Through sections 1135 and 1812(f) of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) along with state Medicaid plans can take proactive steps to reduce healthcare providers’ regulatory burden during public health emergencies. CMS and the Kentucky Cabinet for Health and Family Services have used this ability to temporarily waive or change numerous regulatory requirements for hospitals, long term care facilities and many other healthcare providers.
Dean Dorton has compiled a list of changes applicable to hospitals under these programs:
CMS 1135 – Federal Changes
| Hospital Service Impacted | Change |
|---|---|
| QAPI | Wavies the requirement that hospitals provide details on the scope, incorporation and setting priorities of the QAPI program. CMS still expects hospitals to maintain an effective, ongoing, hospital-wide and data-driven QAPI program. |
| Nursing Services | Waives the requirement to keep a current nursing plan for each patient and the requirement that hospitals have policies and procedures which establish which outpatient departments are not required to have registered nurses present. |
| Food/Dietetic Services | Waives the requirement to have a current therapeutic diet manual approved by the dietitian and medical staff readily available to all medical, nursing and food service personnel at surge capacity sites. |
| Respiratory Care Services | Waives the requirement that hospitals designate in writing the personnel qualified to perform specific respiratory care procedures and the amount of supervision required. |
Other Provider Types – Approved Changes
| Facilities Impacted | Change |
|---|---|
| SNFs | Waives Requirement for Qualifying 3-Day Stays |
| SNFs | Certain beneficiaries with Part A stays exhausted will have coverage extended |
| CAHs | Waiving 25 bed limit and 96 hour LOS average |
| CAHs | Personnel Qualifications. Waives minimum qualifications for NPs, PAs and clinical nurse specialists to provide maximum staffing flexibility. |
| CAHs | Staff Licensure. Deferring to state law regarding staff licensure, certification, or registration. Provides maximum flexibilty to facilities to use all available clinicans. |
| DPUs | Acute care inpatients can be housed in appropriate beds in Distinct Part Units |
| DMEs | Waives certain requirements for replacement/repair coverage, namely: face-to-face requirement, new physician order, and new medical necessity documentation Note: Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and that DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency |
| LTCHs | LTCHs may exclude patients treated in LTCH setting to meet the demands of the emergency from the 25-day ALSO requirement. |
| HHAs | Provides relief on timeframes related to OASIS transmission. Allows MACs to extend the auto-cancellation date of RAPs during emergencies. |
| Provider Locations | Temporarily waive requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state. Applies to Medicare and Medicaid |
| Provider Enrollment | – Establish a toll-free hotline for non-certified Part B suppliers to enroll and receive temporary Medicare billing privileges – Waives application fees, CBCs associated with FCBC, site visits – Postpone revalidation efforts – Allow licensed providers to render services outside of their state of enrollment – Expedite any pending or new applications from providers |
| Medicare Appeals | – Extension to file an appeal – Waive timeliness for requests for additional info to adjudicate appeal – Other changes |
Kentucky 1135 Waiver – Approved Changes
| All | Medicaid Fee-For-Serivce Prior Authorization requirements temporarily suspended. |
|---|---|
| Long Term Care | Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and II Assessments for 30 days. |
| All | Temporarily delays schedules of Medicaid fair hearings. Also allows a mechanism for patients covered by an MCO to effectively bypass the MCO’s appeals process and move immediately to a state fair hearing. |
| Provider Enrollment | – KY may rely upon the screening of Medicare or other State Medicaid Agencies to provide temporary enrollment to providers enrolled with another SMA or Medicare. – KY may reimburse out of state providers not enrolled in KY Medicaid, given certain criteria. – KY may temporarily enroll providers for the duration of the public health emergency without:
Note: these temporarily enrolled providers must meet other minimum requirements for reimbursement. |
| Long Term Care/ICFs/IDDs | Allows facilities to be fully reimbursed for services rendered to an unlicensed facility (during an emergnecy evacuation or due to other need to relocate residents where the placing facility continues to render services) provided that the State makes a reasonable assessment that the facility meets minimum standards, consistent with the context of the public health emergency. The placing facility would be responsible for reimbursing the unlicensed facility. |
| Duration of Waivers | Effective from March 1, 2020 through the termination of the public health emergency. Some appeals and claim processing items have time periods longer than this. |
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