Since the Covid-19 pandemic has been declared, the federal government has issued numerous guidelines about Covid-19 waivers in relation to the Health Insurance Portability and Accountability Act (HIPAA). These guidelines are obviously intended to provide the healthcare provider industry the ability to effectively and efficiently respond to the coronavirus pandemic.
But these guidelines can be overwhelming, too! So let’s take a look at the key areas about these waivers that healthcare practitioners should know now. Keep in mind, however, that the federal government can issue more guidelines so these waivers are applicable at the time of writing. If in doubt, ask a healthcare consulting firm for more clarifications and inquire about possible issues from the concerned federal government agencies.
HIPAA and Covid-19 Waivers in General
First and foremost, the provisions related to the Covid-19 waivers are only applicable during the current public health emergency situation. This also presupposes that the concerned hospitals have already implemented the appropriate disaster protocol and healthcare establishments that have done so should have one ASAP. The Covid-19 waivers only extend for 72 hours, maximum, from the time said disaster protocol was implemented.
The Covid-19 waivers extend to the confidential communication and consent between doctors and patients as well as their family members and friends. Basically, healthcare providers aren’t legally obligated to obtain their patients’ consent to discuss their care to family members and/or friends. They also don’t have to comply with confident communication requests and to give Notice of Privacy Practices.
Hospitals and other healthcare providers also have the option of disclosing the personal health information of individuals with Covid-19 to emergency transport personnel. This is obviously for the protection of the emergency transport personnel, particularly so they can take the appropriate safety precautions during treatment en route to the hospital.
Furthermore, hospitals and other covered entities have the option of disclosing personal health information to the first responders. They are, after all, often the first ones to be exposed to the coronavirus. But the disclosure should be allowed under state laws pertaining to public health investigations and interventions.
The tricky part here is in making judgment calls about disclosing personal health information to medical personnel as well as to the patient and his family and friends. In this case, your professional judgment will come into the picture.
Hospital Providers’ Covid-19 Waivers
The Centers for Medicare and Medicaid Services (CMS) has issued 35 waivers related to Covid-19 services for hospitals, too. These waivers have their place, so to speak, in numerous hospital settings but these can be overwhelming. We chose a few of them for clarification.
First, doctors can be allowed to start using their physician privileges ahead of the governing body’s approval. Both physician assistants and nurses can also meet the requirement that all Covid-19 patients should under a physician’s care. But there’s a waiver for the federal requirements covering clinical nurse specialists, physician assistants and nursing practitioners in critical access hospitals.
An important note, however: The state requirements aren’t waived! You have to coordinate with the concerned government agencies to reconcile these two contradicting guidelines.
Second, the authentication or verification of verbal orders can be made by up to 48 hours provided that there was a surge of patients. The use of soft restraints on an ICU patient who dies can also be reported as late as the close of business the following day. These fairly late reporting is allowed due to the unusual caseload and circumstances brought by the coronavirus pandemic.
Lists of nursing homes, quality measures and other data aren’t also required for inclusion in discharge planning. Again, the keyword here is expediency but strategic planning is still a must for effective response. The utilization review plan requirements – all of them, by the way – have also been waived, while therapeutic diet manuals and nursing care plans may or may not be maintained.
Third, hospitals are allowed a certain flexibility in setting up their services in their healthcare facilities in light of temporary expansions. Hospitals are now allowed to use non-hospital spaces including gyms, schools and other buildings as quarantine sites and patient care facilities. But these converted non-hospital spaces should be approved by the state government.
Doctors’ and Nurses’ Covid-19 Waivers
The CMS has also issued waivers for physicians and other healthcare providers intended to expedite their patient care. A few of these waivers are summarized below.
- Doctors can engage in telehealth services including but not limited to inpatient care in hospitals as well as home visits. They can conduct E-Visits and Virtual Check-ins. Take note that talking with a patient through conference meeting platforms, such as GoToMeeting and Zoom, isn’t considered as telehealth as the CMS defines it.
- Physician supervision can also be provided in line with the general supervision standards of hospitals and similar establishments. They can also practice their profession across state lines as long as they have the necessary license in the state where they are enrolled under Medicare.
Skilled nursing practitioners and facilities also have their Covid-19 waivers. The CMS has waived the 3-day requirement prior to hospitalization for SNF stay-related coverage, particularly for patients transferred due to an emergency. The CMS has also provided relief for the time-frame requirements related to the Minimum Data Set.
As the world continues to know more about SARS-Cov-2, the coronavirus that causes Covid-19, the federal and state governments are continuing to issue guidelines accordingly. People in the healthcare industry should be updates about these guidelines including waivers that will have an impact on their delivery of patient services, among others.
The Secretary of the Department of Health and Human Services (HHS) has the authority to change or waive certain HIPAA, Medicare and Medicaid requirements. These are known as 1135 waivers since these are covered by Section 1135 of the Social Security Act. The 1135 waivers include so-called Medicare blanket waivers where healthcare providers are already covered instead of applying for individual 1135 waivers.
With numerous waivers and often complicated provisions, it’s important to actually read the entirety of the waiver guidelines. You can then make the appropriate decisions in your own practice.