CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge
CMS announced new flexibilities for hospitals to provide acute hospital care at home and flexibilities for ambulatory surgery centers that are temporarily certified as hospitals, during the PHE. The flexibilities are intended to promote hospital capacity in response to the rising numbers of COVID-19 hospitalizations across the country.Acute Hospital Care at HomeCMS announced that it is expanding its March 2020-announced “Hospitals Without Walls” program, by establishing a new Acute Hospital Care At Home program to support models of at-home hospital care. This program is not a blanket waiver–rather, hospitals may apply to CMS to waive §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, 7 days a week and the immediate availability of a registered nurse for care of any patient. Alongside a program description and application, HHS released a “What They’re Saying” document that includes statements from five hospitals that have established Acute Hospital Care At Home programs: Mount Sinai Health System in New York City, Massachusetts General Hospital, Brigham Health Home Hospital, College of Nursing Huntsman Cancer Institute at the University of Utah, and Presbyterian Healthcare Services.Ambulatory Surgical Center FlexibilityCMS issued revised guidance regarding flexibilities for ambulatory surgery centers during the COVID-19 public health emergency. ASCs are typically subject to a requirement that patients remain in their care less than 24 hours or require admission to a regular hospital. Prior guidance allows ASCs to be temporarily certified as hospitals and provide longer-term inpatient care, during the PHE. The now-updated guidance regarding ASC flexibilities clarifies that participating ASCs need only provide 24-hour nursing services when there is one or more patient receiving care onsite. This flexibility will allow ASCs enrolled as hospitals to provide nursing services on demand with a 24-7 on call service in the event a surgeon requests to admit a patient for a required surgical procedure. The change automatically applies to the 85 ASCs participating in the Hospital Without Walls initiative, and is available to the 5700+ other ASCs in the United States, should they seek to participate. Hospitals that are not temporarily enrolled as hospitals must remain in compliance with all non-waived federal ASC requirements.