News: Nursing Policy

CMS 04/29/2020 updates to waiver information

Thursday, April 30, 2020   (0 Comments)
Posted by: Jill York
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UPDATES by Centers for Medicare and Medicaid Services

to COVID-19 Emergency Declaration

Blanket Waivers for Health Care Providers




Published 4/29/2020, document updates info regarding waivers for hospitals, FQHCs and RHCs. Please read the whole document for details, changes are noted with red update notations.


Some items specific to NPs are pulled and noted below:

  • Physician Services. CMS is waiving requirements under 42 CFR §482.12(c)(1)–(2) and §482.12(c) (4), which requires that Medicare patients be under the care of a physician. This waiver may be implemented so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan. This allows hospitals to use other practitioners to the fullest extent possible.

    • Physician Supervision of NPs in RHCs and FQHCs. 42 CFR 491.8(b)(1). We are modifying the requirement that physicians must provide medical direction for the clinic’s or center’s health care activities and consultation for, and medical supervision of, the health care staff, only with respect to medical supervision of nurse practitioners, and only to the extent permitted by state law. The physician, either in person or through telehealth and other remote communications, continues to be responsible for providing medical direction for the clinic or center’s health care activities and consultation for the health care staff, and medical supervision of the remaining health care staff. This allows RHCs and FQHCs to use nurse practitioners to the fullest extent possible and allows physicians to direct their time to more critical tasks. 


    Responsibilities of Physicians in Critical Access Hospitals (CAHs). 42 CFR § 485.631(b)(2). CMS is waiving the requirement for CAHs that a doctor of medicine or osteopathy be physically present to provide medical direction, consultation, and supervision for the services provided in the CAH at § 485.631(b)(2). CMS is retaining the regulatory language in the second part of the requirement at

    § 485.631(b)(2) that a physician be available “through direct radio or telephone communication, or electronic communication for consultation, assistance with medical emergencies, or patient referral.” Retaining this longstanding CMS policy and related longstanding subregulatory guidance that further described communication between CAHs and physicians will assure an appropriate level of physician direction and supervision for the services provided by the CAH. This will allow the physician to perform responsibilities remotely, as appropriate. This also allows CAHs to use nurse practitioners and physician assistants to the fullest extent possible, while ensuring necessary consultation and support as needed. 

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