CMS waivers during COVID-19

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CMS waivers during COVID-19
COVID-19 massively affected US health care. The
American Hospital Association estimates that
American hospitals incurred more than 202
billion in losses between March 1st and June
30th. Medical billing also affected due to
COVID-19.   According to healthcare lawyer
Delphine ORourke, clinical documentation is
critical to serving patients with COVID-19 but
also avoiding medical billing and payment issues
in the months and years following the pandemic.
This is advice to all providers to thoroughly
document care delivery to avoid medical
billing issues due to arise from the COVID-19
pandemic.   Theres a lot of confusion over what
the blanket waivers cover versus what happens
under specific waivers versus what governors are
stating. We find in emergencies, that for months
and years afterward, you are dealing with payment
and insurance issues, said Delphine ORourke,
partner at Duane Morris and former associate
general counsel for Ascension. The Trump
administration declared a national emergency.
Trump administration granted HHS the authority to
waive some Medicare, Medicaid, and CHIP policies
and allow states to provide flexibility for
providers. Providers managed to attempt this
pandemic situation with these flexibilities with
a finite amount of resources.
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CMS waivers during COVID-19

• 1135 Waivers
• As the President declared a disaster or emergency
  under the Stafford Act or National Emergencies
  Act and the HHS Secretary declares a public
  health emergency under Section 319 of the Public
  Health Service Act, the Secretary is authorized
  to take certain actions in addition to her
  regular authorities.
• 1135 waivers or modifications include
• Conditions of participation or other
  certification requirements
• Program participation and similar requirements
• Preapproval requirements
• Requirements that physicians and other health
  care professionals be licensed in the State in
  which they are providing services, so long as
  they have equivalent licensing in another State
• Emergency Medical Treatment and Labor Act
  (EMTALA)
• Stark self-referral sanctions
• Performance deadlines and timetables may be
  adjusted (but not waived)
• Limitations on payment for health care items and
  services furnished to Medicare Advantage
  enrollees by non-network providers

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CMS waivers during COVID-19
According to CMS, the Emergency Preparedness
Requirements for Medicare and Medicaid
Participating Providers and Suppliers regulation
applicable to all 17 provider types, also
requires inpatient providers to have policies and
procedures that address the facilitys role under
an 1135 waiver. See the final rule for more
information or contact your Regional
Offices. With the surge of COVID-19 patients,
providers are trying to prepare and figure out
how theyre going to care for these patients
within existing regulations. Limitation on
hospitals is a major challenge for critical
access hospitals trying to fight with the
pandemic. HHS relaxes that rule with a blanket
waiver. This rule allowed critical access
hospitals to increase capacity and get paid for
it. There are different kinds of 1135 waivers,
including Medicare blanket waivers. When theres
an emergency, sections 1135 or 1812(f) of the SSA
allow us to issue blanket waivers to help
beneficiaries access care.  When a blanket waiver
is issued, providers dont have to apply for an
individual 1135 waiver.
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CMS waivers during COVID-19
1135 blanket waivers According to CMS 1135
blanket waivers, if youre an entity in the
declared emergency area, you can apply for an
1135 waiver. Youll usually hear back from us
within 2-3 days, but if your request is more
complicated, it may take up to a week. If your
waiver request has 1 or 2 items, we may get back
to you within 24 hours. Once approved, waivers
have a retroactive effective date of March 1,
2020, and will end no later than when the
emergency declarations ended. Waivers dont
offer grants or financial assistance. They also
dont allow you to be paid for services that
arent usually covered or for people to be
eligible for Medicare who arent otherwise
eligible. You also shouldnt base your response
decisions, like evacuations, on waivers. Once
your waivers approved, as always to be
reimbursed accurately, be sure to keep careful
records about the services you provide and the
beneficiaries you provide them to. These blanket
waivers will apply to all providers
automatically. These waivers will help providers
to provide effective and quick treatment of
patients with COVID-19.