CMS Suspends Restrictions on Care Venues as Providers Tackle COVID-19 Surges

The sweeping "Hospitals Without Walls" initiative take effect immediately and allows hospitals to bill Medicare for services in unconventional settings.

The Trump Administration has suspended regulatory barriers and will now allow hospitals to clear precious bed capacity by triaging non-COVID-19 patients in thousands of ambulatory surgery centers, rehab hospitals, and even hotels and college dorms.

The sweeping "Hospitals Without Walls" initiative takes effect immediately, will last through the duration of the pandemic, and allows hospitals to bill Medicare and other government payers for providing these services in unconventional settings, the Centers for Medicare & Medicaid Services announced Monday.

"Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible," CMS Administrator Seema Verma said.

"This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly," she said.   

Martie Ross, managing principal of Knoxville, Tenn.-based PYA, says the guidance is meant to give providers wide latitude to manage through the COVID outbreak.

“They have really stripped out a lot of regulatory requirements applicable simply to relieve as much administrative burden as possible,” Ross says. “CMS goes a step further to expand the definition of a hospital. They're really trying to enable hospitals to use other facilities as are appropriate.”

Verma said the temporary waivers will give local health systems and hospitals the option of tapping into community-based healthcare venues and provide greater flexibility to respond to the COVID-19 pandemic as they see fit.

For example, the waiver allows health systems to bill government payers for home-based, or drive-through COVID-19 testing in order to limit exposure for both patients and providers, and to ease the strained supply of personal protective equipment.

The telehealth provisions allow for providers to get reimbursement for services that had been previously blocked, including those that involve simple phone calls between provider and patient, Ross says.

“It's not technically tele-health reimbursement,” Ross says. “They just turned on the telephonic evaluation of management codes. CMS had been staunchly refusing to do now for the last five years.”

Last week, America’s Health Insurance Plans said commercial plans would match CMS's waivers for Medicare beneficiaries in areas where in-patient capacity is under strain.

An Array Analytics study released Wednesday found that health systems across the country could boost ICU hospital bed capacity by 21% if ASCs were utilized, and that leveraging ASCs would boost medical-surgical bed capacity by 8% nationwide.

Under the waiver, ASCs could contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they follow their state’s emergency pandemic preparedness plan.

The waiver also allows ASCs and other care venues to administer services usually provided by hospitals such as cancer procedures, and trauma and other essential surgeries.   

The Ambulatory Surgical Care Association, the lobbying arm for more than 5,800 ASCs across the nation, said Monday that it is still reviewing the waiver. However last week, ASCA CEO Bill Prentice said "our best suggestion would be to keep those patients out of the hospital that is dealing with a pandemic and shift that care to places like ambulatory surgery centers."

"We could be the outflow for necessary surgery that's still going to happen over the next few months," Prentice told HealthLeaders. "Hernias are still going to become strangulated. People are still going to tear their ACLs. People are going to be uncontrollable pain use. Let's use surgery centers as a an off-campus site for that work to do so the hospitals can focus on dealing with a pandemic."

CMS is also suspending Stark Law barriers that it hopes will encourage hospitals to hire local physicians and other clinicians to address pandemic surges, which the American Hospital Association had requested last week.

Suspending the rules will allow hospitals to support physician practices by transferring medical equipment, including items used for telehealth, and providing meals and childcare for healthcare workers, CMS said.

HealthLeaders' Jim Molpus contributed to this report.