Hospitals & Health Systems

Updated Thursday, April 2, 2020

CMS 1135 waivers allow the U.S. Dep’t of Health and Human Services Secretary to temporarily waive or modify certain Medicare, Medicaid, Children’s Health Insurance Policy (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure that sufficient health care items and services are available to meet needs during a declared public health emergency.  Individual health care providers and associations may trigger additional waivers through feedback and requests to the Assistant Secretary for Preparedness and Response or CMS Regional Offices.
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Updated Thursday, April 2, 2020

CMS 1135 waivers allow the U.S. Dep’t of Health and Human Services Secretary to temporarily waive or modify certain Medicare, Medicaid, Children’s Health Insurance Policy (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure that sufficient health care items and services are available to meet needs during a declared public health emergency.  Individual health care providers and associations may trigger additional waivers through feedback and requests to the Assistant Secretary for Preparedness and Response or CMS Regional Offices.
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On March 24, 2020, the Wisconsin Department of Health Services (DHS) prepared correspondence to the Center for Medicare and Medicaid Services (CMS) seeking waivers of certain Medicaid requirements pursuant to Section 1135 of the Social Security Act (42 U.S.C. § 1320b-5) due to the COVID-19 pandemic. The correspondence to CMS was shared on March 24, 2020 with the Wisconsin Legislature Joint Committee on Finance seeking their approval to submit the Section 1135 Waiver to CMS. The letter to CMS prepared by DHS states that Wisconsin is implementing all the blanket waivers issued by CMS on March 13, 2020 in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), to the extent applicable.
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Hallway in a hospitalOn Friday, 3/13/20, CMS issued blanket 1135 waivers that impact acute care hospitals as a result of President Trump’s declaration of a state of an emergency due to COVID-19. The blanket waivers temporarily allow acute care hospitals to relocate acute care inpatients to their excluded distinct part units (DPUs), and patients from the DPUs to the acute care hospital to respond to the COVID-19 emergency. In addition, to these CMS blanket waivers, on 3/13/20, the Texas Hospital Association (THA) requested additional waivers from CMS and the Texas Health and Humans Services Commission (HHSC) from other federal and state requirements. EMTALA has also issued guidance on setting up alternative screening sites to respond to the COVID-19 emergency. Further, HHSC has issued guidance on what visitors are allowed in the hospital.
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On March 17, 2020, the Department of Health and Human Services, Office of Civil Rights (OCR) issued guidance related to how Covered Entities can comply with HIPAA and the Privacy Rule and still disclose protected health information (PHI) about individuals infected with or exposed to COVID-19 to law enforcement, paramedics, other first responders, and public health authorities (Essential Providers).
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Representatives of the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) are reaching out to speak with hundreds of hospital officials nationwide to provide feedback to HHS and to Congress about the most difficult challenges that hospitals are currently facing in responding to COVID-19.  The OIG emphasizes that

Texas Comptroller Glenn Hegar announced last week that he will delay the implementation of a sales tax on medical billing services until the Texas Legislature considers the proposed change when it meets in a regular session in 2021. The Comptroller’s staff will work with industry leaders leading up to the 140-day session in order to develop language that could amend the state’s sales tax statutes. The regular session of the Texas Legislature is scheduled to begin January 12, 2021, and end June 1, 2021.

Our prior article discussed the Texas Comptroller’s policy change in the fourth quarter of 2019, which would have rendered medical billing services subject to Texas sales tax, after longstanding reliance on rulings which exempted such services.
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On Friday, March 13, 2020, CMS issued blanket waivers under 42 U.S.C. 1320b-5 that impact long term acute care hospitals (LTCHs) and inpatient rehabilitation facilities (IRFs) as a result of President Trump declaring a state of an emergency due to COVID-19. The blanket waivers temporarily allow facilities operating inpatient rehabilitation units to exclude patients admitted

Centers for Medicare and Medicaid Services (CMS) has issued broad waivers to assist in the national COVID-19 response. They impact all provider types and generally remove regulatory burdens that could restrict access to care. For example, the waivers remove bed limits on Critical Access Hospitals and will allow Long Term Hospitals to exclude from the 25 ALOS calculation patients who were admitted or discharged to “meet the demands of the emergency.” Restriction on the separation of patients in excluded units in IPPS hospitals are waived. The requirement for three days of hospitalization to receive skilled nursing coverage is also waived. There are a number of other waivers.

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As the novel coronavirus outbreak continues, the federal government and commercial health insurers have taken significant steps to increase Americans’ access to treatment and testing. In the past week, the federal government and private insurers have issued a number of guidance documents expanding coverage and payment requirements in an effort to minimize the spread of the virus. As with any changes in coverage and reimbursement, healthcare providers offering telehealth services should carefully review these changes and take steps to ensure that all regulatory and coverage requirements are met prior to submitting claims for reimbursement.

I. Medicare

On March 6, 2020, the bipartisan Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (“Coronavirus Appropriations Act”) was signed into law authorizing federal spending to combat the ongoing coronavirus outbreak in the United States. This Act, among other things, gives the United States Department of Health and Human Services’ (“HHS”) secretary the authority to temporarily waive certain Medicare requirements for telehealth services.

The Centers for Medicare and Medicaid Services (“CMS”) currently reimburses a limited set of telehealth services provided to Medicare beneficiaries subject to certain criteria under section 1834(m) of the Social Security Act. Generally, the patient receiving telehealth services must be located at one of eight “originating sites”, which include hospitals, physicians’ offices, and rural health clinics. In addition, the originating site must meet certain geographic requirements which have essentially limited the availability of telehealth to patients in rural areas. These requirements have long posed a hurdle to the expansion of telehealth despite the industry’s demand for lessened restrictions. However, with the rapid spread of the coronavirus and the possibility of facing large scale isolations and quarantines, lawmakers have signaled their willingness to expand access to telehealth to fight against this public health crisis.

Within the Coronavirus Appropriations Act is the Telehealth Services During Certain Emergency Periods Act of 2020, which sets forth the waiver authority for the secretary of HHS regarding the certain telehealth requirements. Under the Telehealth Services During Emergency Periods Act, the secretary is authorized to temporarily waive the originating site and geographic requirements for telehealth services provided to Medicare beneficiaries located in an identified “emergency area” during an “emergency period” when provided by a qualified provider. To qualify for the waiver, the provider must have treated the patient within the previous three years or be in the same practice (i.e., as determined by tax identification number) of a practitioner who has treated the patient in the past three years. The bill also lessens the telecommunications requirements by allowing Medicare beneficiaries to receive telehealth services via their smartphones (i.e., telephones that allow for real time, audio-video interaction between the provider and the beneficiary). Because the federal government has declared a nationwide public health emergency as a result of the coronavirus, the waiver will apply across the country until there is no longer a nationwide public health emergency.
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