THE VALUED VOICE

WHA Asks CMS to Permanently Retain Several COVID Response Waivers

WHA sent a letter to the Centers for Medicare & Medicaid Services (CMS) on Oct. 26 encouraging CMS to permanently retain COVID-response waivers and flexibilities impacting telehealth, flexible management of acute-care and post-acute care resources, critical access hospital length of stay and bed limits, and ongoing workforce challenges, including paperwork and compliance burden.

The letter was in response to an Oct. 22 request from CMS Region V for input on which of the Public Health Emergency (PHE) flexibilities CMS should retain permanently. WHA’s letter identified nearly 50 specific current CMS waivers that it asked CMS to consider permanently retaining.  

• Telehealth. Permanently retain waivers that remove barriers to telehealth. The removal of outdated CMS regulatory barriers to telehealth has been critical to providing high-quality, efficient, patient-centric access to care during the COVID-19 pandemic. The utilization of telehealth throughout the pandemic has demonstrated the benefits and utility of telehealth options, and we urge CMS to make the removal of pre-COVID limitations on telehealth permanent. Permanently removing geographic and location-based restrictions as well as audio-only restrictions are particularly high priorities for our members. 
• Flexibility to manage acute care and post-acute care resources. Permanently retain waivers addressing “Hospital at Home” models, required three-day prior hospitalizations and certain post-acute discharge flexibilities. Hospitals’ response to the pandemic has demonstrated the impacts that discharge bottlenecks can create on acute care capacity. We urge CMS to permanently retain hospital at home, the required three-day prior hospitalization for coverage, and certain other post-acute discharge flexibilities so that inpatient hospital infrastructure is efficiently used for patients needing inpatient services. We also ask CMS to modify and then retain swing bed flexibilities for prospective payment system (PPS) hospitals for those situations when a patient needs post-acute care, but a suitable nursing home placement cannot be located.
• “Top of license” workforce practice. Permanently retain waivers that enable advanced practice clinicians and other health care professions to practice at the maximum of their state licensed scope of practice. Workforce is a critical, ongoing need for hospitals and health systems; permanently removing outdated CMS regulatory barriers to licensed non-physician practitioner practice in hospitals is critical to fully utilizing our available health care workforce. 
• Critical access hospital flexibility. Permanently retain waivers impacting critical access hospital (CAH) length of stay and capacity. The waiver of strict limits on CAH beds and length of stay have been important flexibility that has enabled rural hospitals the flexibility to address their communities’ needs. We encourage CMS to permanently waive the 96-hour length of stay limitations on CAHs, and post-Public Health Emergency, create additional flexibility for CAHs to exceed 25 beds as community needs arise that result in abnormally high acute care demand.
• Patients over paperwork. Permanently retain waivers of requirements that create additional paperwork or signatures that provide little value or impact on care quality. Ongoing workforce challenges will continue to impact the ability of hospitals and health systems to meet demands for care. We ask for CMS to retain several waivers of requirements identified by CMS in its “patients over paperwork” initiative that result in providers spending additional time on compliance and paperwork at the expense of direct patient care. Further, in the face of new and ongoing workforce challenges, removing such barriers becomes even more critical to help stem burnout and further loss among the current workforce. The requests to CMS to permanently retain key COVID-response waivers echo requests WHA made to Wisconsin’s congressional delegation in this Oct. 15 letter to take action to permanently retain telehealth and workforce flexibilities.