CMS Blanket Waivers, What You Need to Know.


CMS is continuously updating blanket waivers for healthcare providers.  There are many associations and websites promoting templates for certain waivers, but be careful, they are only for the facility types listed within the waiver. We have received many questions about the blanket waivers and therefore would like to offer clarification.

The updated “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers” does include ambulatory surgery centers, but ASCs are not included in the waiver for Physical Environment Conditions of Participation.  That specific waiver can be found on page 23 of the document;

“Inspection, Testing & Maintenance (ITM ) under the Physical Environment Conditions of Participation: CMS is waiving certain physical environment requirements for Hospitals, CAHs, inpatient hospice, ICF/IIDs, and SNFs/NFs to reduce the disruption of patient care and potential exposure/transmission of COVID-19. The physical environment regulations require that facilities and equipment be maintained to ensure an acceptable level of safety and quality.”

Although ASCs are associated with hospitals, they have a separate license. There are many surgery centers that are maintained by hospital maintenance personnel.  Please be sure they understand that the adjustments made in the hospital do not apply to ASCs.

There are several places where ASCs are included in blanket waivers, as noted below.

  • Medical Staff. 42 CFR 416.45(b ) . CMS is waiving the requirement at § 416.45(b ) … This will allow for physicians whose privileges will expire to continue practicing at the ambulatory surgical center, without the need for reappraisal
  • Temporary Expansion Locations: … 42 CFR §482.41 and §485.623 (as noted elsewhere in this waiver document ) and the provider-based department requirements at §413.65…to allow hospitals to establish and operate as part of the hospital any location meeting those conditions of participation for hospitals that continue to apply during the PHE…. This extends to any entity operating as a hospital (whether a current hospital establishing a new location or an Ambulatory Surgical Center (ASC ) enrolling as a hospital during the PHE pursuant to a streamlined enrollment and survey and certification process )
  • Anesthesia Services. CMS is waiving requirements under 42 CFR §482.52(a ) (5 ) , §485.639(c ) (2 ) , and §416.42 (b ) (2 ) that a certified registered nurse anesthetist (CRNA ) is under the supervision of a physician in paragraphs §482.52(a ) (5 ) and §485.639(c ) (2 ) . CRNA supervision will be at the discretion of the hospital and state law. This waiver applies to hospitals, CAHs, and Ambulatory Surgical Centers (ASCs ) . These waivers will allow CRNAs to function to the fullest extent of their licensure and may be implemented so long as they are not inconsistent with a state’s emergency preparedness or pandemic plan.
  • Claims Submission for Blanket Waivers: When submitting claims covered by the blanket waivers, the “DR” (disaster-related ) condition code should be used for institutional billing (i.e., claims submitted using the ASC X12 837 institutional claims format or paper Form CMS-1450 ) .The “CR” (catastrophe/disaster-related ) modifier should be used for Part B billing, both institutional and non-institutional (i.e., claims submitted using the ASC X12 837 professional claim format or paper Form CMS-1500 or, for pharmacies, in the NCPDP format ) . This requirement does not apply for purposes of compliance with waivers (blanket or individual ) of sanctions under the physician self-referral law.

One thing is certain; there will be additions and changes until this pandemic is over.  As we are all aware of with CMS, AHCA, and accrediting agencies, there will always be changes. Please know we are here to help you navigate through this.  If you have questions on past, present, or future life safety issues, feel free to reach out to our Life Safety Compliance Officer (Franklin Sands ) .

CMS summary of blanket waivers can be found here.

Written by Life Safety Compliance Officer, Franklin Sands