New CMS ‘flexibilities’ aim to expand hospital capacity

By John Commins (

The federal government last Wednesday unveiled “flexibilities” that include allowances for providing hospital care in patients’ homes and waiving some staffing requirements at ambulatory surgery centers as part of an effort to expand hospital capacity during the coronavirus pandemic.

“We’re at a new level of crisis response with COVID-19,” Centers for Medicare & Medicaid Services Administrator Seema Verma said.

“CMS is leveraging the latest innovations and technology to help healthcare systems that are facing significant challenges to increase their capacity to make sure patients get the care they need.” she said.

Six health systems have been approved for the new waivers and include Brigham and Women’s Hospital; Huntsman Cancer Institute; Massachusetts General Hospital; Mount Sinai Health System; Presbyterian Healthcare Services; and UnityPoint Health. CMS expects new applications to be submitted.

“With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond,” Verma said.

Patients will make the final decision about their care venue, but Verma said the initiative allows patients to stay at home with family without COVID-mandated visitation restrictions in hospitals.

The new allowances build on the March 2020 Hospitals Without Walls program that provides broad regulatory flexibility for hospitals to provide services in non-traditional care venues.

CMS identified more than 60 acute conditions, such as asthma, congestive heart failure, pneumonia, and chronic obstructive pulmonary disease, that can be treated and monitored safely in patients’ homes.

Hospitals adopting the allowances must have screening protocols in place before care at home begins to assess both medical and non-medical factors, including working utilities, assessment of physical barriers and screenings for domestic violence concerns.

Medicare enrollees will only be admitted from emergency departments and inpatient hospital beds, and an in-person physician evaluation is required before starting home care.

In addition, a registered nurse must evaluate each patient once a day either in person or remotely, and two in-person visits must take place every day, by either registered nurses or paramedics, based on the patient’s nursing plan and hospital policies.

ASC Flexibility

CMS is also updating its previously announced regulatory flexibility for ASCs during the Public Health Emergency, which will allow them to provide inpatient hospital care for longer periods than the 24-hour period normally allowed.

With the update, ASCs need only provide 24-hour nursing services when there is actually one or more patient receiving care onsite, which allows ASCs to “flex up” staffing as needed to provide a relief valve for overwhelmed hospitals while not mandating nurses be present when no patients are in the ASC.

The flexibility is available to any of the 5,732 ASCs in the United States and will be immediately effective for the 85 ASCs now participating in the Hospital Without Walls initiative.

CMS said the flexibility will allow ASCs enrolled as hospitals to serve as another access point for surgical capacity and other emergent non-COVID-19 procedures, such as cancer surgeries.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Found in Categories: 
CMS, COVID-19, Emergency Management