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All applicable waivers remain in place.

As expected, Xavier Becerra, the Secretary of the U.S. Department of Health and Human Services (HHS), has renewed the COVID-19 public health emergency (PHE), extending the many waivers that are in place until Jan. 16, 2022.

This renewal was anticipated as the COVID-19 pandemic continues without an end in sight, with continued stress on healthcare workers, hospitals, nursing facilities, and other healthcare facilities around the country.

Each declaration of a PHE by law lasts 90 days and must be renewed, with the previous extension issued on July 19, 2021.

“It is very much appreciated that this extension was issued prior to the weekend to alleviate the uncertainty that has been happening every 90 days since the start of the pandemic,” said Ronald Hirsch, MD of R1 RCM. Hirsch said that all applicable waivers remain in place, including the requirement for patients to have a three-day inpatient stay prior to admission to a skilled nursing facility (SNF) for a Part A stay.

“That means that patients with skilled needs may be referred to a SNF from any setting, including home or the emergency department, as long as they have skilled needs,” Hirsch added.

Hirsch also noted that hospitals are continuing to see nursing facilities refuse to accept patients without that three-day inpatient stay. It is not clear why they are refusing to honor the waiver, although many surmise that they used the waiver early in the pandemic and had trouble getting their claims paid.

“CMS (the Centers for Medicare & Medicaid Services) has noted that unlike hospitals that must follow EMTALA (Emergency Medical Treatment and Labor Act) regulations, a SNF is not required to accept any patient. It is understandable that they would want to ensure the patient’s stay will be paid, but there is no mechanism for them to be sure the claim will be paid by the Medicare Administrative Contractor (MAC),” Hirsch said. “In addition, CMS issued a notice that suggests they are seeing patients admitted for Part A stays who may not have skilled needs, increasing the prospects of more audits in the future.”

Hirsch suggests that “hospitals should work closely with the post-acute providers and ensure that the physician and therapist documentation is complete and accurate, so the SNF can clearly determine the patient’s skilled needs and work with the SNF to ensure the claim is submitted with the DR condition code. With the continued capacity issues on hospitals, every open bed counts.”

Dr. Hirsch also reminds hospitals that they may want to contact any rural or critical access hospitals (CAHs)in their regions that have swing beds. Although the distance may be an issue for families, their loved one’s recovery should take precedence. As a last resort, non-rural hospitals continue to have the option to ask CMS for permission to establish swing beds of their own if they are unable to find a SNF bed in the area.  

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