Last month, the Centers for Medicare & Medicaid Services (CMS) announced its intention to end certain blanket waivers associated with the COVID-19 emergency declaration. Specifically, several waivers impacting skilled nursing facilities will end on May 7 and an additional series of waivers will end June 5. CMS notes that it is concerned that continuing to waive certain requirements may negatively impact resident care. They have therefore chosen to terminate these waivers in advance of the termination of the public health emergency. Seven waivers expire on May 7, including three waivers that may most significantly impact PM&R. These waivers expanded the physician’s ability to delegate in the SNF setting and allowed flexibility regarding use of telehealth.
Physician Delegation of Tasks in SNFs - 42 CFR §483.30(e)(4)
CMS waived the requirement that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally. This waiver gave physicians the ability to delegate any tasks to a physician assistant, nurse practitioner, or clinical nurse specialist, but specified that any task delegated under this waiver must continue to be under the supervision of the physician.
Physician Visits - 42 CFR §483.30(c)(3)
CMS waived the requirement that all required physician visits (not already exempted in §483.30(c)(4) and (f)) must be made by the physician personally. The waiver modified this provision to permit physicians to delegate any required physician visit to a nurse practitioner, 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.
Physician Visits in Skilled Nursing Facilities/Nursing Facilities - 42 CFR §483.30
CMS waived the requirement 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.
CMS has chosen to keep many additional waivers in place. Three significant waivers that impact PM&R, relate to increased flexibilities around the 3-day rule in the SNF and the 60 percent and 3-hour rules in the IRF. Per the CMS website:
3-Day Prior Hospitalization Rule
CMS has waived the requirement for a 3-day prior hospitalization for coverage of a SNF stay for those who experience dislocations or are otherwise affected by COVID-19.
60 Percent Rule
CMS allows that patients admitted to the IRF solely to respond to the emergency (as documented in the patient record) will not count towards calculation of thresholds associated with the 60 percent rule.
3-Hour Rule
CMS has waived that payment be contingent upon patients of an inpatient rehabilitation facility receiving at least 15 hours of therapy per week.
These waivers are anticipated to remain in place through the duration of the public health emergency, which is set to end on July 15 if it is not extended further. AAPM&R continues to monitor messaging from CMS and the Department of Health and Human Services regarding policy changes tied to the public health emergency. Members with specific waiver questions can contact the Academy at healthpolicy@aapmr.org.