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Waivers for SNFs

Published on April 26th, 2020

Related to the emergency declaration issued by Trump on March 13 under the Stafford Act, CMS has been exercising authority to grant federal blanket waivers to certain safety requirements for corporate owners and providers. A new round of waivers issued on April 9 grants nursing homes certain “flexibilities” around physician services. These changes are outlined below.  For more information on all waivers granted, refer to the CMS Fact Sheet, updated as new waivers are granted. LeadingAge has also developed charts for nursing homes, hospice, and home health providers that detail the results of our advocacy efforts around 1135 blanket waivers.

As a result of the newest round of waivers, physician tasks in nursing homes may now be delegated to physician assistants, nurse practitioners, or clinical nurse specialists, except in cases prohibited by state law or by the facility’s own policy. This waiver includes the requirement for physician visits and complements previous waivers allowing for the use of telehealth options in lieu of in-person visits as appropriate.

CMS notes that the following requirements are not changed by this waiver:

  • Frequency of visits – This waiver does not change the frequency of required physician visits. The nursing home must continue to ensure that residents are seen, either in-person or via telehealth options as appropriate, by a physician or the appropriate delegate, every 30 days during the first 90 days following admission and at least once every 60 days thereafter.
  • Physician supervision – This waiver does not change the requirement for physician supervision. The nursing home must continue to ensure that the medical care of each resident is supervised by a physician.
  • Physician availability – This waiver does not change the requirement for 24-hour availability of physician services. A nursing home must continue to provide or arrange for the provision of physician services 24 hours per day in case of emergency.

The above waiver regarding physician services joins a growing list of waivers currently enacted, including waivers of nursing home requirements related to the 3-day Medicare qualifying stay, MDS reporting, payroll-based journal (PBJ) submissions, Pre-Admission Screening and Resident Review (PASRR), physical environment, resident groups, training and certification of nurse aides, resident roommates, and transfer and discharge. Federal blanket waivers affect all nursing home providers and do not require additional notification to or permission from CMS. Waivers remain in effect through the end of the emergency declaration or 60 days from the date the waiver is published. Additional waivers may be requested of the CMS Regional Office by states or providers.

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