AHA’s List of COVID-19 Flexibilities That Should Stay and Go

As the country entered both a national emergency and public health emergency, CMS implemented a range of COVID-19 flexibilities, including waivers that enabled hospitals and health systems to increase access to testing and telehealth, create additional workforce capacity, and develop new treatment locations.

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The COVID-19 flexibilities have been key to pivoting hospital operations quickly and meeting evolving patient needs and demands during the pandemic. But the waivers are slated to come to an end as the public health emergency declaration expires later this month, much to the dismay of hospitals.

“This new environment, while difficult to navigate and extremely unpredictable at times, has shed light on opportunities to better serve patients and communities in the future,” the American Hospital Association (AHA) wrote in a letter to CMS Administrator Seema Verma last week.

The hospital group urged CMS to make some COVID-19 flexibilities and innovations part of the permanent health policy landscape. These include waivers related to telehealth, which have allowed hospitals and health systems to deliver “more patient-centered, convenient health care delivery to their communities.”

Telehealth has been core to the healthcare industry’s response efforts largely because of COVID-19 flexibilities. The regulatory flexibilities and waivers allowed hospitals and other providers to offer more virtual care services – and get reimbursed for them – to minimize unnecessary exposure to the novel coronavirus.

Now, hospitals are looking to make enhanced telehealth capabilities a part of normal operations with the support of health policy.

“On a permanent basis, we urge CMS to expand the services that can be provided via telehealth and via audio-only connection; the locations where these services can be delivered, including in all areas of the country and to patients in their homes; and the practitioners and providers, such as hospital outpatient departments, that can bill for these services,” AHA stated.

“These expanded telehealth services support the ability of hospitals and health systems to care for patients, for example, that lack access to transportation and/or for whom visiting the hospital could put them at risk,” the group added.

A bill introduced in the House of Representatives earlier this week is looking to make telehealth flexibilities granted under the CARES Act permanent.

“This bill will allow seniors to utilize telehealth services even after the emergency declaration has ended. COVID-19 presented unprecedented challenges, one being the facilitation of a safe environment for our seniors to receive high quality health care,” Rep. Liz Cheney (R-WY), who introduced the bill with Reps. Greg Gianforte (R-MT), David Kustoff (R-TN), and Jason Smith (R-MO), said in a press release.

“Congress has worked with the Trump Administration to remove many of the barriers that prevented seniors from utilizing telehealth services from the safety of their homes,” Cheney said. “As a result, telehealth use among seniors has continued to rise and this legislation would continue this successful trend well after the pandemic is over, while allowing Medicare to adapt to the ever-changing innovation in medical technology.”

But telehealth reimbursement flexibility will be key to increasing access to virtual care, the AHA pointed out in its letter.

CMS has already moved to make telehealth expansion in the home health industry permanent, but the proposal fails to include reimbursement for the services, leaving many industry leaders to wonder if enhanced telehealth capabilities are sustainable.

AHA advised CMS to not only allow more providers to bill for telehealth services, but also for CMS to work with Congress to permanently allow hospitals to bill the originating site fee when hospital-based clinicians render telehealth services to patients at home who would normally receive services at a hospital outpatient department.

The association also pushed for policymakers to permanently allow providers to bill for a new patient visit provided via telehealth without a physical exam, amend current regulations to allow payment for certain additional expanded services when furnished via telehealth, and ensure remote patient monitoring is treated similar to other existing telehealth flexibilities in terms of coverage.

Additionally, AHA asked for other COVID-19 flexibilities to made permanent, including the removal of specific practice limitations on nurse practitioners that are more restrictive under CMS rules compared to state laws, the scaling back of current Conditions of Participation regulations (e.g., use of verbal orders and discharge planning requirements), and flexibility for site-neutral payment exceptions for providers looking to relocate hospital outpatient departments and other off-campus provider-based departments.

Making these COVID-19 flexibilities permanent will support the ability of hospitals to “provide high-quality health care to each and every community they serve, no matter the circumstances,” AHA stated.

“While our members continue to do everything they can to address COVID-19 cases, they also must begin to assess how to best care for all patients moving forward,” the group wrote. “The actions we are requesting will help hospitals and health systems continue to put the health and safety of patients first by removing barriers that impact efficiency and opening up opportunities to better put the health, well-being and wishes of patients first in the future.”

Other COVID-19 flexibilities, however, do not support high-quality care beyond the pandemic, the group stated, and should not be considered by CMS for permanent placement in the health policy landscape.

“For example, waivers such as those relaxing physical environment requirements should cease to remain in place beyond the public health emergency,” the AHA explained. “Waivers treating ambulatory surgery centers and certain freestanding emergency departments as if they were hospitals to expand the surge capacity should also expire at the end of the public health emergency. These are effective triage mechanisms, but are not appropriate or applicable to longer term patient care.”

Specifically, the group urged CMS to:

• End the flexibility for physician-owned hospitals (POHs) to increase beds, operating rooms, and procedure rooms to meet a patient surge and require POHs to return to pre-COVID-19 bed and room counts, considering data indicates that the hospitals cherry-pick the healthiest and wealthiest patients, resulting in overutilization and high costs
• Discontinue the ability for independent freestanding emergency departments to participate in the Medicare and Medicaid programs as hospitals or clinics since these facilities are not built, equipped, or staffed to meet necessary requirements established for Medicare- or Medicaid-participating hospitals and health systems
• Terminate physical environment flexibilities that allowed for non-hospital buildings and spaces to be used for patient care once the need for increased capacity subsides