New Blanket Waivers for Health Care Providers Include Waivers for Physician Visits and Delegation of Tasks in SNFs

The Centers for Medicare & Medicaid Services (CMS) recently issued new waivers for providers in response to COVID-19 . Below are some key waivers for the Skilled Nursing Facilities/Nursing Facilities (SNFs/NFs) setting:

• Physician Visits in SNFs/NFs: 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.
• 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. CMS is 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. It is modifying this provision to permit physicians to delegate any required physician visit to a nurse practitioner (NP), 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
• 3-Day Prior Hospitalization: Using the authority under section 1812(f) of the act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).

Click here for a full list of waivers.