Request is to invoke emergency powers to issue an 1135 disaster and emergency waiver of certain regulations.

As updates on the COVID-19 pandemic change day by day, and the number of cases in the U.S. climbs, hospitals are starting to see the effects. In Seattle, it has been reported that there are patients in 10 nursing homes that are infected with COVID-19, leading to speculation that the number of patients requiring hospital care and possibly intensive care will increase.

There are also reports from Italy that the healthcare system is getting overwhelmed, accompanied by shortages of critical care beds and ventilators.

In response to this pandemic, the American Hospital Association (AHA) has asked President Trump and the U.S. Department of Health and Human Services (HHS) to invoke their emergency powers to issue an 1135 disaster and emergency waiver of certain regulations. The AHA has asked for three specific items: first, a waiver of the requirement for a three-day inpatient admission for a Medicare beneficiary to gain access to Part A skilled nursing facility (SNF) benefits. This will allow offloading of hospitalized patients who can be safely cared for in a SNF, where they can receive skilled medical care under the direction of licensed practitioners, including intravenous therapy, nebulizers, and other complex care.

The AHA also has requested the waiver of the 25-inpatient bed limit for critical access hospitals (CAHs), along with waiver of the 96-hour average length of stay (LOS). Many health systems own or affiliate with CAHs in locations that do not have the density of major cities, and the ability to use these beds for less seriously ill patients could also alleviate potential bed shortages in urban areas.

Finally, the AHA has requested that physicians and other licensed practitioners be able to practice in states in which they are not licensed. Healthcare workers are not immune to infection, even with optimal use of personal protective equipment, since patients may be asymptomatic at the onset of illness. If healthcare workers are exposed and must self-isolate for 14 days, a shortage of physicians would have devastating consequences. Allowing national organizations to redeploy practitioners across state borders would be critical if this disease spreads.

The Centers for Medicare & Medicaid Services (CMS) has been keeping the provider community up to date with multiple press releases per day, and it is hoped that they will quickly respond to this request. The parameters of such waivers are unknown, if they are indeed approved, so it would be premature to start transferring patients to SNFs or to CAHs.

This is a developing story. RACmonitor will continue to report on the coronavirus.

Programming Note: Listen to Dr. Hirsch’s live reporting every Monday on Monitor Mondays, 10-10:30 a.m. EST.


Ronald Hirsch, MD, FACP, CHCQM, CHRI

Ronald Hirsch, MD, is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays. The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).

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