MHCA and Maine DHHS Strongly Encourage Waiver RequestsOn the last ME DHHS/CDC LTC Med Dir's call, several participants asked about requesting waivers to the upcoming change in CMS regulations (per attached QSO-22-15-NH) that had previously allowed several waivers to CMS regulations related to the Public Health Emergency. Since that call, we learned that CMS has advised that all provider/facility requests for CMS waivers should be submitted directly to CMS through the “CMS PHE Emergency Web Portal “ outlined in the attached memo and summarized below:
<<CMS has created an automated 1135 process with a publicly accessible web form. The form offers standardized, user-friendly submission by requesters. All 1135 waiver requests and/or inquiries should be directed to the CMS 1135 web portal at: https://cmsqualitysupport.servicenowservices.com/cms_1135 >>
While the state is taking steps to request a state-level waiver, it is important for individual facilities to submit their own requests as that will help reflect the importance of this issue in Maine facilities, and because we have no way of knowing if or when CMS will grant a state-level waiver. In follow up of discussion on our last call, the state has had discussions with CMS on the possibility of extending the CMS waivers statewide related to the following physician services
• Physician Delegation of Tasks in SNFs - 42 CFR §483.30(e)(4) o 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) o 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 o 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.
If we are successful with a statewide extension of the waivers mentioned above, we will send out a notice to this group. However, as noted, we have no way of knowing if or when a statewide waiver will be granted, and strongly encourage individual facilities to submit their own requests directly through the CMS portal.
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