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CMS Adopts Greater Regulatory Flexibility Amid COVID-19 Outbreak 

by Seema Kanwar, Justin Hickerson

Published: March, 2020

Submission: March, 2020


On March 30th, the Centers for Medicare and Medicaid Services (CMS) announced a number of regulatory reforms aimed at giving healthcare providers more tools to combat COVID-19. In addition to approving hundreds of waiver requests from state governments and healthcare providers, CMS temporarily adopted the following policies:

Expansion of Sites of Service

  • Ambulatory surgery centers (ASCs) may contract with local healthcare systems to provide hospital services or may directly enroll and bill as hospitals, provided such action is not inconsistent with their state’s emergency preparedness plan (or equivalent).
  • Non-hospital buildings and other locations may serve as patient care and quarantine sites if the location is approved by the state and protects patient safety and comfort. Hospitals are still expected to control and oversee the services provided at these locations.
  • Hospitals, laboratories, and other providers may perform COVID-19 tests at a patient’s home or at other locations outside of the hospital.
  • Hospital emergency departments may perform COVID-19 tests and screenings at drive-through and off-campus locations, such as hotels, and may provide telehealth services. Screenings at alternate treatment and testing sites are not subject to the Emergency Medical Labor and Treatment Act (EMTALA).
  • Physician-owned hospitals may temporarily increase the number of licensed beds, operating rooms, and procedure rooms at their facilities, including the conversion of observation beds to inpatient beds.
  • Ambulances may now transport patients to community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers, and any locations furnishing dialysis services when an end-stage renal disease (ESRD) facility is not available.

Increase the Number and Role of Providers

  • If permitted under state law, physician assistants and nurse practitioners may now order tests and medications that would typically require a physician’s order.
  • Residents have greater flexibility to provide services under the direction of a teaching physician, and the teaching physician may provide supervision through audio/video communication technology.
  • Hospital physicians may use verbal orders in a wider number of cases.
  • The requirement that home health and hospice providers conduct an onsite visit every two weeks has been waived.
  • Certified registered nurse anesthetists (CRNAs) may practice without the supervision of a physician.
  • Hospitals may provide benefits and support to medical staff. For example, a hospital may provide multiple daily meals, laundry service for personal clothing, and child care services.
  • Providers may temporarily enroll in Medicare.


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