Changes in health care rules during the COVID-19 crisis.

The global pandemic crisis has led to many changes in rules for health care including the Medicare program. Most of the changes are temporary, but some changes may remain in effect after the crisis. The Public Health Emergency is renewed for another 90 days until April 16. It will be reviewed again at that time. The Biden Administration will not end the Public Health Emergency without giving a 60-day notice. 90 days is the maximum length of time the Public Health Emergency can be extended at one time.

Many of the changes affect health care providers including payments and waivers of certain requirements. Many of the changes also relate to beneficiaries and their access to covered care. These changes have been issued by Centers for Medicare and Medicaid Services (CMS) through regulation and sub-regulatory guidance.

Specific Medicare coverage changes apply to Medicare Part A services in an acute care hospital and skilled nursing facilities. In a hospital, extra days can be covered for inpatients who would have been discharged but were diagnosed with COVID-19 and had to stay longer to quarantine. Charges for a private room in a hospital are lifted if the need for the private room is medically necessary. Discharge planning will focus on ensuring patients are discharged to appropriate settings with the necessary medical information and goals of care.

On August 25, 2020, CMS summarized and provided links to guidance and updates for nursing homes during the pandemic. Revisions to or expansions of eligibility and covered criteria have changed. The three-day inpatient hospital stay requirement for Part A skilled nursing facilities (SNF) has been waived. This waiver provides temporary emergency coverage of skilled nursing facilities services without a qualifying hospital stay for individuals who experience dislocations or are affected by COVID-19.

SNF benefits that have exhausted Medicare Part A benefits are extended for another 100 days. For certain beneficiaries who have recently exhausted their SNF benefit, a onetime renewal of 100 days of coverage is authorized without having to start a new benefit period. This applies to the beneficiary being delayed or prevented by the emergency itself, from starting or stopping the process to end the current benefit period and renewing SNF benefits what would have normally occurred.

A list and explanation of the waivers currently in place can be found by searching COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers.

If you have a loved one in a facility that is requiring more assistance and could benefit from therapy, speak to the facility regarding skilled services under Medicare Part A.

Provided by Aimee Kroeger, BSN, RN, Care Coordinator at Clinkscales