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Joint Commission Issues Statement on Homemade Personal Protective Equipment

Tue, 04/07/2020 - 23:19
On March 31, the Joint Commission released a statementsupporting policies that permit healthcare workers to bring their own facemasks or respirators to work if their healthcare facilities cannot provide enough PPE to protect them from COVID-19 risks. The Joint Commission statement recognizes that:
  1. Hospitals must conserve PPEs during shortages for workers who perform high-risk procedures.
  2. Privately owned PPE’s full ability to protect hospital workers from COVID-19 is unknown, but may provide some degree of protection.
  3. The Joint Commission does not have standards or regulations prohibiting hospital staff from using homemade PPE. 
  4. Hospital workers should only use homemade masks when standard PPE is unavailable.
Read more about the evidencethe Joint Commission used to develop this position.

CMS Provides Hospitals Flexibilities to Support COVID-19 Efforts

Fri, 04/03/2020 - 22:52
The Centers for Medicare and Medicaid Services (CMS) recently issued a series of waivers and modifications to help prepare and equip healthcare systems and workers to meet patient-demand resulting from COVID-19. These efforts seek equip hospitals for COVID-19 surges, expedites healthcare practitioner onboarding, and expands telehealth services, increases site-based COVID-19 testing, and reduces paperwork requirements.

These issuances will remain in effect throughout the COVID-19 Public Health Emergency. The following may affect your medical staffs: 
    •  CMS Hospital without Walls (Temporary Expansion Sites)o   Conditions of Participation Modifications §  Enables ambulatory surgery centers to provide hospital services to help meet patient volume. §  Grants freestanding emergency departments a pathway for treating patients during the declared emergency. o   Paperwork Reduction§  Waives certain paperwork requirements for hospitals facing significant strain from COVID-19. §  See CMS guidance for the specific waived requirements. o   Physical Environment§  Allows designated health systems to use offsite, non-hospital buildings such as hotels and community facilities for patient care, room and board, and other patient services. §  Enables facilities to separate non-COVID-19 patients to reduce exposure.o   Temporary Expansion Sites §  Waives certain COP requirements to allow provider-based departments to establish and operate as a hospital.§  Enables hospitals to change their provider-based department location status to meet patient needs in a specific area.o   Critical Access Hospital Length-of-Stay§  Waives the 25 CAH-bed requirement. §  Lifts the 96-hour length-of-stay requirement. o   CAH Status and Location§  Lifts the CAH rural-area stipulation to help meet patient surge.§  Removes location parameters so CAHs can help with surge capacity.o   Hospital Acute-Care Patients in Excluded Distinct Part Units§  Allows acute-care facilities to house acute-care patients in excluded distinct-part units, as appropriate.§  Provides documentation guidance via the applicable patients’ medical records.o   Telemedicine §  Modifies hospital and CAH telemedicine conditions to expand telehealth services. §  Enables patients to receive telehealth care through agreements with off-site hospitals. Patients over Paperwork    •  Verbal Orderso   Grants facilities flexibility for verbal orders. o   Maintains read-back verification requirements but extends the authentication requirement to 48 hours.     •  Reporting Requirementso   Extends the time period hospitals have to report intensive-care patient deaths who required soft-wrist restraints.o   Increases the reporting period to close of the next business day.     •  Limit Discharge Planning for Hospital and CAHso   Waives certain requirements regarding discharge planning and care goals.o   Facilities should work with patients, families, or patient representatives to select post-acute care providers by using and sharing data with post-acute entities.     •  Emergency Preparedness Policies and Procedureso   Waives requirements to establish emergency preparedness communication policies.o   Lifts requirements to provide contact information for staff, entities providing services under arrangement, practitioners, and volunteers.     •  Provider Enrollmento   Makes available toll-free hotlines for providers.o   Waives certain screening requirements, postpones all revalidation actions, and expedites pending or new provider applications. Workforce    •  Medical Staff Requirementso   Waives COPs to allow physicians with expiring privileges to continue practicing at their current facilities. o   Enables new physicians to start practicing in a hospital before medical staff or governing body approval to help meet patient surges.     •  Physician Serviceso   Lifts requirements that Medicare patients be under a physician’s care.o   Enables physician’s assistants and nurses to help meet patient surges.     •  Anesthesia Serviceso   Lifts current nurse anesthetist supervision requirements and permits facilities to set temporary supervision parameters, in accordance with applicable state law.o   Allows nurse anesthetists to function at the fullest extent of their licenses, as it complies with facilities’ activated emergency plans.    •  Respiratory Care Serviceso   Waives requirement that facilities designate in writing qualified personnel to perform specific respiratory-care procedures and their appropriate supervision levels.o   Requires state and activated emergency plan alignment.     •  CAH Personnel Qualificationso   Waives federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants.o   The above practitioners must still meet state-licensure requirements and scope parameters.     •  CAH Staff Licensureo   Defers all staff licensure, certification, or registration to state law by waiving COP requirements that staff be licensed, certified, or registered in compliance with federal, state, and local laws. o   Defers all licensure, certification, and registration requirements for CAH staff to the state. 
The CMS COVID-19 site provides more information on the above modifications, as well as other facility modifications. 
Additional CMS Guidance:    •  The Interim Final Rule and Waivers     •  Provider Guidance for Relaxed Quality Reporting Programs     •  Standards of Practice Flexibility Guidance for Hospital Facilities     •  EMTALA Flexibility Guidance 

HHS Secretary Calls for Governors to Ease Onboarding Protocol as Part of COVID-19 Response

Tue, 03/31/2020 - 20:24
U.S. Health and Human Services Secretary, Alex Azar, recently requestedthat governors modify their states’ onboarding protocol to enable more practitioners to meet the current and upcoming patient demand related to COVID-19.

The Secretary’s letterasks governors to take the following eight actions:
  1. Relax state-licensure requirements and enable practitioners with out-of-state licenses to provide services in person and remotely.
  2. Waive certain regulatory requirements so practitioners can more readily establish patients, diagnose, and delivery treatment options via telemedicine services.
  3. Ease scope-of-practice parameters so more practitioners can provide services in all applicable care settings.
  4. Enable physicians to supervise more practitioners, remotely and via telephone.
  5. Expedite certification and licensure processes for certain practitioners.
  6. Compile state liability protections for in-state and out-of-state practitioners, paid and volunteer. Modify or temporarily withdraw medical malpractice policies that do not cover practitioners that facilities onboard in response to the COVID-19 emergency.
  7. Enable medical students to triage, diagnose, and treat patients with supervision from a licensed medical staff member.
  8. Amend laws or regulations that require signatures for pharmaceutical deliveries.
The Secretary also asks governors to invoke existing state-compact agreements that enable states to modify normal protocol to expand healthcare services and increase access to healthcare practitioners. Look for more information and guidance from the HHS COVID-19 Page.
Visit the NAMSS COVID-19 Page for more MSP resources.

Guidance on the Joint Commission’s Temporary and Disaster Privileging Policies

Mon, 03/30/2020 - 20:07
As COVID-19 increases the demand for healthcare personnel, hospitals are activating their emergency plans to quickly onboard practitioners to meet patient demand. In the current national emergency, the Secretary of Health and Human Services has modified certain CMS requirements, including Conditions of Participation, by invoking 1135 Waivers. This enables hospitals to amend their credentialing and onboarding processes to quickly accommodate more practitioners. The Joint Commission provides the following guidance on temporary and disaster privileging for such emergencies through Medical Staff Chapter, Standard MS.06.01.13.

Temporary Privileges
Per Medical Staff Chapter, Standard MS.06.01.13, Joint Commission-accredited hospitals may grant temporary privileges to quickly increase its number of privileged practitioners when the current number of privileged personnel cannot meet patient volume.

Disaster Privileges
The Joint Commission refers to Emergency Management Chapter, Standard EM.02.02.13 protocol to enable its accredited hospitals to provide temporary privileges once their governing body or hospital board activates their emergency operations plans and need to increase privileged personnel to meet patient demand.  According to Standard EM.02.02.13, EP2 refers to the hospital’s medical staff bylaws to identify the personnel responsible for issuing disaster privileges. In designated emergencies, accredited hospitals may also privilege volunteer licensed independent practitioners.

Typically, those who are licensed independent practitioners in professions that a hospital medical staff recognizes and privileges can practice without supervision. MSPs should refer to their hospital bylaws and state licensure laws to confirm supervision requirements.  State licensure law will also provide guidance on practitioner supervision requirements.

Through Standard EM.02.02.15, the Joint Commission also enables its accredited hospitals to privilege volunteer practitioners who are not licensed independent practitioners, but required to have a license, certification, or registration.

Credentialing and Privileging for Temporary Privileges
The Joint Commission requires its accredited hospitals to verify a practitioner’s current license and competence, as well as document the current need for granting temporary privileges via the MSO Chief of Staff or designee recommendation, in the practitioner’s credentialing file.  MSPs should also query the NPDB before granting temporary privileges.

All hospitals that provide temporary or disaster-related privileges must have protocol for overseeing these practitioners. The Joint Commission provides more logistical guidance on credentialing practitioners during disasters, as well as overseeing practitioners with temporary or disaster-related privileges.

Additional COVID-19 Hospital Resources:
The Joint Commission’s COVID-19 Page.
American Hospital Association
Arent Fox

Member Telemedicine Credentialing Resource: NAMSS-ATA Credentialing by Proxy Guidebook

Sat, 03/28/2020 - 00:00

The sudden reliance on telemedicine amid the COVID-19 pandemic prompts many questions on credentialing practitioners for services not originally considered for telemedicine. The resulting questions often fall to MSPs, who are essential to ensuring and streamlining practitioner access during this pandemic. As such, NAMSS would like to remind its members that the NAMSS/ATA (American Telemedicine Association) Credentialing by Proxy Guidebook is available for this very purpose.
In August 2019, NAMSS introduced the NAMSS-ATA CBP Guidebook, which provides guidance on proxy credentialing for practitioners providing telemedicine. The Guidebook is a result of a multi-year collaborative effort between NAMSS and ATA members that originated from the need to develop a process to more efficiently facilitate proxy credentialing—and to establish standards and guidance for the CBP process. 
The CBP Guidebook also includes an overview of credentialing practitioners providing telemedicine, laws and regulations around telemedicine credentialing, a set of guidelines institutions can use to create CBP programs, and potential solutions to obstacles institutions may encounter when with implementing or facilitating a CBP process. The CBP Guidebook is also applicable for implementing modified credentialing and privileging requirements for additional medical professionals to respond in emergencies such as pandemics.
NAMSS is monitoring the evolving COVID-19 pandemic and is committed to serving you and the medical service profession. Useful resources and information can be viewed here

A Guide to Emergency Credentialing and Privileging for Healthcare Staff during COVID-19 Pandemic

Thu, 03/26/2020 - 01:31

The COVID-19 pandemic implements non-pharmaceutical interventions daily and hospitals and medical professionals are preparing for a large wave of coronavirus cases. Medical professionals and hospitals are eliminating obstacles to provide medical care for COVID-19 patients as quickly as possible such as waiving the need to credential and privilege additional medical professionals in events of emergency or disaster. Here are some key takeaways and resources from recent events:
On March 13, 2020, the President declared a State of National Emergency  Key takeaways:
  1. Grants the Secretary of Health and Human Services Emergency Authority to temporarily waive Medicare and Medicaid program requirements and HIPAA.
  2. The Secretary of HHS is granted power to waive “Conditions of Participation or other certification requirements” and to waive requirements that medical professionals be licensed in the State they practice in.
  3.  The declaration exempts healthcare practitioners who do not have one or more requirements from sanctions or penalties.
Read more here for additional COVID-19 updates from HHS.
California Governor Newsom declared a State of Emergency for California. Key takeaways:  
  1. Permits any out-of-state medical professionals to provide services with respect to licensing and certification as described in the Multi-state Emergency Management Assistance Compact.
  2. The Medical Board of California is granted permission to re-activate expired licenses of physicians if the license expired within the past five years using an accelerated approval process.
The Joint Commission Emergency Management Standards outline hospital requirements in the event of emergency or disaster. Key takeaways include:
  1. Under the Standards, a hospital in the event of disaster “may use a modified credentialing and privileging process on a case-by-case basis for eligible volunteer practitioners” if the hospital implements its Emergency Operations Plan and there is a need for additional medical assistance.
  2. These disaster privileges may be granted only if the volunteer practitioner presents proof of current licensure, privileging at another medical facility, participation in a state of federal response organization, or governmental approval.
  3. A primary source of the hospital may verify the abilities of a volunteer practitioner to act as a licensed independent practitioner during a disaster within 72 hours and the hospital must have an oversight mechanism in writing.
Read more here
NAMSS is monitoring the evolving COVID-19 pandemic and is committed to serving you and the medical service profession. Useful resources and information can be viewed here

COVID-19 Updates

Fri, 03/20/2020 - 01:19

CMS waives state licensure requirements for physicians and recommends hospitals to suspend elective procedures
Becker’s Hospital Review reports that on March 18, CMS waived licensure requirements for physicians and other healthcare professionals allowing them to provide services in states where they are not formally licensed. With the number of U.S. cases now surpassing 7,000, CMS has recommended that all hospitals comply with the American College of Surgeons’ guidance to cancel elective procedures. The Pentagon has immediately taken action and provided the first million of five million respirator masks to federal health agencies. In addition to respirator masks, 2,000 ventilators will be provided in days to come. In the wake of urgency, President Trump has asked Congress to pass a stimulus package that would include $250 billion to Americans affected by this pandemic. HIPAA penalties will not be enforced, allowing healthcare practitioners to communicate with patients by phone.
FSMB is keeping an updated chart of the states waiving licensure requirements and renewals in the wake of the COVID-19 virus.
The Joint Commission Suspends Regular Surveys
The Joint Commission has suspended regular accreditation and certification surveys beginning March 16, 2020 to enable healthcare organizations to respond to COVID-19. The Joint Commission will administer a small number of situational surveys and report on them soon. The Commission will extend healthcare organizations’ accreditation without penalty if the renewal date passes while the surveys are suspended.
Read more from The Joint Commission
CMS Expands Medicare Telehealth Services to Fight COVID-19
The Trump Administration announced the expansion of telehealth services for Medicare beneficiaries to combat the COVID-19 virus. As of March 6, Medicare-funded healthcare professionals and hospitals can provide temporary telehealth services to beneficiaries. Telehealth visits will reflect the same reimbursement rate as in-person visits. These services will also apply to nursing homes and outpatient departments. To facilitate telehealth services, HHS will temporarily suspend some HIPAA requirements, so healthcare practitioners can use their personal devices for telehealth services. Since state Medicaid agencies do not require federal permission, the Administration has requested that states implement telehealth services as well. CMS released a Telehealth Fact Sheet and FAQ Sheet providing guidance for healthcare providers on the telehealth waiver in the Supplemental Appropriations package. Officials hope that the expanding telehealth services will slow the spread of the coronavirus.
Read more here

NAMSS is monitoring the evolving COVID-19 pandemic and is committed to serving you and the medical service profession. Useful resources and information can be viewed here