Updated CMS Waiver on Physician Services for Nursing Facilities

On April 21, 2020, the federal Centers for Medicare and Medicaid Services (CMS) updated its COVID-19 Emergency Declaration Blanket Waiver for Health Care Providers, which provides waivers to the requirements of participation in Medicare and Medicaid for nursing facilities.  Under the original Blanket Waiver issued, CMS waived the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allowed visits to be conducted, as appropriate, via telehealth options.  In addition to the previous waiver of in-person physician and non-physician practitioner visits, the updated Blanket Waiver waives specific portions of 42 CFR 483.30, as follows:

• Physician Delegation of Tasks:  CMS waived the requirement in § 483.30(e)(4) that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally.  This waiver gives physicians the ability to delegate tasks to a physician assistant, nurse practitioner, or clinical nurse specialist who meets the applicable definition in 42 CFR 491.2, or in the case of a clinical nurse specialist, is licensed as such by Indiana and is acting within the state’s scope of practice laws.  Any task delegated under this waiver must continue to be under the supervision of the physician, and a physician is still prohibited from delegating a task when the delegation is prohibited under state law or by a nursing facility’s own policy.
• Personal Physician Visits:  CMS waived the requirement in § 483.30(c)(3) that requires physician visits, not already exempted in § 483.30(c)(4) and (f), to be made by the physician personally.  Physicians may delegate any required physician visit to a nurse practitioner, physician assistant, or clinical nurse specialist who is not an employee of the facility, who is working in collaboration with the physician, and who is licensed by Indiana and is acting within the state’s scope of practice laws.

Please note, CMS did not waive the requirement in § 483.30(c)(1) setting forth the frequency of required physician visits; CMS only modified the requirement to allow for the number of visits to be met by a nurse practitioner, physician assistant, or clinical nurse specialist, and/or via telehealth or other remote communication options, as appropriate.  Further, CMS did not waive the requirement of physician supervision of the medical care of each resident, as required under § 483.30(a)(1), or the requirement that a nursing facility provide or arrange for the provision of physician services 24 hours a day in case of an emergency, as required under § 483.30(d).