- In response to the COVID-19 pandemic, CMS late Thursday announced relaxation of a variety of guidelines regulating the way, physicians, nurse practitioners and occupational therapists can do their jobs, expanding earlier easing to let clinicians practice at the top of their licenses and across state lines, including for telehealth.
- The relaxation is aimed at assisting rural hospitals, skilled nursing facilities and hospice, which are considered to be particularly vulnerable during the outbreak. Other providers expected to benefit include critical access hospitals, rural health clinics, federally qualified health centers and home health agencies.
- The rule changes go into effect immediately and in many cases are retroactive to early March. It's the second wave of major rules relaxations CMS has issued in the past 10 days.
CMS took the unprecedented step late last month of relaxing a variety of sacrosanct regulations, including allowing physicians to practice telemedicine across state lines without licensure. Now, it has followed up with a second wave of relaxing rules. It comes amid a crush of patients into hot spots like New York and New Jersey fighting the coronavirus, with waves expected to spread geographically in coming weeks.
"All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic," CMS Administrator Seema Verma said in a statement.
Physicians have long objected to giving more authority to mid-level providers, but hospitals in hard hit areas have reported staff shortages, with some areas turning to retirees and medical students to fill the gaps and temporary staffing firms report surges in demand.
Among the changes announced by CMS on Thursday: Doctors practicing at critical access hospitals can provide care across state lines using phones, radio or online communications. Their instructions may be carried out by a nurse practitioner or physician assistant. In fact, the waiver eliminates the need for a physician or osteopath to be on the premises of the hospital so long as they are providing supervision.
Tasks a physician must perform in-person at skilled nursing facilities may be delegated to nurse practitioners, physician assistants and clinical nurse specialists. Moreover, federal rules regarding their training and experience have been waived, deferring instead to state authorities.
Occupational therapists working on behalf of home health agencies can now perform some assessments on homebound patients, with the intent of launching home healthcare services sooner, although this does not supersede any state laws that say otherwise. CMS is also suspending rules requiring that nurses perform on-site visits every two weeks to evaluate whether home health aides are providing appropriate care.
Hospice nurses can temporarily put aside training aides in order to spend more time with patients, although they only need to perform such evaluations every two weeks. However, CMS has also suspended a requirement that hospice aides undergo 12 hours of annual in-service training. It is also waiving requirements that hospices provide physical therapy, occupational therapy and speech-language pathology.