NURS4212 SUMMARY|COVID-19 Emergency Declaration Blanket Waivers for
Health Care Providers
The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to
help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS
is empowered to take proactive steps through 1135 waivers as well as, where applicable,
authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the
Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers
are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency
declaration. For general information about waivers, see Attachment A to this document. These
waivers DO NOT require a request to be sent to the mailbox or that
notification be made to any of CMS’s regional offices.
Flexibility for Medicare Telehealth Services
Eligible Practitioners. Pursuant to authority granted under the Coronavirus Aid, Relief, and
Economic Security Act (CARES Act) that broadens the waiver authority under section 1135 of
the Social Security Act, the Secretary has authorized additional telehealth waivers. CMS is
waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which
specify the types of practitioners that may bill for their services when furnished as Medicare
telehealth services from the distant site. The waiver of these requirements expands the types
of health care professionals that can furnish distant site telehealth services to include all those
that are eligible to bill Medicare for their professional services. This allows health care
professionals who were previously ineligible to furnish and bill for Medicare telehealth
services, including physical therapists, occupational therapists, speech language pathologists,
and others, to receive payment for Medicare telehealth services.
Audio-Only Telehealth for Certain Services. Pursuant to authority granted under the CARES
Act, CMS is waiving the requirements of section 1834(m)(1) of the ACT and 42 CFR §
410.78(a)(3) for use of interactive telecommunications systems to furnish telehealth services,
to the extent they require use of video technology, for certain services. This waiver allows the
use of audio-only equipment to furnish services described by the codes for audio-only
telephone evaluation and management services, and behavioral health counseling and
educational services Unless provided otherwise, other services included on the Medicare
telehealth services list must be furnished using, at a minimum, audio and video equipment
permitting two-way, real-time interactive communication between the patient and distant
site physician or practitioner.
1
, NURS4212 SUMMARY|COVID-19 Emergency Declaration Blanket Waivers for
Health Care Providers
Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAHs), including Cancer
Centers and Long-Term Care Hospitals (LTCHs)
Emergency Medical Treatment & Labor Act (EMTALA). CMS is waiving the enforcement of
section 1867(a) of the Act. This will allow hospitals, psychiatric hospitals, and critical access
hospitals (CAHs) to screen patients at a location offsite from the hospital’s campus to prevent
the spread of COVID-19, so long as it is not inconsistent with a state’s emergency preparedness
or pandemic plan.
Verbal Orders. CMS is waiving the requirements of 42 CFR §482.23, §482.24 and §485.635(d)
(3) to provide additional flexibility related to verbal orders where read-back verification is
required, but authentication may occur later than 48 hours. This will allow more efficient
treatment of patients in surge situations. Specifically, the following requirements are waived:
o §482.23(c)(3)(i) - If verbal orders are used for the use of drugs and biologicals
(except immunizations), they are to be used infrequently.
o §482.24(c)(2) - All orders, including verbal orders, must be dated, timed, and
authenticated promptly by the ordering practitioner or by another practitioner who is
responsible for the care of the patient.
o §482.24(c)(3) - Hospitals may use pre-printed and electronic standing orders, order
sets, and protocols for patient orders. This would include all subparts at §482.24(c)(3).
o §485.635(d)(3) - Although the regulation requires that medication administration be
based on a written, signed order, this does not preclude the CAH from using verbal
orders. A practitioner responsible for the care of the patient must authenticate the
order in writing as soon as possible after the fact.
2
, NURS4212 SUMMARY|COVID-19 Emergency Declaration Blanket Waivers for
Health Care Providers
Reporting Requirements. CMS is waiving the requirements at 42 CFR §482.13(g) (1)(i)-(ii),
which require that hospitals report patients in an intensive care unit whose death is caused by
their disease, but who required soft wrist restraints to prevent pulling tubes/IVs, no later than
the close of business on the next business day. Due to current hospital surge, CMS is waiving
this requirement to ensure that hospitals are focusing on increased patient care demands and
increased patient census, provided any death where the restraint may have contributed is still
reported within standard time limits (i.e., close of business on the next business day following
knowledge of the patient’s death).
Patient Rights. CMS is waiving requirements under 42 CFR §482.13 only for hospitals that are
considered to be impacted by a widespread outbreak of COVID-19. Hospitals that are located
in a state which has widespread confirmed cases (i.e., 51 or more confirmed cases*) as
updated on the CDC website, CDC States Reporting Cases of COVID-19, at would not be
required to meet the following requirements:
o §482.13(d)(2) - With respect to timeframes in providing a copy of a medical record.
o §482.13(h) - Related to patient visitation, including the requirement to have written
policies and procedures on visitation of patients who are in COVID-19 isolation and
quarantine processes.
o §482.13(e)(1)(ii) - Regarding seclusion.
*The waiver flexibility is based on the number of confirmed cases as reported by CDC and will
be assessed accordingly when COVID-19 confirmed cases decrease.
Sterile Compounding. CMS is waiving requirements (also outlined in USP797) at 42 CFR
§482.25(b)(1) and §485.635(a)(3) in order to allow used face masks to be removed and
retained in the compounding area to be re-donned and reused during the same work shift in
the compounding area only. This will conserve scarce face mask supplies. CMS will not review
the use and storage of face masks under these requirements.
Detailed Information Sharing for Discharge Planning for Hospitals and CAHs. CMS is waiving
the requirement 42 CFR §482.43(a)(8), §482.61(e), and §485.642(a)(8) to provide detailed
information regarding discharge planning, described below:
o The hospital, psychiatric hospital, and CAH must assist patients, their families, or the
patient’s representative in selecting a post-acute care provider by using and sharing
data that includes, but is not limited to, home health agency (HHA), skilled nursing
facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH)
quality measures and resource use measures. The hospital must ensure that the
post- acute care data on quality measures and resource use measures is relevant and
applicable to the patient’s goals of care and treatment preferences.
3
, NURS4212 SUMMARY|COVID-19 Emergency Declaration Blanket Waivers for
Health Care Providers
o CMS is maintaining the discharge planning requirements that ensure a patient is
discharged to an appropriate setting with the necessary medical information and goals
of care as described in 42 CFR §482.43(a)(1)-(7) and (b).
Limiting Detailed Discharge Planning for Hospitals. CMS is waiving all the requirements and
subparts at 42 CFR §482.43(c) related to post-acute care services so as to expedite the safe
discharge and movement of patients among care settings, and to be responsive to fluid
situations in various areas of the country. CMS is maintaining the discharge planning
requirements that ensure a patient is discharged to an appropriate setting with the necessary
medical information and goals of care as described in 42 CFR §482.43(a)(1)-(7) and (b). CMS is
waiving the more detailed requirement that hospitals ensure those patients discharged home
and referred for HHA services, or transferred to a SNF for post-hospital extended care
services, or transferred to an IRF or LTCH for specialized hospital services, must:
o §482.43(c)(1): Include in the discharge plan a list of HHAs, SNFs, IRFs, or LTCHs that
are available to the patient.
o §482.43(c)(2): Inform the patient or the patient’s representative of their freedom to
choose among participating Medicare providers and suppliers of post-discharge
services.
o §482.43(c)(3): Identify in the discharge plan any HHA or SNF to which the patient is
referred in which the hospital has a disclosable financial interest, as specified by the
Secretary, and any HHA or SNF that has a disclosable financial interest in a hospital
under Medicare.
Medical Staff. CMS is waiving requirements under 42 CFR §482.22(a)(1)-(4) to allow for
physicians whose privileges will expire to continue practicing at the hospital and for new
physicians to be able to practice before full medical staff/governing body review and
approval to address workforce concerns related to COVID-19. CMS is waiving §482.22(a) (1)-
(4) regarding details of the credentialing and privileging process. (Please also refer to
Practitioner Locations Blanket Waiver listed below.)
Medical Records. CMS is waiving requirements under 42 CFR §482.24(a) through (c), which
cover the subjects of the organization and staffing of the medical records department,
requirements for the form and content of the medical record, and record retention
requirements, and these flexibilities may be implemented so long as they are not inconsistent
with a state’s emergency preparedness or pandemic plan. CMS is waiving §482.24(c)(4)(viii)
related to medical records to allow flexibility in completion of medical records within 30 days
following discharge from a hospital. This flexibility will allow clinicians to focus on the patient
care at the bedside during the pandemic.
4
Health Care Providers
The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to
help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS
is empowered to take proactive steps through 1135 waivers as well as, where applicable,
authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the
Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers
are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency
declaration. For general information about waivers, see Attachment A to this document. These
waivers DO NOT require a request to be sent to the mailbox or that
notification be made to any of CMS’s regional offices.
Flexibility for Medicare Telehealth Services
Eligible Practitioners. Pursuant to authority granted under the Coronavirus Aid, Relief, and
Economic Security Act (CARES Act) that broadens the waiver authority under section 1135 of
the Social Security Act, the Secretary has authorized additional telehealth waivers. CMS is
waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which
specify the types of practitioners that may bill for their services when furnished as Medicare
telehealth services from the distant site. The waiver of these requirements expands the types
of health care professionals that can furnish distant site telehealth services to include all those
that are eligible to bill Medicare for their professional services. This allows health care
professionals who were previously ineligible to furnish and bill for Medicare telehealth
services, including physical therapists, occupational therapists, speech language pathologists,
and others, to receive payment for Medicare telehealth services.
Audio-Only Telehealth for Certain Services. Pursuant to authority granted under the CARES
Act, CMS is waiving the requirements of section 1834(m)(1) of the ACT and 42 CFR §
410.78(a)(3) for use of interactive telecommunications systems to furnish telehealth services,
to the extent they require use of video technology, for certain services. This waiver allows the
use of audio-only equipment to furnish services described by the codes for audio-only
telephone evaluation and management services, and behavioral health counseling and
educational services Unless provided otherwise, other services included on the Medicare
telehealth services list must be furnished using, at a minimum, audio and video equipment
permitting two-way, real-time interactive communication between the patient and distant
site physician or practitioner.
1
, NURS4212 SUMMARY|COVID-19 Emergency Declaration Blanket Waivers for
Health Care Providers
Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAHs), including Cancer
Centers and Long-Term Care Hospitals (LTCHs)
Emergency Medical Treatment & Labor Act (EMTALA). CMS is waiving the enforcement of
section 1867(a) of the Act. This will allow hospitals, psychiatric hospitals, and critical access
hospitals (CAHs) to screen patients at a location offsite from the hospital’s campus to prevent
the spread of COVID-19, so long as it is not inconsistent with a state’s emergency preparedness
or pandemic plan.
Verbal Orders. CMS is waiving the requirements of 42 CFR §482.23, §482.24 and §485.635(d)
(3) to provide additional flexibility related to verbal orders where read-back verification is
required, but authentication may occur later than 48 hours. This will allow more efficient
treatment of patients in surge situations. Specifically, the following requirements are waived:
o §482.23(c)(3)(i) - If verbal orders are used for the use of drugs and biologicals
(except immunizations), they are to be used infrequently.
o §482.24(c)(2) - All orders, including verbal orders, must be dated, timed, and
authenticated promptly by the ordering practitioner or by another practitioner who is
responsible for the care of the patient.
o §482.24(c)(3) - Hospitals may use pre-printed and electronic standing orders, order
sets, and protocols for patient orders. This would include all subparts at §482.24(c)(3).
o §485.635(d)(3) - Although the regulation requires that medication administration be
based on a written, signed order, this does not preclude the CAH from using verbal
orders. A practitioner responsible for the care of the patient must authenticate the
order in writing as soon as possible after the fact.
2
, NURS4212 SUMMARY|COVID-19 Emergency Declaration Blanket Waivers for
Health Care Providers
Reporting Requirements. CMS is waiving the requirements at 42 CFR §482.13(g) (1)(i)-(ii),
which require that hospitals report patients in an intensive care unit whose death is caused by
their disease, but who required soft wrist restraints to prevent pulling tubes/IVs, no later than
the close of business on the next business day. Due to current hospital surge, CMS is waiving
this requirement to ensure that hospitals are focusing on increased patient care demands and
increased patient census, provided any death where the restraint may have contributed is still
reported within standard time limits (i.e., close of business on the next business day following
knowledge of the patient’s death).
Patient Rights. CMS is waiving requirements under 42 CFR §482.13 only for hospitals that are
considered to be impacted by a widespread outbreak of COVID-19. Hospitals that are located
in a state which has widespread confirmed cases (i.e., 51 or more confirmed cases*) as
updated on the CDC website, CDC States Reporting Cases of COVID-19, at would not be
required to meet the following requirements:
o §482.13(d)(2) - With respect to timeframes in providing a copy of a medical record.
o §482.13(h) - Related to patient visitation, including the requirement to have written
policies and procedures on visitation of patients who are in COVID-19 isolation and
quarantine processes.
o §482.13(e)(1)(ii) - Regarding seclusion.
*The waiver flexibility is based on the number of confirmed cases as reported by CDC and will
be assessed accordingly when COVID-19 confirmed cases decrease.
Sterile Compounding. CMS is waiving requirements (also outlined in USP797) at 42 CFR
§482.25(b)(1) and §485.635(a)(3) in order to allow used face masks to be removed and
retained in the compounding area to be re-donned and reused during the same work shift in
the compounding area only. This will conserve scarce face mask supplies. CMS will not review
the use and storage of face masks under these requirements.
Detailed Information Sharing for Discharge Planning for Hospitals and CAHs. CMS is waiving
the requirement 42 CFR §482.43(a)(8), §482.61(e), and §485.642(a)(8) to provide detailed
information regarding discharge planning, described below:
o The hospital, psychiatric hospital, and CAH must assist patients, their families, or the
patient’s representative in selecting a post-acute care provider by using and sharing
data that includes, but is not limited to, home health agency (HHA), skilled nursing
facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH)
quality measures and resource use measures. The hospital must ensure that the
post- acute care data on quality measures and resource use measures is relevant and
applicable to the patient’s goals of care and treatment preferences.
3
, NURS4212 SUMMARY|COVID-19 Emergency Declaration Blanket Waivers for
Health Care Providers
o CMS is maintaining the discharge planning requirements that ensure a patient is
discharged to an appropriate setting with the necessary medical information and goals
of care as described in 42 CFR §482.43(a)(1)-(7) and (b).
Limiting Detailed Discharge Planning for Hospitals. CMS is waiving all the requirements and
subparts at 42 CFR §482.43(c) related to post-acute care services so as to expedite the safe
discharge and movement of patients among care settings, and to be responsive to fluid
situations in various areas of the country. CMS is maintaining the discharge planning
requirements that ensure a patient is discharged to an appropriate setting with the necessary
medical information and goals of care as described in 42 CFR §482.43(a)(1)-(7) and (b). CMS is
waiving the more detailed requirement that hospitals ensure those patients discharged home
and referred for HHA services, or transferred to a SNF for post-hospital extended care
services, or transferred to an IRF or LTCH for specialized hospital services, must:
o §482.43(c)(1): Include in the discharge plan a list of HHAs, SNFs, IRFs, or LTCHs that
are available to the patient.
o §482.43(c)(2): Inform the patient or the patient’s representative of their freedom to
choose among participating Medicare providers and suppliers of post-discharge
services.
o §482.43(c)(3): Identify in the discharge plan any HHA or SNF to which the patient is
referred in which the hospital has a disclosable financial interest, as specified by the
Secretary, and any HHA or SNF that has a disclosable financial interest in a hospital
under Medicare.
Medical Staff. CMS is waiving requirements under 42 CFR §482.22(a)(1)-(4) to allow for
physicians whose privileges will expire to continue practicing at the hospital and for new
physicians to be able to practice before full medical staff/governing body review and
approval to address workforce concerns related to COVID-19. CMS is waiving §482.22(a) (1)-
(4) regarding details of the credentialing and privileging process. (Please also refer to
Practitioner Locations Blanket Waiver listed below.)
Medical Records. CMS is waiving requirements under 42 CFR §482.24(a) through (c), which
cover the subjects of the organization and staffing of the medical records department,
requirements for the form and content of the medical record, and record retention
requirements, and these flexibilities may be implemented so long as they are not inconsistent
with a state’s emergency preparedness or pandemic plan. CMS is waiving §482.24(c)(4)(viii)
related to medical records to allow flexibility in completion of medical records within 30 days
following discharge from a hospital. This flexibility will allow clinicians to focus on the patient
care at the bedside during the pandemic.
4
