News: Public health emergency extended, waiver provisions stand

CDI Strategies - Volume 15, Issue 7

The U.S. Department of Health and Human Services (HHS) has extended the current COVID-19 public health emergency (PHE) meaning all waivers remain in place, according to Revenue Cycle Advisor.

Waiver 1135, which was put into effect in spring 2020, is aimed at helping hospitals and other healthcare facilities better respond to the surge in demand from the COVID-19 pandemic. Waiver 1135 allows CMS to bypass traditional rules, including Conditions of Participation, to help organizations move patients through levels of care so that they can free up needed hospital beds. It also includes the following provisions (among others):

  • Eliminates the three-day qualifying inpatient stay requirement for Medicare beneficiaries.
    • Medicare normally requires beneficiaries to complete three inpatient days in a hospital before they can qualify for SNF coverage. The waiver does away with this requirement, allowing patients to qualify for SNF services whether they are inpatients, receive outpatient services, are treated in the emergency department, or are referred for services from home. This applies to all patients, not just those with COVID-19.
    • Keep in mind that in order to qualify, your facility must be treating COVID-19 patients, and patients still need to consent to the SNF transfer. Also, the level of care must meet the patient’s needs in order for them to qualify.
  • Waives the average length of stay limits for critical access hospitals (CAH).
    • This change allows CAHs to waive their 25-patient and 96-hour stay limits using condition code DR on the claim. Under this change, hospitals can transfer non-critical patients to CAHs for care to free up bed space.
  • Reallocates beds within distinct hospital units.
    • The waiver also gives hospitals new flexibility in using other wards for acute care services, which again allows them to expand bed space within the organization.
  • Waives appeals and documentation submission deadlines.
    • CMS is temporarily waiving beneficiary and provider appeals and documentation submission deadlines.

Editor’s note: This article was originally published in Revenue Cycle Advisor. To read more of ACDIS’ coverage of the COVID-19 pandemic and about its impact on CDI professionals and organizations, click here

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