Blog, News

Medicare Fee-For-Service Response to COVID-19

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Mary Devine Senior Director of Revenue Cycle

This blog post is based on information released in MLN SE20011

In light of COVID-19 and its expected demands on hospitals, the Secretary of the Department of Health & Human Services (Alex Azar) declared a public health emergency for the United States on January 31, 2020.  Soon after that, on March 13, Secretary Azar authorized waivers and modifications to Section 1135 of the Social Security Act.  The waivers and modifications are retroactive back to March 1st.

Section 1135 of the Social Security Act (1135-Waiver) allows the Secretary of HHS to take certain actions once a public health emergency is declared. The Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that healthcare is available to meet the needs of Medicare, Medicaid and CHIP participants. It also helps to protect reimbursement for the providers who provide the healthcare.

Some examples of these waivers include:

  • Conditions of participation or other certification requirements
  • Program participation and similar requirements
  • Preapproval requirements
  • Licensing requirements for providers and the States they practice in
  • EMTALA waivers, providing the actions are not based on the ability of the patient to pay
  • Medicare enrollees to use out-of-network providers in an emergency situation
  • SNF coverage with absence of a qualifying stay

In past emergencies, providers were required to submit a request for a waiver. Requests for specific waivers typically include the justification and duration needed for the waiver.

There is also a “blanket” waiver which eliminates the need for providers to submit for individual waivers. Secretary Azar has approved a blanket waiver and modifications. It is recommended that providers still inform CMS about waivers they need, but it is not required.

This waiver and modifications for COVID-19 allow for:

  • SNFS
    • Waives the 3-day requirement and exhausted benefit coverage
    • Timeframe requirements on the minimum data set assessments (MDS)
  • HHAs
    • Timeframes for OASIS recertification requirements
    • MACS can extend the time of autocanceling of RAPS (request for anticipated payment)
  • Acute care providers can house acute patients in excluded distinct parts as needed based on demand
  • Excluded Inpatient Psychiatric Unit Patients can be cared for in the Acute Care Unit of a Hospital
  • Excluded Inpatient Rehabilitation Unit Patients can be cared for in the Acute Care Unit of a Hospital
  • Care for Patients in Long-Term Care Acute Hospitals (LTCH)s does not have to meet the 25-day expected length of stay based on needs
  • Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) that are lost, damaged or unavailable can be replaced with the flexibility of waiving replacements requirements

All of these waivers and modifications were put in place to assist providers in caring for a higher volume of patients and to protect provider reimbursement.

All billing regulations and requirements are still in force to ensure proper reimbursement of the care provided. The above waivers and modifications ensure you as a provider have the ability to care for patients during this public health emergency.

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