VIA ELECTRONIC MAIL – [email protected] TRUSTEES & OFFICERS Chair Phillip Kambic March 20, 2020 Riverside Healthcare Chair-Elect Karen Teitelbaum Sinai Health System Immediate Past Chair Mr. Douglas O’Brien Mary Starmann-Harrison Regional Director – Region V Hospital Sisters Health System Treasurer Centers for Medicare and Medicaid Services Ted Rogalski Chicago Regional Office (Region V) Genesis Medical Center Secretary 233 N Michigan Avenue Mary Lou Mastro Edward-Elmhurst Health Suite 1300 President Chicago, Illinois 60601 A.J. Wilhelmi Illinois Health and Hospital Association Steven Airhart RE: Notice of Intent to Operate Under 1135 Waiver(s) Hartgrove Behavioral Health System and Garfield Park Behavioral Hospital Jeremy Bradford The Illinois Health and Hospital Association (IHA) is providing notice of the intent of each SSM Good Samaritan Hospital Katherine Bunting Illinois hospital and health system and their respective affiliates in Illinois (each a “Provider” Fairfield Memorial Hospital and collectively “Providers”) to operate under certain “blanket” waiver(s) as further described Ruth Colby below in Table 1. The Providers that would operate under such waiver(s) are set forth in Silver Cross Hospital M. Edward Cunningham Exhibit A: Gateway Regional Medical Center J.P. Gallagher NorthShore University HealthSystem Dean M. Harrison [Intentionally left blank] Northwestern Memorial HealthCare Maureen Kahn Blessing Health System James Leonard, MD The Carle Foundation George Miller Loretto Hospital Keith Parrott AMITA Health José R. Sánchez Norwegian American Hospital William Santulli Advocate Aurora Health David Schreiner Katherine Shaw Bethea Hospital Stephen Scogna Northwest Community Healthcare Robert Sehring OSF HealthCare Mark B. Steadham Morris Hospital & Healthcare Centers Steven D. Tenhouse Kirby Medical Center Mark Turner Memorial Regional Health Services Shawn P. Vincent Loyola University Health System Brenda J. Wolf La Rabida Children’s Hospital 1151 East Warrenville Rd. 700 South 2nd St. 400 North Capitol St. N.W. 833 West Jackson Blvd. www.team -iha.org P.O. Box 3015 Springfield, IL 62704 Suite 585 Suite 610 Naperville, IL 60566 217.541.1150 Washington, DC 20001 Chicago, IL 60607 630.276.5400 630.276.5645 312.906.6150 Mr. Douglas O’Brien, Regional Director – Region V Centers for Medicare and Medicaid Services March 22, 2020 Page 2 The Providers intend to operate under the “blanket” waivers as identified in Table 1: Waiver Description of Waiver Provider(s) Electing to Operate Under Each Waiver Skilled Nursing CMS is waiving the requirement at All applicable Providers in Exhibit A Facilities – 3 Day Section 1812(f) of the Social Security Act Rule for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay provides temporary emergency coverage of (SNF services without a qualifying hospital stay, for those people who need to be transferred as a result of the effect of a disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period. Skilled Nursing CMS is waiving 42 CFR 483.20 to provide All applicable Providers in Exhibit A Facilities – relief to SNFs on the timeframe Timeframe for requirements for Minimum Data Set MDS assessments and transmission. Critical Access CMS is waiving the requirements that All applicable Providers in Exhibit A Hospitals Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours. Housing Acute CMS is waiving requirements to allow All applicable Providers in Exhibit A Care Patients In acute care hospitals to house acute care Excluded Distinct inpatients in excluded distinct part units, Part Units where the distinct part unit’s beds are appropriate for acute care inpatient. The Inpatient Prospective Payment System (IPPS) hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the disaster or emergency. Durable Medical Where Durable Medical Equipment All applicable Providers in Exhibit A Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) is lost, destroyed, irreparably damaged, or otherwise rendered unusable, contractors have the flexibility Mr. Douglas O’Brien, Regional Director – Region V Centers for Medicare and Medicaid Services March 22, 2020 Page 3 Waiver Description of Waiver Provider(s) Electing to Operate Under Each Waiver to waive replacements requirements such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency. Care for Excluded CMS is waiving to allow acute care All applicable Providers in Exhibit A Inpatient hospitals with excluded distinct part Psychiatric Unit inpatient psychiatric units that, as a Patients in the result of a disaster or emergency, need Acute Care Unit of to relocate inpatients from the excluded a Hospital distinct part psychiatric unit to an acute care bed and unit. The hospital should continue to bill for inpatient psychiatric services under the Inpatient Psychiatric Facility Prospective Payment System for such patients and annotate the medical record to indicate the patient is a psychiatric inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the hurricane. This waiver may be utilized where the hospital’s acute care beds are appropriate for psychiatric patients and the staff and environment are conducive to safe care. For psychiatric patients, this includes assessment of the acute care bed and unit location to ensure those patients at risk of harm to self and others are safely cared for. Care for Excluded CMS is waiving requirements to allow All applicable Providers in Exhibit A Inpatient acute care hospitals with excluded Rehabilitation distinct part inpatient rehabilitation Unit Patients in units that, as a result of a disaster or the Acute Care emergency, need to relocate inpatients Unit of a Hospital from the excluded distinct part Mr. Douglas O’Brien, Regional Director – Region V Centers for Medicare and Medicaid Services March 22, 2020 Page 4 Waiver Description of Waiver Provider(s) Electing to Operate Under Each Waiver rehabilitation unit to an acute care bed and unit. The hospital should continue to bill for inpatient rehabilitation services under the inpatient rehabilitation facility prospective payment system for such patients and annotate the medical record to indicate the patient is a rehabilitation inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the disaster or emergency. This waiver may be utilized where the hospital’s acute care beds are appropriate for providing care to rehabilitation patients and such patients continue to receive intensive rehabilitation services. Inpatient CMS is waiving requirements to allow All applicable Providers in Exhibit A Rehabilitation IRFs to exclude patients from the Facility (IRF) – hospital’s or unit’s inpatient population 60% Rule for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF (commonly referred to as the “60 percent rule”) if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such. In addition, during the applicable waiver time period, we would also apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain classification as an IRF. Supporting Care Allows a LTCH to exclude patient stays All applicable Providers in Exhibit A for Patients in where an LTCH admits or discharges Long-Term Care patients in order to meet the demands Acute Hospitals of the emergency from the 25-day (LTCH)s average length of stay requirement which allows these facilities to be paid as LTCHs. Home Health Provides relief to Home Health Agencies All applicable Providers in Exhibit A Agencies on the timeframes related to OASIS Transmission. Allows Medicare Mr. Douglas O’Brien, Regional Director – Region V Centers for Medicare and Medicaid Services March 22, 2020 Page 5 Waiver Description of Waiver Provider(s) Electing to Operate Under Each Waiver Administrative Contractors to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs) during emergencies. Provider Locations Temporarily waive requirements that All applicable Providers in Exhibit A out-of-state providers be licensed in the state where they are providing services when they are licensed in another state. This applies to Medicare and Medicaid. Provider Waive the following screening All applicable Providers in Exhibit A Enrollment – requirements: Screening Requirements Application Fee (42 C.F.R 424.514) Criminal background checks associated with FCBC (42 C.F.R 424.518) Site visits (42 C.F.R 424.517) Medicare appeals Waive timeliness for requests for All applicable Providers in Exhibit A in Fee for Service, additional information to adjudicate the MA and Part D appeal Section 1851(i) Waive limitations on payments under All applicable Providers in Exhibit A section 1851(i) of the Act for health care items and services furnished to individuals enrolled in a Medicare Advantage plan by health care professionals or facilities not included in the plan’s network. Section 1135(b)(7) Waive sanctions and penalties arising All applicable Providers in Exhibit A HIPAA Privacy from noncompliance with the following Rule provisions of the HIPAA privacy regulations: (a) the requirements to obtain a patient’s agreement to speak with family members or friends or to honor a patient’s request to opt out of the facility directory (as set forth in 45 C.F.R. § 164.510); (b) the requirement to distribute a notice of privacy practices (as set forth in 45 C.F.R.