Association Executive Directors Community

Dear Association Executives - Below, please find a summary of last night's national stakeholder call that was led by Kim Brandt, Deputy Administrator Centers for Medicare and Medicaid Services (CMS). She read from the agency's fact sheet on the national emergency, which you received last night  It was clear during the call that their focus is on hospitals and nursing homes. We are working on broadening their focus to include outpatient behavioral health facilities.  

• 1135 Waivers: Ms. Brandt explained that CMS will be utilizing Section 1135 waivers to provide as much flexibility to providers and agencies as possible. She explained that the agency will be issuing several blanket waivers that states can use to expedite specific plans aimed at promoting access to care without abiding by certain statutory requirements. A full range of these measures can be found at cms.gov/emergency.
• There will NOT be blanket waivers issued through Medicaid. States and territories can work with the agency to submit a request for a Section 1135, but they must clearly state the scope of the issue and its impact. 
• Medicare Appeals in FFS, MA, & Part D -CMS is taking several steps regarding the Medicare appeals process in fee-for-service (FFS), Medicare Advantage, and Part D. This includes: (1) an extension to file appeals; (2) waiving timeliness requests for additional information needed to adjudicate; (3) process requests that don't meet required elements using available information; and (4) utilizing all flexibilities available in the appeals process as good cause if requirements are satisfied.
• Nursing Homes - Ms. Brandt noted that CMS will be issuing guidance on nursing home visitations. A number of questions were asked regarding eligibility guidelines within this forthcoming guidance, particularly whether certain health care workers and ombudsmen will be allowed to enter. CMS officials stated that they hope to flesh this out further prior to issuing the guidance, but may need to issue a FAQ document to further elaborate on these restrictions. 
• Telehealth - Ms. Brandt stated that CMS will be issuing guidance regarding telehealth coverage during the emergency as early as this weekend.  She pointed out that the agency's action will seek to promote more flexibility on site of service visits, and will build on tools found in CMS's existing telehealth regulatory framework.
• Provider Locations - CMS plans to temporarily waive requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed. This applies to Medicare and Medicaid. 
• Provider Enrollment - Steps CMS is taking to boost provider enrollment include: (1) establishing a toll-free hotline for non-certified Part B suppliers, physicians, and non-physician practitioner's to enroll and receive Medicare billing privileges; (2) waiving certain screening requirements (application fee, criminal background checks, and site visits); (3) postponing all revalidation actions; (4) allowing providers to render services outside their state of enrollment; and (5) expediting pending or new applications.
• SNFs -  CMS is waiving the three-day prior hospitalization requirement for coverage at a skilled nursing facility (SNF). The agency will also authorize renewed SNF coverage without having to start a new benefit period, and is waiving certain requirements for Minimum Data Set assessments and transmission.
• Critical Access Hospitals -CMS will waive the requirements that Critical Access Hospitals limit the number of beds to 25, as well as the 96-hour time limit.
• Durable Medical Equipment - CMS plans to waive requirements for Durable Medical Equipment Prosthetics. Orthotics, and Supplies (DMEPOS) that are lost, destroyed, or otherwise rendered unusable. The agency will waive the face-to-face requirement, a new physician's order, and new medical necessity documentation, but suppliers must still include a narrative description on the claim explaining why the DMEPOS must be replaced.
• Acute Care - CMS is waiving requirements to allow care for excluded inpatient psychiatric unit and inpatient rehabilitation unit patients in the Acute Care Units of hospitals. Hospitals are encourage to continue billing for these services through their specific prospective payment programs, and indicate that these patients are being cared for in an emergency situation. The waivers may also be utilized where the hospital's acute care beds are appropriate for these patients, and the staff and environment are conducive to safe care, Ms. Brandt explained.
• LTCH - CMS will be allowing long-term care hospitals (LTCH) to exclude patient stays where an LTCH admits or discharges patients in order to meet demands of the emergency from the 25-day average length of stay requirement.
• Home Health Agencies - CMS is looking to provide relief to Home Health Agencies on timeframes related to the Open Access Same-Time Information System (OASIS) Transmissions. Ms. Brandt explained that this will allow Medicare Administrative Contractors to extend the auto-cancellation date of Requests for Anticipated Payments (RAPs) during the emergency.
• EMTALA - CMS plans to issue additional guidance on Emergency Medical Treatment and Labor Act (EMTALA) waivers for the national emergency declaration. Stakeholders on the call encouraged the agency to promote telehealth flexibility in this forthcoming guidance, stressing its importance during this crisis. 

Chuck Ingoglia

President & CEO

National Council for Behavioral Health

Direct: (202) 684-3749

ChuckI@TheNationalCouncil.org

Dear Association Executives - Below, please find a summary of last night's national stakeholder call that was led by Kim Brandt, Deputy Administrator Centers for Medicare and Medicaid Services (CMS). She read from the agency's fact sheet on the national emergency, which you received last night  It was clear during the call that their focus is on hospitals and nursing homes. We are working on broadening their focus to include outpatient behavioral health facilities.  

• 1135 Waivers: Ms. Brandt explained that CMS will be utilizing Section 1135 waivers to provide as much flexibility to providers and agencies as possible. She explained that the agency will be issuing several blanket waivers that states can use to expedite specific plans aimed at promoting access to care without abiding by certain statutory requirements. A full range of these measures can be found at cms.gov/emergency.
• There will NOT be blanket waivers issued through Medicaid. States and territories can work with the agency to submit a request for a Section 1135, but they must clearly state the scope of the issue and its impact. 
• Medicare Appeals in FFS, MA, & Part D -CMS is taking several steps regarding the Medicare appeals process in fee-for-service (FFS), Medicare Advantage, and Part D. This includes: (1) an extension to file appeals; (2) waiving timeliness requests for additional information needed to adjudicate; (3) process requests that don't meet required elements using available information; and (4) utilizing all flexibilities available in the appeals process as good cause if requirements are satisfied.
• Nursing Homes - Ms. Brandt noted that CMS will be issuing guidance on nursing home visitations. A number of questions were asked regarding eligibility guidelines within this forthcoming guidance, particularly whether certain health care workers and ombudsmen will be allowed to enter. CMS officials stated that they hope to flesh this out further prior to issuing the guidance, but may need to issue a FAQ document to further elaborate on these restrictions. 
• Telehealth - Ms. Brandt stated that CMS will be issuing guidance regarding telehealth coverage during the emergency as early as this weekend.  She pointed out that the agency's action will seek to promote more flexibility on site of service visits, and will build on tools found in CMS's existing telehealth regulatory framework.
• Provider Locations - CMS plans to temporarily waive requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed. This applies to Medicare and Medicaid. 
• Provider Enrollment - Steps CMS is taking to boost provider enrollment include: (1) establishing a toll-free hotline for non-certified Part B suppliers, physicians, and non-physician practitioner's to enroll and receive Medicare billing privileges; (2) waiving certain screening requirements (application fee, criminal background checks, and site visits); (3) postponing all revalidation actions; (4) allowing providers to render services outside their state of enrollment; and (5) expediting pending or new applications.
• SNFs -  CMS is waiving the three-day prior hospitalization requirement for coverage at a skilled nursing facility (SNF). The agency will also authorize renewed SNF coverage without having to start a new benefit period, and is waiving certain requirements for Minimum Data Set assessments and transmission.
• Critical Access Hospitals -CMS will waive the requirements that Critical Access Hospitals limit the number of beds to 25, as well as the 96-hour time limit.
• Durable Medical Equipment - CMS plans to waive requirements for Durable Medical Equipment Prosthetics. Orthotics, and Supplies (DMEPOS) that are lost, destroyed, or otherwise rendered unusable. The agency will waive the face-to-face requirement, a new physician's order, and new medical necessity documentation, but suppliers must still include a narrative description on the claim explaining why the DMEPOS must be replaced.
• Acute Care - CMS is waiving requirements to allow care for excluded inpatient psychiatric unit and inpatient rehabilitation unit patients in the Acute Care Units of hospitals. Hospitals are encourage to continue billing for these services through their specific prospective payment programs, and indicate that these patients are being cared for in an emergency situation. The waivers may also be utilized where the hospital's acute care beds are appropriate for these patients, and the staff and environment are conducive to safe care, Ms. Brandt explained.
• LTCH - CMS will be allowing long-term care hospitals (LTCH) to exclude patient stays where an LTCH admits or discharges patients in order to meet demands of the emergency from the 25-day average length of stay requirement.
• Home Health Agencies - CMS is looking to provide relief to Home Health Agencies on timeframes related to the Open Access Same-Time Information System (OASIS) Transmissions. Ms. Brandt explained that this will allow Medicare Administrative Contractors to extend the auto-cancellation date of Requests for Anticipated Payments (RAPs) during the emergency.
• EMTALA - CMS plans to issue additional guidance on Emergency Medical Treatment and Labor Act (EMTALA) waivers for the national emergency declaration. Stakeholders on the call encouraged the agency to promote telehealth flexibility in this forthcoming guidance, stressing its importance during this crisis. 

Chuck Ingoglia

President & CEO

National Council for Behavioral Health

Direct: (202) 684-3749

ChuckI@TheNationalCouncil.org