CMS Waives Certain Conditions of Participation During COVID-19 National Emergency

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For the duration of the COVID-19 pandemic, the Secretary of the Department of Health and Human Services (HHS) has waived or flexed various Conditions of Participation of the Centers for Medicare & Medicaid Services (CMS). This has been done to ensure sufficient health care services are available to meet the needs of Medicare and Medicaid patients and to make sure providers are reimbursed for services and exempt from sanctions for non-compliance (absent any determination of fraud and abuse). Providers, acting in good faith, are exempt from sanctions for non-compliance with:

  1. Certain program certification requirements, program participation or other similar requirements
  2. Requirements that physicians or other health care professionals hold licenses in the state in which they provide services, if they have an equivalent license from another state (and are not affirmatively barred in that state)
  3. The Emergency Medical Treatment and Labor Act (EMTALA) for the transfer or relocation of an individual to another location to receive medical screening pursuant to a hospital’s emergency preparedness plan
  4. Limitations on physician referrals under such conditions as deemed appropriate by CMS
  5. Limitations on payments for health care items and services furnished to individuals enrolled in a Medicare Advantage plan by health care professionals or facilities not included in the plan’s network.

For more information, view the Waiver or Modification of Requirements under Section 1135 of the Social Security Act as the result of the consequences of the 2019 Novel Coronavirus.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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