Requesting Waivers for Physician Delegation/Visits

On April 7th, CMS released QSO-22-15-NH outlining the end of specific emergency declaration blanket waivers for SNFs/NFs, inpatient hospices, ICF/IIDs and ESRD facilities listed below. The termination of these blanket waivers will have no effect on other blanket waivers that remain in place such as those for hospitals and CAHs. Those blanket waivers remain in effect to assist hospitals and CAHs, among others, in dealing with their response to the surges of COVID-19 cases in the community.

In this memo, CMS stated that providers are expected to take immediate steps so that they may return to compliance with the reinstated requirements according to the timeframes listed below. Several homes have shared their concern regarding the end of waivers related to physician delegation and visits. Specifically, these waivers were to allow:
  • Physician Delegation of Tasks in SNFs - 42 CFR §483.30(e)(4)
    • CMS waived the requirement that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally. This waiver gave physicians the ability to delegate any tasks to a physician assistant, nurse practitioner, or clinical nurse specialist, but specified that any task delegated under this waiver must continue to be under the supervision of the physician.
  • Physician Visits - 42 CFR §483.30(c)(3)
    • CMS waived the requirement that all required physician visits (not already exempted in §483.30(c)(4) and (f)) must be made by the physician personally. The waiver modified this provision to permit physicians to 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 a physician, and who is licensed by the State and performing within the state's scope-of-practice laws.
  • Physician Visits in Skilled Nursing Facilities/Nursing Facilities - 42 CFR §483.30
    • CMS waived the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.
In the most recent Maine CDC medical director calls Lynn Hadyniak of Maine DHHS Division of Licensing stated that “if facilities feel that they will have difficulty meeting the requirement that physicians/clinicians do in-person visits in SNF/NFs (i.e. requirement that will otherwise go back into effect on May 7, 2022) they can email DLC a request for a waiver.”

In this waiver request homes should outline the following:
  1. Explains why they need the waiver;
  2. How they intend to eventually come into compliance with the CMS requirement for doing in-person visits; and
  3. how long they want the waiver (note that CMS generally grants waivers for 6mos).
These requests should be emailed to or who will then present the waiver request to CMS for official approval.

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