated in accordance with the manufacturer’s recommendations (§ 494.60) and follow infection control requirements at § 494.30.
SNF, ESRD APPROVED

3/30/2020
Utilization Review. CMS is waiving certain requirements under 42 CFR §482.1(a)(3) and 42 CFR §482.30 which address the statutory basis for hospitals and includes the requirement that hospitals participating in Medicare and Medicaid must have a utilization review plan that meets specified requirements.

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. Removing these administrative requirements will allow hospitals to focus more resources on providing direct patient care.
Hospitals APPROVED

3/30/2020
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. This removes the burden on facilities to develop and establish additional policies and procedures at their surge facilities or surge sites related to the assessment, initial treatment and referral of patients. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Hospitals with emergency rooms APPROVED

3/30/2020
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 waivers allow nurses increased time to meet the clinical care needs of each patient and allows for the provision of nursing care to an increased number of patients. In addition, we expect that hospitals will need relief for the provision of inpatient services and as a result, the requirement to establish nursing-related policies and procedures for outpatient departments is likely of lower priority. These flexibilities apply to both hospitals and CAHs §485.635(d)(4), and may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Hospitals APPROVED

3/30/2020
Quality Assessment and Performance Improvement Program. CMS is waiving 42 CFR §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 (for hospitals that are part of a hospital system). These flexibilities, which apply to both hospitals and CAHs, 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 hospital or CAH QAPI program, the requirement that hospitals and CAHs maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement program will remain. This waiver applies to both hospitals and CAHs. Hospitals APPROVED

3/30/2020
Emergency Preparedness Policies and Procedures. CMS is waiving 42 CFR §482.15(b) and §485.625(b), which requires the hospital and CAH 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 and CAHs to contain specified elements with respect to the surge site. The requirement under the communication plan requires hospitals and CAHs to have specific contact information for staff, entities providing services under arrangement, patients’ physicians, other hospitals and CAHs, and volunteers. This would not be an expectation for the surge site. This waiver applies to both hospitals and CAHs, and removes the burden on facilities to establish these policies and procedures for their surge facilities or surge sites. Hospitals APPROVED

3/30/2020
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 in paragraphs §482.52(a)(5) and §485.639(c)(2). CRNA supervision will be at the discretion of the hospital and state law. This waiver applies to hospitals, CAHs, and Ambulatory Surgical Centers (ASCs). These waivers will allow CRNAs to function to the fullest extent of their licensure, and may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Hospitals APPROVED

3/30/2020
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. Not being required to designate these professionals in writing will allow qualified professionals to operate to the fullest extent of their licensure and training in providing patient care. Hospitals APPROVED

3/30/2020
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. Such manuals would not need to be maintained at surge capacity sites. These flexibilities may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan. Removing these administrative requirements will allow hospitals to focus more resources on providing direct patient care. Hospitals APPROVED

3/30/2020
Medicare Parts C and D and PACE Program Audits
CMS is reprioritizing its scheduled program audits for Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid Plans, and PACE organizations until further notice.2 CMS will continue its oversight of these organizations, but will temporarily shift our oversight activities from conducting routine audit activities to prioritizing the investigation and resolution of:
  • Instances of noncompliance where the health and/or safety of beneficiaries are at serious risk (for example, lack of access to critically needed health services or prescription drugs); and
  • Complaints alleging infection control concerns, including COVID-19 or other respiratory illnesses
PACE Organizations APPROVED

3/30/2020
(5) Quality Reporting Programs
CMS issued supplemental public guidance excepting multiple providers from the requirement to report any QRP data for certain quarters.
IRF, LTCH, HHA, Acute Care Hospitals, ASCs, Psychiatric Hospitals, Dialysis, Hospice APPROVED

3/27/2020
Physical Environment – 42 CFR 483.90 — provided State approves location, allow non-SNF building to be used for SNF care if there are needs for isolation

CMS is waiving requirements related at 42 CFR 483.90, specifically the following:
  • 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 § 483.90 to allow for a non-SNF building to be temporarily certified 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 are available while protecting other vulnerable adults. CMS believes this will also provide another measure that will free up inpatient care beds at hospitals for the most acute patients while providing beds for those still in need of care. CMS will waive certain conditions of participation and certification requirements for opening a NF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.
  • CMS is also waiving requirements under 42 CFR 483.90 to temporarily allow 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.
SNF APPROVED

3/26/2020;

Updated 3/30/2020
Resident Groups – 42CFR 483.10(f)(5) — allow restriction of resident groups during emergency

CMS is waiving the requirements at 42 CFR 483.10(f)(5), which ensure residents can participate in-person in resident groups. This waiver would only permit the facility to restrict 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.
SNF APPROVED

3/26/2020

Updated 3/30/2020
Training and Certification of Nurse Aides – 42 CFR 483.35(d) — allows SNFs to employ someone longer than 4 months without the training and certification requirements

CMS is waiving the requirements at 42 CFR 483.35(d) (with the exception of 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). CMS is waiving these requirements to assist in potential staffing shortages seen with the COVID-19 pandemic. To ensure the health and safety of nursing home residents, CMS is not waiving 42 CFR § 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. We further note that we are 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.
SNF APPROVED

3/26/2020

Updated 3/30/2020
Use of IRF, LTCH and IPH Units — Allow acute care hospitals to house acute patients in excluded distinct part units (IRFs, LTCHs, IPH)

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 (commonly referred to as the “60 percent rule”) if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such. In addition, during the applicable waiver time period, we would also apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain classification as an IRF
Hospitals, IRFs, LTCHs, IPHs APPROVED

3/13/2020

Updated 3/30/2020
QIN-QIO — suspend deadlines and work under 12th SOW QIN QIOs APPROVED

3/27/2020
Verbal Orders 42 CFR 482.23, 482.24 and 485.635(d)(3) to allow for flexibility where read-back verification is still required but authentication can occur later than 48 hours Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
Patient Rights 42 CFR 482.13 only for hospitals which are considered to be impacted by a widespread outbreak of COVID-19 not required to:
Honor timeframes for providing medical records; have written visiting policies; comply with seclusion requirements
Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
Discharge planning — all requirements related to post-acute care to expedite safe discharge 42CFR 482.43(c) Hospitals APPROVED

3/26/2020
Medical Staff privileges 42 CFR 482.22(a) and 485.627(a) to allow MDs whose privileges will expire to continue practicing and for new MDs to be able to practice before full medical staff/governing body review/approval Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
Medical Records Timing42 CFR 482.24(c)(4)(viii) and 485.638(a)(4)(iii) to allow flexibility in completion of medical records within 30 days following discharge Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
Patient Self-Determination Act Section 1902(a)(58) and 1902(w)(1)(A), 1852((i) and 1866(f) and 42 CFR 489.102 — provide information about advance directive policies. This DOES NOT waive requirement for patients to receive information about policy regarding recognition of advance directives Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
Detailed information for discharge planning — waive requirement to provide detailed information related to post-acute placement 42 CFR 482.43(a)(8), 482.61(e) and 485.642(a)(8) Hospitals APPROVED

3/26/2020
Sterile Compounding 42 cfr 482.25(b)(1) and 485.635(a)(3) allows face masks to be removed and retained in the compounding area to be re-donned and reused during same shift in the compounding area only Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
Physical Environment 42 CFR 482.41 and 485.623 — permit non-hospital buildings/space to be used for patient care and quarantine sites, provided location is approved by State Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
ICU reporting requirements 42CFR 482.13(g)(1)(i)-(iii) Hospitals APPROVED

3/26/2020
EMTALA — Section 1867(a) screening patients at location offsite from hospital campus to prevent spread of COVID-19 Hospitals, Psychiatric Hospitals APPROVED

3/26/2020
Staffing Data Submission 42 CFR 483.70(q) — relieves requirements to submit staffing data through Payroll Based Journal system SNFs APPROVED

3/26/2020
PASRR – 42 CFR 483.106(b)(4) — Level 1 can be done within first few days following admission; If not enough information, document in record. Level II also not required pre-admission when residents are transferred between NFs. Level I and II assessments should be done within 30 days of admission SNFs APPROVED

3/26/2020
Home Health Assessments – 42 CFR 484.55(a) — allows agencies to conduct initial assessment and determine homebound status remotely or by record review

https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf
Home Health Agencies APPROVED

3/26/2020
Hospice Volunteers 42 CFR 418.78(c) — waives use of volunteers for at least 5% of patient care hours Hospice APPROVED

3/26/2020
Non-Core Services 42 CFR 418.72 — waives requirement to provide Hospice APPROVED

3/26/2020
Onsite Aide Supervision – 42 CFR 418.76(h) and 484.80(h)2 — waives on-site supervision by RN or other professional every two weeks

Waive onsite visits for HHA Aide Supervision. CMS is waiving the requirements at 42 CFR §484.80(h), 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.
Home Health Agencies and Hospice APPROVED

3/26/2020
Hospice Comprehensive Assessment – 42 CFR 418.54 — timeframe for completing updates to assessment increased from 15 to 21 days Hospice APPROVED

3/26/2020
Hospital and Post-Acute Data Reporting — NHSN, NDNQI and QRP relief for clinicians, providers, hospitals and facilities participating in quality reporting programs

Memo | Fact Sheet
Medicare providers APPROVED

3/26/2020
Home Health OASIS Reporting — extends 5-day completion requirement for comprehensive assessment and waives the 30-day submission requirements Home Health Agencies APPROVED

3/13/2020 and clarified 3/26/2020
Extend Medicaid pre-authorizations for which Medicaid beneficiaries had a prior auth to the end of the emergency – retro to 3/1/2020 Medicare providers APPROVED

3/23/2020
Provider Enrollment — New Jersey is authorized to provisionally, temporarily enroll providers who are enrolled with another State Medicaid agency or Medicare. Allows payment of claims from out of state providers depending on certain criteria

If a provider is not enrolled in another state or in Medicare, NJ can enroll the provider under minimum requirements set forth in the CMS letter

Revalidation of providers is approved to be temporarily halted
Medicaid and CHIP providers from outside NJ and in NJ APPROVED

3/23/2020
Modification of timeframe for Medicaid MCOs to resolve appeals under 42 CFR 438.408(f)(1) — before an enrollee may request a State fair hearing to no less than 1 day. If the State uses this authority, all appeals filed between March 1, 2020 and the end of the emergency satisfy the exhaustion requirement in 42 CFR 438.408(f)(1) after one day

Modification of timeframe under 42 CFR 438.408(f)(2) — allow an additional 120 days to request a fair hearing when the initial 120th day deadline occurred during the period of the waiver
Medicaid beneficiaries and providers APPROVED

3/23/2020
Payment for Services in Alternative Settings — Medicaid may pay for services rendered to an unlicensed facility where patients have been relocated as long as the State makes assessment that facility meets minimum standards Medicaid providers APPROVED

3/23/2020
Modify deadlines/timeframes and performance of required activities to allow for payment for items/services provided absent any determination of fraud/abuse Medicare providers APPROVED

3/13/2020
3/13/2020 3-day qualifying hospital stay prior to coverage of SNF Part A stay Skilled nursing facilities APPROVED

3/13/2020
SNF Benefits — For beneficiaries who exhaust SNF benefit, renewed coverage w/o first having to begin a new benefit period Skilled nursing facilities APPROVED

3/13/2020
MDS Requirements 42 CFR 483.20 — relieves SNFs on timeframe for MDS assessment and transmission Skilled nursing facilities APPROVED

3/13/2020
3/16/2020 IRF Pre-Admission; Three-Hour Rule Rehabilitation Hospitals and Units APPROVED
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 the 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 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
SNF APPROVED
Extending deadlines for the collection and submission of the Hospice Item Set until the conclusion of the nationwide public health emergency (42 C.F.R. § 418.312);

Suspending all face-to-face visit requirements by hospice physicians and nurse practitioners in favor of permitted telephone and telehealth modalities (42 C.F.R. § 418.22(a)(4));

Extending the five-day timeframe for hospice providers to submit Notices of Election and Notices of Termination/Revocation (42 C.F.R. § 418.24);

Encouraging all included hospice services to be provided by telephone and telehealth modalities, including bereavement counseling, social work, spiritual services, dietary services, and other counseling;

Suspending the requirement for certified hospices to have a contract with a nursing home if a patient has moved (42 C.F.R. § 418.108);

Suspending the requirement that hospices conduct background checks on employees with direct patient contact or access to records before hiring them, such that employees can be on-boarded while the background check is processed (42 C.F.R. § 418.113);
Hospice APPROVED
3/16/2020 CMS-13 Requirements Rehabilitation Hospitals and Units PENDING
3/16/2020 PACE: waiver of semi-annual assessment; in person assessment; contracting flexibilities PACE organizations PENDING
Extension of Accreditation Status for Expirations in 2020
NJHA has requested of CMS and Joint Commission an extension of accreditation for a 12-month period for all providers that have expiration dates that occur in 2020
All Accredited Entities PENDING
PACE: Allowing a place or residence can include services provided at a temporary alternative site, such as a family member’s home (CMS Call Letter (June 23, 2004) and February 2006 Guidance);

PACE: Extending time periods for conducting the initial assessment and reassessments and permitting the substitution of telephone and telehealth modalities, rather than conducting these assessments and reassessments “in-person” (42 C.F.R. § 460.104);

PACE: Permitting POs to maintain enrollment in cases where the enrollee was required to move out of the service area (42 C.F.R. § 438.56);

PACE: Enabling emergency care to be provided outside of a written contract for PACE services (42 C.F.R. § 460.70); and

PACE: Allowing interdisciplinary team assessments and reassessments, and in response to a request for service, relaxing scope of disciplines required (physician therapy, occupational therapy, etc.) to be completed (42 C.F.R. §§ 460.102-104)
PACE organizations PENDING
Long Term Care Hospital PPS Requirements — waive 3-day ICU stay for full LTCH PPS payment Long Term Care Hospitals PENDING
USP 800 related to hazardous drug preparation — free up negative pressure rooms Hospitals PENDING
Allowing certified nurse aide students who have completed the nurse aide training program, but who have not yet completed the practicum due to closure of testing sites, to function as a certified nurse aide under the guidance and supervision of licensed nursing staff (42 C.F.R. § 483.35(d));

Allowing nursing students who have completed at least one semester of classroom training to be allowed to function as a certified nurse aide after receiving expedited training and competency evaluation from a skilled nursing facility (42 C.F.R. § 483.35(d));

Permitting all training requirements for certified nurse aides to be delivered online to avoid unnecessary contact during in-person trainings (42 C.F.R. § 483.152);

Suspending required eligibility assessment for patients going from a SNF to home setting, which will expedite transfers of these residents to a safe home-based environment 42 C.F.R. § 484.55);
SNFs PENDING
Physical Presence Requirement. Medicare GME billing rules under 42 C.F.R. § 415.172 require that a training physician be “physically present” during the critical or key portions of the procedure performed by a medical resident in order for services to be billed under the Medicare Physician Fee Schedule by the teaching physician. CMS should clarify that this physical presence requirement may be satisfied through telehealth or telephonic modalities permitted by federal or state telehealth guidance specific to COVID-19

Indirect Medical Education. 42 C.F.R. § 412.105 calculates Indirect Medical Education reimbursement to the ratio of residents to beds within a hospital facility. Given that these IME ratios will likely change during the pendency of the nationwide public health emergency as bed counts increase and hospital facilities are reconfigured, NJHA seeks for a “hold harmless” or similar protections to the IME reimbursement paid to academic medical centers based on swings in bed counts that will likely accompany the public health response
Academic Medical Centers PENDING
Observation Beds (42 CFR § 440.2). Suspend the 24-hour limit on observation services and permit payment for hospital outpatient observation services up to 48 hours, if not longer, especially for patients who have been admitted from a nursing home or SNF, and who are awaiting testing before returning to the nursing home or SNF. Permitting this reimbursement will encourage that these patients are treated quickly and do not occupy hospital beds that may become scarce during a surge in COVID-19 cases PENDING
Request for CMS to provide a waiver of this specific EMTALA requirement which we believe to be 42CFR 489.24(d)(5). It is unclear to us whether this provision is considered waived because of the existence of the 1135 waivers already issued for EMTALA as described at 42 CFR 489.24(a)(2)(i). Hospitals PENDING

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Department of Health and Human Services

Submission DateWaiverApplies ToStatus
Sanctions under Section 1877 related to limitations on physician referral as CMS deems appropriate

CMS has issued blanket waivers of sanctions under section 1877(g) of the Act. The blanket waivers may be used now without notifying CMS. Individual waivers of sanctions under section 1877(g) of the Act may be granted upon request.

https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf
Physicians APPROVED

3/1/2020

Updated 3/30/2020
3/13/2020 Certain COPs, certification requirements, program participation for providers (individual and facility) and pre-approval requirements Medicare providers APPROVED

3/1/2020
Professional licenses in the state in which they provide services if they have equivalent license in another State and are not barred from practice Medicare and Medicaid providers APPROVED

3/1/2020
Sanctions under EMTALA section 1867 for direction/relocation of person to another location to receive medical screening or transfer of person who has not been stabilized if transfer is required by PH emergency Emergency rooms APPROVED

3/1/2020
Limits on payment to out of network providers/facilities for Medicare advantage enrollees Medicare Advantage providers APPROVED

3/1/2020
Sanctions and penalties from HIPAA noncompliance with obtaining patient’s agreement to speak with family/friends; distribution of notice of privacy practices; patient’s right to request privacy restrictions or confidential communication

BULLETIN: HIPAA Privacy and Novel Coronavirus
Medicare and Medicaid providers APPROVED

3/1/2020
HIPAA Breach Notification: The breach notification requirements under 45 CFR Part 164, Subpart D contain specific timeframes for investigation and notification of a potential breach involving unsecured PHI and then written notification of affected individuals by first-class mail. Given the limited resources available to Covered Entities to investigate potential breaches of unsecured PHI, as well as the ability to print and mail notices and comply with these breach notification requirements within the prescribed timeframes, NJHA requests that Covered Entities be permitted to deliver breach notification communications electronically, whenever possible, and to extend the breach notification times for the duration of the public health emergency

Valid Authorizations: Under 45 C.F.R. § 164.508(c)(1), HIPAA requires that authorizations for release or certain uses of PHI be obtained through a signed written document. Given the difficulty of obtaining hard copy, signed authorizations based on staffing and access shortages, and the importance of ensuring that authorized PHI may be transmitted as directed by a patient, NJHA requests Covered Entities be permitted to rely on verbal authorizations as documented in the individual’s record as a valid authorization during the nationwide public health emergency

Code Sets: NJHA requests that CMS waive HIPAA EDI code set requirements under 45 CFR § 162.1002. This waiver would permit New Jersey, as with other states, additional flexibility to define and implement code sets not currently available in a standard federal code set or provide additional specificity to a code set definition that allows us to track and set rates for services specific to COVID-19
PACE organizations PENDING

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Department of Banking & Insurance

Submission DateWaiverApplies ToStatus
3/25/2020 Healthcare organization would benefit from any provider application in the queue being immediately granted participation status and provisioned with an effective date retroactive to March 1, 2020 to make sure that any patient services that have been rendered will be paid

Facilities and providers are ramping up clinical operations in front line urgent care & primary care practices. They are exploring the benefit of redeploying certain physician specialists into those site locations to offer telehealth services and direct face to face patient care. These would be providers that are already PAR with the payer; however, they have taxonomy codes that are specialty and linked to locations that are not aligned with proper practice site. We respectfully ask that your organizations relax the need to process link letters and provide the healthcare group an opportunity to deliver the necessary urgent and primary care to keep patients from going to the ER

As long as a provider has entered into a participating agreement with the insurance company, it would be expected that health care organizations would not need to sign additional agreements and link letters before providing patient care and processing claims

There are new providers that have been in the process of getting their hospital privileges that need to be fast tracked for early hire and deployment. Payers generally require 60-180 days for any new provider application to be assigned under contractual agreements. NJHA respectfully requests that the payer community should adopt the similar protocol outlined by CMS
Providers PENDING

Health plans have all taken some steps related to prior authorization and provider enrollment, but there is no blanket requirement or approach at this time
3/16/2020 Out of network requirements PENDING
Waive Prior Authorization — all insurance All providers PENDING
Waive medical management All providers PENDING
Halt administrative and technical denials All providers PENDING
Relax NOA requirements Institutional providers PENDING
Halt concurrent review or continued stay review requirements Institutional providers PENDING
Suspend deadlines for claims filing and appeals filing All providers PENDING
Suspend all audits All providers PENDING
Require TPAs to follow rules for fully insured market Self-funded plans PENDING

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Department of Community Affairs

Submission DateWaiverApplies ToStatus
3/23/2020 Waive provisions that affect health care organizations’ ability to offer services to accommodate surge; provide temporary measures to assist facilities with health care plan review; local municipality permitting; local inspections; certificate of occupancy All facilities PENDING
For CCRCs — 180 day extension for filing of community disclosure statements CCRCs PENDING

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Internal Revenue Service

Submission DateWaiverApplies ToStatus
Request for 12-month extension for submission of CHNA or implementation strategies due in 2020 Non-profit Hospitals PENDING

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Statutes

Submission DateWaiverApplies ToStatus
Alcoholism Treatment and Rehabilitation Act

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Medicare/Medicaid/Insurance

Telehealth

Submission DateWaiverApplies ToStatus
Audio-only services that are being furnished primarily as a replacement for care that would otherwise be reported as an in-person or telehealth visit using the office/outpatient E/M codes, CMS established new RVUs for the telephone E/M services based on crosswalks to the most analogous office/outpatient E/M codes, Specifically, CPT codes 99212, 99213, and 99214 are crosswalked to 99441, 99442, and 99443 respectively. Also finalizing, on an interim basis and for the duration of the COVID-19 PHE the following work RVUs: 0.48 for CPT code 99441; 0.97 for CPT code 99442; and 1.50 for CPT code 99443. We are also finalizing the direct PE inputs associated with CPT code 99212 for CPT code 99441, the direct PE inputs associated with CPT code 99213 for CPT code 99442, and the direct PE inputs associated with CPT code 99214 for CPT code 99443. We are not finalizing increased payment rates for CPT codes 98966-98968

These audio-only services are being furnished as substitutes for office/outpatient E/M services, CMS is adding them to the list of Medicare telehealth services for the duration of the PHE. CMS will separately issue a 1135 waiver of the requirements under section 1834(m) of the Act and our regulation at § 410.78 that Medicare telehealth services must be furnished using video technology. The full list of Medicare telehealth services, including those added during the PHE, is available here
APPROVED

5/8/2020
Effective March 1, 2020, when a practitioner who ordinarily practices in a HOPD furnishes a telehealth service to a patient who is located at home they would submit a professional claim with the place of service code indicating the service was furnished in the HOPD and using the Current Procedural Terminology (CPT) telehealth modifier, modifier 95. Medicare would pay the practitioner under the PFS at the “facility” rate as if the service was furnished in the HOPD. The hospital will bill and be paid the originating site facility fee amount for those telehealth services. HOPDs APPROVED

5/8/2020

effective retroactive to March 1
The N.J. Department of Banking and Insurance Commissioner issued a Bulletin to all automobile insurers that provide personal injury protection coverage concerning telemedicine and telehealth use during the COVID-19 pandemic. Effective April 24, and continuing for the duration of the declared public health emergency, PIP insurers must:

  • Ensure network adequacy for telemedicine and telehealth networks
  • Encourage network providers to utilize telemedicine or telehealth services wherever possible and clinically appropriate
  • Update procedures to include reimbursement for telehealth services that are provided by a provider in any manner that is practicable and appropriate, including by telephone
  • Disseminate information via website, or other reasonable means, to notify providers of reimbursement procedures
  • Reimburse providers that deliver covered services to claimants via telemedicine or telehealth in accordance with this guidance
  • Not impose any specific requirements on the technologies used to deliver telemedicine and/or telehealth services (including any limitations on audio-only or live video technologies)
  • Ensure that payment to providers for services delivered via telemedicine or telehealth are not lower than would typically be paid for services rendered via traditional methods


Additional requirements and details are available in the DOBI Bulletin.
PIP Insurers APPROVED

4/27/2020
Guidance Regarding Telemedicine/Telehealth and Telecommunication Support Services for Behavioral Health Provider Agencies Behavioral Health Provider Agencies APPROVED

4/22/2020
Telemedicine Permitted to Replace On-Site Visit by Health Care Practitioner
necessary and appropriate to permit a telemedicine or telehealth examination to substitute for anyon-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. Accordingly, I am waiving the rule requirements set forth in N.J.A.C. 8:39, N.J.A.C. 8:36, N.J.A.C. 8:37, and N.J.A.C. 8:43 that require on-site examinations or in-office visits for residents of healthcare facilities to which this memorandum is directed for the duration of the Public Health Emergency, with the following conditions:
  1. The health care facility shall ensure that the outside healthcare provider conducting the telemedicine or telehealth examination:
    1. Notes in the resident's record that the resident is appropriate for a telemedicine or telehealth examination; and
    2. Advises the facility whether the telemedicine or telehealth examination indicates that an on-site or in-office examination of the resident is necessary.
  2. If the outside health care provider advises the facility that an on-site or in-office examination of the resident is needed, then the facility shall make the necessary arrangements for the exam to take place within the timeframe indicated by the outside health care provider.
  3. Health care providers performing telehealth or telemedicine services pursuant to this waiver/modification shall comply with the requirements and practice standards set forth in N.J.S.A. 45:1-61 to -63, unless and until these provisions are waived or modified by the Commissioner or any other state or federal department.


This waiver applies only to regulations that may require an on-site examination or in-office visit of a resident by an outside healthcare provider.

Long-term care facilities, assisted living facilities, assisted living programs, comprehensive personal care homes, dementia care homes and residential health care facilities are still required to maintain adequate on-site medical staff, including nurses and personal care assistants (PCAs), consistent with the mandatory staffing provisions set forth in N.J.A.C. 8:39, N.J.A.C. 8:36, N.J.A.C. 8:37, and N.J.A.C. 8:43 (except as otherwise waived or modified by the Commissioner). On-site medical staff are required to monitor residents and provide routine in-person care and medical treatment in accordance with all applicable statutes, regulations, and professional standards (except as otherwise waived or modified by the Commissioner).
Nursing Home, Assisted Living, Dementia Care Homes, RHCF APPROVED

4/17/2020
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 inperson visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options. SNF APPROVED

4/9/2020
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.
SNF APPROVED

3/30/2020
Telehealth expansion Medicare and Medicaid:

Medicare Telemedicine Health Care Provider Fact Sheet

General Provider Telehealth and Telemedicine Toolkit

Long-Term Care Nursing Homes Telehealth and Telemedicine Toolkit

ESRD Provider Telehealth and Telemedicine Toolkit

Medicare Telehealth FAQs

Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth

Temporary Telehealth Guidelines

FAQs on Availability and Usage of Telehealth Services Through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
Hospitals, Physicians, Nursing Homes APPROVED

Approved various dates
March 2020
Face to Face Requirement for Home Health and Hospice – waive completely. CMS has allowed telehealth F2F for home health Home Health and Hospice PENDING

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Centers for Medicare & Medicaid

Submission DateWaiverApplies ToStatus
Indirect medical education
For the duration of the COVID-19 PHE, for purposes of determining a hospital’s IME payment amount, the hospital’s available bed count is considered to be the same as it was on the day before the COVID-19 PHE was declared. CMS is revising § 412.105(d)(1), to state that beds temporarily added during the timeframe of the COVID-19 PHE, as defined in § 400.200, is in effect, are excluded from the calculations to determine IME payment amounts.
Teaching Hospitals APPROVED

5/8/2020
CMS revised §§ 412.105(f)(1)(iii)(A) for IME and 413.78 for DGME to allow teaching hospitals during the COVID-19 PHE to claim for purposes of IME and DGME payments the time spent by residents training at other hospitals. During the COVID-19 PHE, the presence of residents in non-teaching hospitals will not trigger establishment of per resident amounts or FTE resident caps at those non-teaching hospitals.

CMS has suspended the requirement that a hospital cannot claim the time spent by residents training at another hospital so that a hospital which sends residents to another hospital can claim those FTE residents on its Medicare cost report while they are training at another hospital in its FTE count, as long as all conditions are met.
Teaching Hospitals APPROVED

5/8/2020
IRF and IPF teaching status
To ensure that teaching IRFs or teaching IPFs can alleviate bed capacity issues by taking patients from the inpatient acute care hospitals without being penalized by lower teaching status adjustments, CMS has frozen the IRFs’ or IPFs’ teaching status adjustment payments at their values prior to the COVID-19 PHE.
Rehabilitation and Psychiatric Hospitals APPROVED

5/8/2020
Billing for specimen collection — physicians and other practitioners
For the duration of the PHE, CMS will recognize physician and NPP use of CPT code 99211 for all patients, not just patients with whom they have an established relationship, to bill for a COVID-19 symptom and exposure assessment and specimen collection provided by clinical staff incident to their services.
Physicians and NPPs APPROVED

5/8/2020
Testing — CMS created a new E/M code solely to support COVID-19 testing for the PHE, HCPCS code C9803 (Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source). CMS will assign HCPCS code C9803 to APC 5731 Level 1 Minor Procedures. Hospital Outpatient APPROVED

5/8/2020
With respect to Medicaid, CMS amended § 440.30 to permit flexibility for coverage of COVID-19 tests, including coverage for tests administered in non-office settings, and coverage for laboratory processing of self-collected COVID-19 tests that are FDA-authorized for self-collection. The flexibility would apply not only during the current COVID-19 PHE, but also during any subsequent periods of active surveillance, to allow for continued surveillance as part of strategies to detect recurrence of the virus in individuals and populations to prevent further spread of the disease. Medicaid Providers APPROVED

5/8/2020
Psychological and neuropsychological testing
CMS is amending § 410.32(b)(2)(iii)(B) which addresses supervision of COVID-19-related diagnostic psychological and neuropsychological testing to allow these services to be supervised by a NP, CNS, PA and CNM. Also amending § 410.32 to allow diagnostic tests to be performed by a PA without physician supervision when authorized to perform the tests under applicable state law. Amending § 410.32(b)(3) regarding the levels of supervision, to also authorize NPs, CNSs, PAs, and CNMs to provide the appropriate level of supervision assigned to diagnostic tests. When ordering diagnostic tests, the physician (or qualified NPP), who orders the service must maintain documentation of medical necessity in the beneficiary’s medical record.
Physicians, NP, CNS, PA, CNM APPROVED

5/8/2020
Opioid use disorder services
CMS has revised § 410.67(b)(7) to allow periodic assessments to be furnished via two-way interactive audio-video communication technology. In addition, in cases where beneficiaries do not have access to two-way audio-video communications technology, the periodic assessments may be furnished using audio-only telephone calls provided all other applicable requirements are met. CMS expects that OTPs will use clinical judgment to determine whether they can adequately perform the periodic assessment over audio-only phone calls, and if not, then they should perform the assessment using two-way interactive audio-video communication technology or in person as clinically appropriate. Regardless of the format that is used, the OTP should document in the medical record the reason for the assessment and the substance of the assessment.
OTPs APPROVED

5/8/2020
Relocation of provider-based outpatient services
CMS has adopted a temporary relocation exception policy so that hospitals can maintain treatment capacity and deliver needed care for patients.

On-campus departments that relocate on or after March 1, 2020 through the remainder of the PHE for the purposes of addressing the COVID-19 pandemic may seek an extraordinary circumstances relocation exception so that they may bill at the OPPS rate, as long as their relocation is not inconsistent with the state’s emergency preparedness or pandemic plan. The temporary extraordinary circumstances relocation policy established here will end following the end of the PHE for the COVID-19 pandemic, and we anticipate that most, if not all, PBDs that relocate during the COVID-19 PHE will relocate back to their original location prior to, or soon after, the COVID-19 PHE concludes. Hospitals with on-campus and excepted off-campus PBDs that relocate due to the COVID-19 PHE in a manner that is not inconsistent with their state’s emergency preparedness or pandemic plan should append modifier “PO” to OPPS claims for services furnished at the relocated PBDs. This modifier indicates a service that is provided at an excepted off-campus PBD and is paid the OPPS payment rate. Hospitals that relocate excepted on- or off-campus PBDs to off-campus locations in response to the COVID-19 PHE should notify their CMS Regional Office by email of their hospital’s CCN; the address of the current PBD; the address(es) of the relocated PBD(s); the date which they began furnishing services at the new PBD(s); a brief justification for the relocation and the role of the relocation in the hospital’s response to COVID-19; and an attestation that the relocation is not inconsistent with their state’s emergency preparedness or pandemic plan.Hospitals should include in their justification for the relocation why the new PBD location (including instances where the relocation is to the patient’s home) is appropriate for furnishing covered outpatient items and services.
HOPDs that are provider-based APPROVED

5/8/2020
Outpatient and partial hospitalization BH services
Effective as of March 1, 2020, a temporary expansion location where the beneficiary may be located, including a beneficiary’s home, may be a provider-based department of the hospital, or may be a temporary extension of the CMHC. Therefore, the following types of services—to the extent they were already billable as PHP services in accordance with existing coding requirements prior to the COVID-19 PHE—can now be furnished to beneficiaries by facility staff using telecommunications technology during the COVID-19 PHE: (1) individual psychotherapy; (2) patient education; and (3) group psychotherapy. Because of the intensive nature of PHP, we expect PHP services to be furnished using telecommunications technology involving both audio and video. However, we recognize that in some cases beneficiaries might not have access to video communication technology. In order to maintain beneficiary access to PHP services, only in the case that both audio and video are not possible can the service be furnished exclusively with audio. To be clear, services that require drug administration cannot be furnished using telecommunications technology.
Outpatient and PHP BH providers APPROVED

5/8/2020
ACOs
CMS has modified Shared Savings Program policies to: (1) allow ACOs whose current agreement periods expire on December 31, 2020, the option to extend their existing agreement period by 1-year, and allow ACOs in the BASIC track’s glide path the option to elect to maintain their current level of participation for PY 2021; (2) clarify the applicability of the program’s extreme and uncontrollable circumstances policy to mitigate shared losses for the period of the COVID-19 PHE; (3) adjust program calculations to mitigate the impact of COVID-19 on ACOs; and (4) expand the definition of primary care services for purposes of determining beneficiary assignment to include telehealth codes for virtual check-ins, e-visits, and telephonic communication.
ACOs APPROVED

5/8/2020
Maintenance therapy services
CMS is permitting the PT or OT who established a maintenance program to delegate the performance of maintenance therapy services to a PTA or OTA when clinically appropriate.
Rehabilitation Therapy Providers APPROVED

3/31/2020
Documentation
CMs has announced a general policy that there is broad flexibility for all members of the medical team to add documentation in the medical record which is then reviewed and verified (signed) by the appropriate clinician. Any individual who has a separately enumerated benefit under Medicare law that authorizes them to furnish and bill for their professional services, whether or not they are acting in a teaching role, may review and verify (sign and date), rather than re-document, notes in the medical record made by physicians, residents, nurses, and students (including students in therapy or other clinical disciplines), or other members of the medical team.
All Providers APPROVED

3/31/2020
Applicability of NCD and LCD
CMS finalized on an interim basis that to the extent an NCD or LCD (including articles) would otherwise require a face-to-face or in-person encounter or other implied face-to-face services, those requirements would not apply during the PHE for the COVID-19 pandemic. Additionally, we finalized on an interim basis that we will not enforce the clinical indications for coverage across respiratory, home anticoagulation management and infusion pump NCDs and LCDs (including articles) allowing for flexibility for practitioners to care for their patients.
All Providers APPROVED

3/31/2020
CMS finalized on an interim basis that clinical indications for therapeutic continuous glucose monitors in LCDs will not be enforced. All Providers APPROVED

3/31/2020
Extension for Inpatient Prospective Payment System (IPPS) Wage Index Occupational Mix Survey Submission
CMS collects data every 3 years on the occupational mix of employees for each short-term, acute care hospital participating in the Medicare program. Completed 2019 Occupational Mix Surveys, Hospital Reporting Form CMS-10079, for the Wage Index Beginning FY 2022, are due to the Medicare Administrative Contractors (MACs) on the Excel hospital reporting form available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Wage-Index-Files.html by July 1, 2020. CMS is currently granting an extension for hospitals nationwide affected by COVID-19 until August 3, 2020. If hospitals encounter difficulty meeting this extended deadline date, hospitals should communicate their concerns to CMS via their MAC, and CMS may consider an additional extension if CMS determines it is warranted.
Hospitals APPROVED

3/30/2020
CMS has suspended Medicare FFS RAC, MAC and other audits All Medicare providers APPROVED

3/30/2020
Waive timely filing requirements for billing that will allow providers getting correct coding and other structural pieces built into their systems and even payer ability to adjudicate (42 U.S.C. § 1396a(a)(54), and 42 U.S.C. §§ 1395cc(a)(1)(57), & (w), 42 CFR§ 424.44)

Removing the 13-day payment “floor” before clean Medicare claims can be processed for payment, as this removal will help expedite cash flow for providers in this critical time

Trump Administration Provides Financial Relief for Medicare Providers

An informational fact sheet on the accelerated/advance payment process and how to submit a request
Medicare Providers APPROVED

Action Taken 3/28/2020
Medicare, Medicaid and Other Insurance APPROVED

Provided on various dates
QCDR
CMS amended the QCDR measure approval criteria previously finalized in the CY 2020 PFS final rule. Specifically: (1) completion of QCDR measure testing at § 414.1400(b)(3)(v)(C) and (2) collection of data on QCDR measures at § 414.1400(b)(3)(v)(D)
APPROVED
Serology Laboratory testing
CMS is amending several Medicare policies to cover FDA-authorized COVID-19 serology tests, to allow any healthcare professional authorized to do so under State law to order COVID-19 diagnostic laboratory tests (including serological and antibody tests), and to provide for new specimen collection fees for COVID-19 testing under the Physician Fee Schedule and Outpatient Prospective Payment System. Adding flexibility for NPs, CNSs, PAs, and CNMs, to the extent authorized under their State scope of practice.

CMS finalized that these FDA-authorized COVID-19 serology tests fall under the Medicare benefit category of diagnostic laboratory test.
APPROVED
Rehabilitation Therapy — Therapy Assistants Furnishing Maintenance Therapy (PFS)
We currently make payment under Medicare Part B for outpatient occupational and physical therapy (§§ 410.59(a) and 410.60(a), respectively) when they are furnished by an individual meeting qualifications in part 484 for an occupational therapist (OT) or physical therapist (PT), or an appropriately supervised occupational therapy assistant (OTA) or physical therapy assistant (PTA). This includes our policy for rehabilitative services for which improvement of the beneficiary’s functional status is expected. However, in cases where it is medically necessary.
APPROVED

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Department of Human Services/N.J. Division of Medical Assistance and Health Services

Submission DateWaiverApplies ToStatus
Presumptive eligibility for Aged, Blind Disabled applications APPROVED

4/27/2020
Temporary Adjustment to Allow Telehealth for Partial Care and Partial Hospitalization Services Partial Care and Partial Hospitalization - Mental Health APPROVED

4/16/2020
Reinstatement of Medicaid eligibility for those who were terminated March 31 and suspension of Medicaid redeterminations for the duration of the public health emergency All Providers; Medicaid Beneficiaries APPROVED

4/16/2020
3/20/2020 Long Term Care Hospitals – Permit Medicaid FFS and MCOs to pay for LTCH services Long Term Care Hospitals APPROVED

4/10/2020
Halt all Medicaid Audits by HMS, Permedion APPROVED

4/10/2020
Separately, DMAHS has also directed that long term acute care hospitals, which are either freestanding or a separately licensed hospital within a hospital, may be used for discharge during the emergency period. Long Term Care Hospitals APPROVED

4/10/2020
Medicaid RAC Audits - flexibilities granted on a case-by-case basis Medicaid providers APPROVED

4/3/2020
For the emergency period, health plans will suspend prior authorization (PA) requirements, concurrent utilization reviews for inpatient admissions, and prior authorization for placement in post-acute care settings.

Hospitals should coordinate closely with health plans on discharge planning to ensure coordinated care for the member, particularly for individuals who live alone in the community. In no way shall the discharge process be delayed by the health plan.

New prior authorizations may continue as follows and within expedited timely process guidelines:
Medicare providers APPROVED

4/2/2020
Current regulations require that when a new patient meets admission criteria and all beds are full in a short-term care facility (STCF) within a general acute care hospital, all current patients must be re-assessed for possible transfer to a different setting to allow for admission of the new patient. During the emergency period, IMD facilities, including specialty hospitals with available “diversion” beds, may be used to accept these transferred patients. Acute care services shall be provided until the patient is ready for discharge to the community, or until a bed becomes available in a State institution if the individual continues to remain on commitment status and requires long term inpatient treatment. IMDs with diversion beds APPROVED

4/2/2020
Permedion Audits for Utilization Review have been suspended Hospitals, IRFs, Psychiatric Hospitals APPROVED

4/1/2020
NJDMAHS/DOAS PACE Policy Guidance — MMandates PACE Center closure except for essential clinic and therapy services; suspends involuntary disenrollments; suspends NJ Choice reassessments for current enrollees; mandates daily report to DoAS of enrollees attending clinic PACE organizations APPROVED

3/26/2020
Blanket waiver for face to face and related requirements for FQHCs to allow for payment for telehealth/telephonic services PACE organizations APPROVED
3/19/2020 For Personal Care Assistance program (PCA), allow member of a beneficiary household or others with alternative professional qualifications to receive payment PENDING
Suspend E-ARC process PENDING
Temp modifications to 1115 waiver to allow:
  • Bed retention payments for NF when patients are hospitalized due to covid-19
  • Payment to family members for PCA services when ordinary sources are disrupted
  • More flexible eligibility requirements for LTSS
  • Increase limits on home delivered meals or other services
  • Allow additional providers to offer various services
  • Suspend/modify care management and level of care assessment requirements including use of telephone outreach
  • Flexibility around eligibility, services, payment rates for members of at-risk populations, including those in DD waiver program
PENDING
CHIP: suspend premiums and cost-sharing; maximize flexibility around eligibility requirements, processing and timelines PENDING
Flexibility in Medicaid eligibility determinations, redets, verification of eligibility criteria PENDING
FFS and managed care rate adjustments to address workforce challenges PENDING

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Department of Health

Submission DateWaiverApplies ToStatus
3/31/2020 Quarterly Financial Reporting and Cost Reports
NJHA respectfully requests that DOH suspend the quarterly financial reporting required of hospitals because this reporting requires significant time to compile data. In addition, as a result of the public health emergency, the financial condition of hospitals is in extreme flux

NJHA also respectfully requests a 90-day extension to the deadline for filing the State Hospital Acute Care Cost Report. This would include Chapter 160 reporting
APPROVED

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Department of Banking & Insurance

Submission DateWaiverApplies ToStatus
The Department of Banking and Insurance issued Bulletin 20-08 which modifies the Independent Health Care Appeals Program process and the related application form. For appeals related to the denial, limitation or delay of a covered treatment, prescription or service for reasons of medical necessity or experimental/investigative reasons must now be filed electronically.

Additionally, the Bulletin suspends the $25 filing fee and instructs carriers to alter their appeal notices to conform with the modifications noted in the Bulletin.

These changes were effective March and will continue for the duration of the declared state of emergency and public health emergency.

DOBI posted a Bulletin to its website today that I encourage you to take a moment and review. It addresses activities the carrier must take related to requirements established by P.L. 2020, c. 7 including:
  • Appropriate cost-sharing waivers;
  • In-plan exceptions;
  • Pre-authorization requirements;
  • Policy updates; and
  • Reimbursement requirements
APPROVED

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UnitedHealthCare

Submission DateWaiverApplies ToStatus
Prior Authorization: UnitedHealthcare is suspending prior authorization requirements to post-acute care settings and member transfers to a new provider through May 31. Details include:
  • Waiving prior authorization for admissions to: long-term care acute facilities, acute inpatient rehabilitation and skilled nursing facilities
  • Consistent with existing policy, the admitting provider must notify us within 48 hours of transfer and penalties still apply
  • Length of stay reviews still apply, including denials for days that exceed approved length
  • Discharges to home health will not require prior authorization
  • Prior authorization is not required for COVID-19 testing and COVID-19 testing related visits


UHC also is suspending review for site of service for the surgical codes listed here until April 30

Telehealth
Updated Provided — 3/31/2020

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CIGNA

Submission DateWaiverApplies ToStatus
Cigna will waive prior authorizations for the transfer of its non-COVID-19 customers from acute inpatient hospitals to in-network LTACHs. In place of prior authorizations, Cigna will require notification from the LTACH on the next business day following the transfer. This policy will remain in place through May 31, 2020 and applies to Cigna commercial and Medicare Advantage plans. Cigna has also waived prior authorizations for the transfer of its patients to other in-network subacute facilities, including skilled nursing facilities and acute rehab centers. Updated Provided — 3/31/2020

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AmeriHealth

Submission DateWaiverApplies ToStatus
Telehealth Updated Provided — 3/31/2020

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Aetna

Submission DateWaiverApplies ToStatus
Aetna will waive cost-sharing and co-pays for commercially insured patients for in-patient hospital admissions related to COVID-19

Telehealth

Prior Authorization

Aetna Better Health: it is their standard policy, provider and patient receiving services must be in state, no waiver of cost-sharing and it does note it will cover any service
Updated Provided — 3/31/2020

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Horizon

Submission DateWaiverApplies ToStatus
Horizon Announces CS Modifier Must Append Claims When Cost-Share Not Collected

Recently, it was announced that when filing claims for Horizon and Horizon NJ Health members, providers must append Modifier CS to procedure codes to indicate that a member’s cost share (i.e., copay, deductible or coinsurance) was not collected for services performed during the COVID-19 pandemic for both.

This requirement applies to services performed in-person, via telemedicine and phone services occurring during the COVID-19 public health emergency.
Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions

Horizon BCBSNJ continues to work with doctors and hospitals to help treat patients during this pandemic. We appreciate everyone’s dedication within the health care system. To help you continue to treat your patients, we are waiving certain administrative requirements for inpatient care at acute facilities, recognizing the diversion of staff needed to dedicate to the COVID-19 patients.

Horizon BCBSNJ has waived precertification/prior authorization requirements for inpatient admissions with date of admission on or prior to April 30, 2020, unless extended. These changes take effect immediately for all Horizon BCBSNJ members, including those covered through Medicaid, Medicare, fully insured and self-insured policies. These changes apply to all inpatient admissions at acute care facilities.

Effective immediately, for all inpatient admissions prior to or on April 30, 2020, Horizon BCBSNJ is waiving:
  • Precertification/prior authorization requirements
  • Admission reviews
  • Concurrent utilization reviews


Horizon BCBSNJ will continue to require notice of admissions for all hospital inpatient stays before claims are submitted. If you have a patient with a COVID-19 diagnosis, please report the diagnosis for tracking purposes for applicable inpatient stays.

Discharging patients
The discharging process will remain the same to ensure that patients are safely and appropriately discharged. Please continue to submit authorizations requests for any discharge needs and provide notification of discharge date to ensure timely claims payment.

If you are experiencing any difficulties when discharging a COVID-19 patient, please notify us immediately for assistance.

These changes are effective until April 30, 2020, subject to extension by Horizon BCBSNJ as the COVID-19 pandemic evolves.



Telehealth
Extended Until 5/31/2020

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Clover Health

Submission DateWaiverApplies ToStatus
4/1/2020 Clover Health posted an updated list of policies that have been modified in light of the COVID-19 outbreak. The modifications include:
Updated Provided — 3/31/2020

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