Waivers involving the authority and duties of various workforce members will be expiring at the end of the Public Health Emergency (PHE). These CMS waivers allowed for many changes in healthcare delivery during the PHE. While some waivers will become permanent, the following are workforce waivers that will terminate on May 11, 2023:
- Medical Staff Requirements (42 CFR § 482.22(a)(1)-(4)): Allowed physicians with expired privileges to continue practicing at the hospital and new physicians to begin practicing prior to medical staff/governing body review and approval.
- Physician Services (42 CFR § 482.12(c)(1)-(2) and § 482.12(c)(4)): Waived the requirements that patients be under the care of a physician and allowed hospitals to use other practitioners, such as physician’s assistant and nurse practitioners in their place.
- Anesthesia Services (42 CFR § 482.52(a)(5), § 485.639(c)(2) and § 416.42 (b)(2)): Waived the physician supervision requirement for Certified Registered Nurse Anesthetist’s (CRNA) and allowed CRNA’s to function to the fullest extent of their license.
- Respiratory Care Services (42 CFR § 482.57(b)(1)): Waived the requirement that hospitals designate in writing the personnel qualified to perform specific respiratory care procedures and waived the amount of supervision required for personnel to carry out specific procedures.
- Critical Access Hospital (CAH) Personnel Qualifications (42 CFR 485.604(a)(2), § 485.604(b)(1)-(3), and § 485.604(c)(1)-(3)): Waived the federal minimum personnel qualifications related to licensure and scope of practice for clinical nurse specialist, nurse practitioners, and physician assistants.
- CAH Staff Licensure (42 CFR 485.608(d)): Waived the federal requirements related to licensure, certification, and registration for CAH staff.
- Responsibilities of Physicians in CAHs (42 CFR § 485.631(b)(2)): Waived the requirement for CAHs that a Doctor of Medicine or Osteopathy be physically present to provide medical direction, consultation, and supervision for specified services. Instead, CMS allowed physicians to provide this role remotely.
In order to ensure compliance, organizations should review current practices and determine what will change due to the termination of these waivers. Specifically, organizations should conduct a targeted review of each waiver area to determine which, if any, are currently being utilized. After this review, organizations must ensure processes are in place to comply with each regulatory requirement. It is important for compliance departments to identify training opportunities and develop targeted training related to the appropriate regulatory requirement.
Since the beginning of the PHE, many of these workforce waivers have become intertwined into the healthcare delivery system. This makes it even more crucial for compliance departments to partner with operations, revenue cycle, and legal departments to develop a work plan for auditing and monitoring these activities as they come to a close near the end of the PHE.
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