CMS Set to End Key Nursing Home COVID-19 Waivers for Physician Visits and Telehealth

April 8, 2022
Policy Snapshot

The Centers for Medicare & Medicaid Services (CMS) announced guidance last week that restores certain minimum standards for compliance with CMS requirements. Restoring these standards will be accomplished by phasing out some temporary emergency declaration waivers that have been in effect throughout the COVID-19 public health emergency (PHE). These temporary emergency waivers were designed to provide facilities with the flexibility needed to respond to the COVID-19 pandemic.

Several key waivers will expire on May 7, 2022 (30 days after the publication of the memo). These include:

  • Physician Delegation of Tasks in SNFs - 42 CFR §483.30(e)(4): CMS waived the requirement that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally. This waiver gave physicians the ability to delegate any tasks to a physician assistant, nurse practitioner, or clinical nurse specialist, but specified that any task delegated under this waiver must continue to be under the supervision of the physician.
  • Physician Visits - 42 CFR §483.30(c)(3): CMS waived the requirement that all required physician visits (not already exempted in §483.30(c)(4) and (f)) must be made by the physician personally. The waiver modified this provision to permit physicians to delegate any required physician visit to a nurse practitioner, physician assistant, or clinical nurse specialist who is not an employee of the facility, who is working in collaboration with a physician, and who is licensed by the state and performing within the state’s scope-of-practice laws.
  • Physician Visits in Skilled Nursing Facilities/Nursing Facilities - 42 CFR §483.30: CMS waived the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options

It is unclear whether the expiration of this waiver means that all other medically necessary visits can be done via telehealth without limitation. On March 30, 2020, CMS issued a memo stating that subsequent care codes (99307-99310) can be billed without the limitation that was in place. As a reminder, in November 2021 CMS finalized a policy that without a waiver, CMS limits the use of these codes via telehealth to once every 14 days. AMDA is seeking clarification from CMS on this issue.

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