With the growing concern surrounding Coronavirus (COVID-19) and the slew of emails you’re likely receiving, we want to provide you with a brief, focused summary of how this pandemic has temporarily changed our current practices and regulations surrounding our Medicare beneficiaries.

On Friday, March 13, 2020 the Centers for Medicare & Medicaid Services (CMS) relaxed certain rules and conditions of participation for many healthcare providers in response to this national emergency:


A) The 3-day qualifying hospital stay (3-midnight rule) has been waived

    • Certain beneficiaries who recently exhausted their SNF benefits may have renewed SNF coverage without first having to start a new benefit period
    • SNF care without a 3-day inpatient hospital stay will be covered for beneficiaries who experience dislocations or are otherwise affected by the emergency, such as those who are (1) evacuated from a nursing home in the emergency area, (2) discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or (3) need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency.
    • The waiver applies to admissions from the hospital, community, or even dually eligible residents in the facility who may be transitioned to Medicare Skilled if they meet skilled criteria
    • Residents being admitted under the waiver do not have to have COVID-19, but must still meet skilled criteria
    • The waiver takes effect retroactively to March 1, 2020
    • AHCA reports the waiver applies nationally and is in effect for 60 days with an option for renewal as needed
    • The “DR” condition code should be used by institutional providers for billing related to a declared emergency/disaster and to allow CMS to track these stays
    • The waiver was released on Saturday, March 14, 2020, and is now in effect for traditional Medicare beneficiaries. Guidance is pending from Managed Care entities.


Proactive Recommendations:

    1. Maintain a Temporary Qualifying Stay and New Spell of Illness log
    2. Document reasoning for waiver criteria being met in the medical record
    3. Train billing staff on requirements re: use of the “DR” condition code on claims

B) CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission

    • 42 CFR 483.20 refers to the Resident Assessment for which the facility must conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident’s functional capacity. Please note this waiver focuses on relaxing the requirements for assessment completion and transmission; the assessments must still be conducted.


Proactive Recommendations:

    1. Maintain a Resident Assessment Log including the beneficiary Name, admission date, type of MDS Assessment, Assessment Reference Date (ARD), and MDS completion and transmission dates.
    2. Continue to open & set ARDs on the MDS Item Set paper copy or in the facility software within the required time frame of the assessment type being completed. Train IDT how to open assessments or document on paper in the absence of the MDS Coordinator. See also RAI Manual Page 2-9.
    3. Consider back-up process for supporting documentation and/or review of section GG self-care & mobility performance in the absence of the MDS Coordinator.


C) Where Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) is lost, destroyed, irreparably damaged, or otherwise rendered unusable, contractors have the flexibility to waive replacements requirements such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required


D) Certain Medicare screening requirements have been suspended including site visits and fingerprinting for non-certified Part B suppliers


E) Medicare appeals in Fee for Service, MA and Part D

    • Extension to file an appeal
    • Waive timeliness for requests for additional information to adjudicate the appeal;
    • Processing the appeal even with incomplete Appointment of Representation forms but communicating only to the beneficiary;
    • Process requests for appeal that don’t meet the required elements using information that is available.
    • Utilizing all flexibilities available in the appeal process as if good cause requirements are satisfied.


Additional regulatory flexibilities for other health care providers and Medicaid and CHIP can be found in the full CMS memo. Additional information regarding Emergency Preparedness and Coronavirus can be found at http://www.cms.gov/emergency


Source: IHCA 3.16.2020 and CMS SNF Waiver Memo


Blog by Eleisha Wilkes, RN, RAC-CTA, Proactive Medical Review

Click here to learn more about Eleisha and the rest of the Proactive team.