CMS’ “Special Open Door Forum” Discussed Hospitals Without Walls
April 13, 2020
On April 9, 2020, the Centers for Medicare & Medicaid Services (“CMS”) hosted a call to allow hospitals, health systems, and providers the opportunity to ask CMS agency officials questions pertaining to the waivers and regulatory flexibilities issued by CMS in response to COVID-19 related to hospitals without walls. The complete recording of the April 9, 2020 Office Hour will be made available here. Below are some highlights from CMS’ April 9, 2020 “Special Open Door Forum”:
CMS is exercising its enforcement discretion and will not be conducting on-site surveys for hospital surge locations during the COVID-19 public health emergency. Hospitals may begin billing for care in such locations prior to completing an amended CMS-855A.
If a hospital and an ambulatory surgical center (“ASC”) arrange for the ASC to be a temporary hospital expansion site, but the site cannot comply with state licensure requirements for hospitals subject to the state’s COVID-19 pandemic plan, CMS will not pay for services performed at the site.
CMS is in the process of actively considering how it will handle payments to hospitals which may temporarily relocate an on-campus provider-based department to an off-campus location in response to COVID-19.
Freestanding emergency medical care facilities that are not connected to a hospital may provide services on behalf of a hospital during the COVID-19 emergency. Further, CMS will pay for inpatient care furnished at sites under arrangement if the hospital can guarantee quality and that the hospital has sufficient control and responsibility over patients.
If a hospital believes a blanket waiver that has not been issued but should be issued to apply for all hospitals, a hospital can send a request to 1135waiver@cms.hhs.gov. If flexibility is needed on a case-to-case basis, a hospital can also request an issue-specific waiver.
If a governmental or other entity has retrofitted or organized an off-site facility, generally, a hospital may operate the facility and bill Medicare for providing inpatient/outpatient hospital services at such temporary expansion sites. These sites need to meet the refined conditions of participation and billing rules under the applicable Medicare payment system. Hospitals should add “DR” condition codes to claims for patients treated in temporary expansion sites. Providers that furnish covered professional services in the temporary expansion sites can bill Medicare, as well. They should use applicable place of service codes and should add the modifier “CR” for patients treated in temporary expansion sites. CMS’ goal is to be as supportive as possible for these potential partnerships. If there is a unique circumstance that has not been addressed, CMS asks that it be contacted to consider the arrangement.
