CMS Sets Timelines for Modifying, Phasing Out COVID Waivers

The U.S. Centers for Medicare & Medicaid Services (CMS) has offered further guidance on what rules will change when the COVID-19 public health emergency (PHE) ends on May 11.

Generally, the temporary flexibilities and waivers will expire with the federal declaration. Still, some will continue in a modified form or end within different time frames to give providers a chance to catch up. Others have been extended through acts of Congress, though the CMS waivers themselves will terminate.

“At present, the administration’s plan is to extend the emergency declarations to May 11, and then end both [the COVID-19 national emergency and public health emergency] on that date,” the White House Office of Management and Budget (OMB) recently indicated in a statement. “This wind-down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.”


The 1135 waiver for patient recertification via telehealth will end 151 days after the PHE expires. While the waiver specifically is going away, hospices can continue this practice through at least 2024 through provisions in the 2023 omnibus spending bill.

During the PHE, CMS waived requirements for annual onsite assessments of aides by a registered nurse or another skilled professional. This flexibility will go away when the PHE ends, and hospices must complete all postponed assessments within 60 days of May 11.

Also returning is the rule mandating annual skills and competency assessments for all staff offering care, as well as in-service training and education programs as needed. Operators must comply with this requirement by the end of the first full quarter after the PHE declaration expires.


CMS is modifying rules for hospice Quality Assurance and Performance Improvement (QAPI) programs, narrowing the scope of those processes to concentrate on infection control. The agency is keeping the provision that other activities should continue to focus on adverse events.

“This modification decreases burden associated with the development and maintenance of a broad-based QAPI program, allowing the providers to focus efforts on aspects of care delivery most closely associated with COVID-19 and tracking adverse events during the PHE,” CMS indicated. “The requirement that [home health agencies] and hospices maintain an effective, ongoing, agency-wide, data-driven quality assessment and performance improvement program will remain.”

As of May 11, hospices will have to ensure that volunteers provide at least 5% of patient care hours. Clinicians will also return to updating comprehensive assessments within 15 days rather than 21, and hospices must resume offering non-core services as needed. This can include services like physical therapy, occupational therapy and speech-language pathology.

Temporary waivers will also end for portions of the National Fire Protection Association’s Life Safety Code for inpatient facilities, pertaining to placement and storage of alcohol-based hand-rub (ABHR) products and dispensers, temporary construction procedures and fire drills.

For fee-for-service programs, some of the flexibilities around provider appeals to Medicare contractors will remain in place. However, most will end for Medicare Advantage and Part D plans.

CMS will continue to allow contractors to extend the timeframes for fee-for-service operators to file appeals — if they have a good cause for the late filing and their requests meet all regulatory requirements. They will also allow Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) to process appeals that lack complete Appointment of Representation forms or other required elements.

Some flexibilities related to provider enrollment will also change when the PHE ends, such as the expedited processing of hospices’ enrollment applications. Also, practitioners who provide telehealth services from their homes as of May 11 will have to report their home addresses on their Medicare enrollment.

Also going away are opportunities for temporary Medicare billing privileges extended during the public health emergency.

“During the PHE, CMS has established toll-free hotlines for physicians, non-physician practitioners, and Part A certified providers and suppliers who have established isolation facilities to enroll and receive temporary Medicare billing privileges,” CMS noted. “When the PHE ends, the hotlines will be shut down.”