CMS waiving utilization review, discharge planning requirements during COVID-19 pandemic

CMS has issued a plethora of waivers in recent weeks with the intention of limiting the spread of the novel coronavirus (COVID-19) and allowing healthcare facilities to focus entirely on the pandemic.

In a 26-page document published on April 9, CMS outlined dozens of blanket waivers that are retroactively effective March 1. The entire utilization review (UR) condition of participation will be waived, according to CMS.

Prior to the waiver, all hospitals participating in Medicare and Medicaid were required to have a UR plan with a UR committee that regularly reviews services furnished to Medicare and Medicaid beneficiaries to evaluate the medical necessity of the admission, length of stay, and services provided. However, as hospitals deal with the COVID-19 pandemic, CMS determined that the removal of these administrative requirements “will allow hospitals to focus more resources on providing direct patient care.”

Additionally, several discharge planning requirements will change with the implementation of the waiver. While hospitals are still required to ensure patients are discharged to appropriate settings with necessary medical information and goals, they no longer will need to share data and information with patients to help them select post-acute care providers.

CMS is waiving the following discharge planning requirements:

• Hospitals must include in the discharge plan a list of home health aide services (HHA), skilled nursing facilities (SNF), inpatient rehabilitation facilities, and long-term care hospitals that are available to the patient
• Hospitals must inform the patient or the patient’s representative of their freedom to choose among participating Medicare providers and suppliers of post-discharge services
• Hospitals must identify in the discharge plan any HHA or SNF to which the patient is referred in which the hospital has a disclosable financial interest, as specified by the secretary, and any HHA or SNF that has a disclosable financial interest in a hospital under Medicare

The changes will “expedite the safe discharge and movement of patients among care settings,” according to CMS.

For additional information, visit CMS’ list of emergency declaration blanket waivers.