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situations needed to help with surge capacity. Rooms that may be used for this purposeinclude activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long asresidents can be kept safe, comfortable, and other applicable requirements for participationare met. This can be done so long as it is not inconsistent with a state’s emergencypreparedness or pandemic plan, or as directed by the local or state health department.3- Day Prior Hospitalization: Using the waiver authority under Section 1812(f) of the SocialSecurity Act, CMS is temporarily waiving the requirement for a 3-day prior hospitalization forcoverage of a skilled nursing facility (SNF) stay. This waiver provides temporary emergencycoverage of SNF services without a qualifying hospital stay. In addition, for certainbeneficiaries who exhausted their SNF benefits, it authorizes renewed SNF coverage withoutfirst having to start and complete a 60-day “wellness period” (that is, the 60-day period ofnon-inpatient status that is normally required in order to end the current benefit periodand renew SNF benefits). This waiver will apply only for those beneficiaries who have beendelayed or prevented by the emergency itself from commencing or completing the 60-day“wellness period” that would have occurred under normal circumstances. By contrast, ifthe patient has a continued skilled care need (such as a feeding tube) that is unrelated tothe COVID-19 emergency, then the beneficiary cannot renew his or her SNF benefits underthe Section 1812(f) waiver, as it is this continued skilled care in the SNF rather than theemergency that is preventing the beneficiary from beginning the 60-day “wellness period.”Reporting Minimum Data Set: CMS is waiving 42 CFR §483.20 to provide relief to SNFs onthe timeframe requirements for Minimum Data Set assessments and transmission.Staffing Data Submission: CMS is waiving 42 CFR 483.70(q) to provide relief to long termcare facilities on the requirements for submitting staffing data through the Payroll-BasedJournal system. Submission of staffing data through the Payroll Based Journal system wasreinstated on June 25, 2020.Waive Pre-Admission Screening and Annual Resident Review (PASRR): CMS is allowing statesand nursing homes to suspend these assessments for new residents for 30 days. After 30days, new patients admitted to nursing homes with a mental illness (MI) or intellectualdisability (ID) should receive the assessment as soon as resources become available.Resident Groups: CMS is waiving the requirements at §483.10(f)(5) to allow for residentsto have the right to participate in-person in resident groups. This waiver would only permitthe facility to restrict having in-person meetings during the national emergency given therecommendations of social distancing and limiting gatherings of more than ten people.Refraining from in-person gatherings will help prevent the spread of COVID-19.Quality Assurance and Performance Improvement (QAPI). CMS is modifying certainrequirements in 42 CFR §483.75, which requires long-term care facilities to develop,implement, evaluate, and maintain an effective, comprehensive, data-driven QAPI program.Specifically, CMS is modifying §483.75(b)–(d) and (e)(3) to the extent necessary to narrowthe scope of the QAPI program to focus on adverse events and infection control. Thiswill help ensure facilities focus on aspects of care delivery most closely associated withCOVID-19 during the PHE.In-Service Training: CMS is modifying the nurse aide training requirements at §483.95(g)(1) for SNFs and NFs, which requires the nursing assistant to receive at least 12 hoursof in-service training annually. In accordance with section 1135(b)(5) of the Act, we arepostponing the deadline for completing this requirement throughout the COVID-19 PHEuntil the end of the first full quarter after the declaration of the PHE concludes.402/01/2021

Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities. CMSis waiving the discharge planning requirement in §483.21(c)(1)(viii), which requires LTCfacilities to assist residents and their representatives in selecting a post-acute care providerusing data, such as standardized patient assessment data, quality measures and resourceuse. This temporary waiver is to provide facilities the ability to expedite discharge andmovement of residents among care settings. CMS is maintaining all other dischargeplanning requirements, such as but not limited to, ensuring that the discharge needs of eachresident are identified and result in the development of a discharge plan for each resident;and involving the interdisciplinary team, as defined at 42 CFR §483.21(b)(2)(ii), in theongoing process of developing the discharge plan address the resident's goals of care andtreatment preferences.Clinical Records. Pursuant to section 1135(b)(5) of the Act, CMS is modifying therequirement at 42 CFR §483.10(g)(2)(ii) which requires long-term care (LTC) facilities toprovide a resident a copy of their records within two working days (when requested by theresident). Specifically, CMS is modifying the timeframe requirements to allow LTC facilitiesten working days to provide a resident’s record rather than two working days.Provider Enrollment: CMS has established toll-free hotlines for all providers and PartA certified providers and suppliers establishing isolation facilities to enroll and receivetemporary Medicare billing privileges. In addition, the following flexibilities are provided forprovider enrollment: Waive certain screening requirements. Postpone all revalidation actions. Expedite any pending or new applications from providers.Establish data reporting vehicle critical to addressing the pandemic Required Facility Reporting: Under §483.80(g), long-term care facilities are required toreport COVID-19 cases in their facility to the CDC National Health Safety Network (NHSN) ona weekly basis. CDC and CMS will use information collected through the new NHSN Longterm Care COVID-19 Module to strengthen COVID-19 surveillance locally and nationally;monitor trends in infection rates; and help local, state, and federal health authorities gethelp to nursing homes faster. Nursing home reporting to the CDC is a critical componentof the national COVID-19 surveillance system and to efforts to reopen America. Theinformation will also be posted online for the public to be aware of how the COVID-19pandemic is affecting nursing homes. In COVID-19 Public Health Emergency Interim FinalRule #3 (CMS-3401-IFC), CMS is codifying enforcement actions for facilities noncompliancewith this requirement. Failure to report will result in the imposition of a civil money penaltyfor each occurrence of non-reporting as follows: A civil money penalty of 1,000 for the firstoccurrence, followed by 500 added to the previously imposed civil money penalty for eachsubsequent occurrence, not to exceed the maximum amount set forth in § 488.408(d)(1)(iii).Facilities are also required to notify residents, their representatives, and families of residentsin facilities of the status of COVID-19 in the facility, which includes any new cases ofCOVID-19 as they are identified. This action supports CMS’ commitment to transparency sothat individuals know important information about their environment, or the environmentof a loved one.502/01/2021

Payment Accelerated/Advance Payments: In order to provide additional cash flow to healthcareproviders and suppliers impacted by COVID-19, CMS expanded and streamlined theAccelerated and Advance Payments Program, which provided conditional partial paymentsto providers and suppliers to address disruptions in claims submission and/or claimsprocessing subject to applicable safeguards for fraud, waste and abuse. Under this program,CMS made successful payment of over 100 billion to healthcare providers and suppliers. Asof April 26, 2020, CMS is reevaluating all pending and new applications for the AcceleratedPayment Program and has suspended the Advance Payment Program, in light of directpayments made available through the Department of Health & Human Services’ (HHS)Provider Relief Fund. Distributions made through the Provider Relief Fund do not need tobe repaid. For providers and suppliers who have received accelerated or advance paymentsrelated to the COVID-19 Public Health Emergency, CMS will not pursue recovery of thesepayments until 120 days after the date of payment issuance. Providers and suppliers withquestions regarding the repayment of their accelerated or advance payment(s) shouldcontact their appropriate Medicare Administrative Contractor (MAC).Requirement for Hospitals and CAHs to report COVID-19 Data. Hospitals and CAHs are toreport information in accordance with a frequency and in a standardized format as specifiedby the Secretary during the PHE for COVID-19. More information is available at itydata-reporting.pdf.Medicare appeals in Fee for Service, Medicare Advantage (MA) and Part D CMS is allowing Medicare Administrative Contractors (MACs) and Qualified IndependentContractor (QICs) in the FFS program 42 CFR 405.942 and 42 CFR 405.962 and MA and PartD plans, as well as the Part C and Part D Independent Review Entity (IREs), 42 CFR 562, 42CFR 423.562, 42 CFR 422.582 and 42 CFR 423.582 to allow extensions to file an appeal;CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 andthe Part C and Part D IREs to waive requirements for timeliness for requests for additionalinformation to adjudicate appeals; MA plans may extend the timeframe to adjudicateorganization determinations and reconsiderations for medical items and services (but notPart B drugs) by up to 14 calendar days if: the enrollee requests the extension; the extensionis justified and in the enrollee's interest due to the need for additional medical evidencefrom a noncontract provider that may change an MA organization's decision to deny an itemor service; or, the extension is justified due to extraordinary, exigent, or other non-routinecircumstances and is in the enrollee's interest 42 CFR § 422.568(b)(1)(i), § 422.572(b)(1) and§ 422.590(f)(1);CMS is allowing MACs and QICs in the FFS program 42 C.F.R 405.910 and MA and Part Dplans, as well as the Part C and Part D IREs to process an appeal even with incompleteAppointment of Representation forms 42 CFR § 422.561, 42 CFR § 423.560. However, anycommunications will only be sent to the beneficiary;CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 andMA and Part D plans, as well as the Part C and Part D IREs to process requests for appealthat don’t meet the required elements using information that is available 42 CFR § 422.562,42 CFR § 423.562.CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 andMA and Part D plans, as well as the Part C and Part D IREs, 42 CFR 422.562, 42 CFR 423.562602/01/2021

to utilize all flexibilities available in the appeal process as if good cause requirements aresatisfied.Cost Reporting CMS is delaying the filing deadline of certain cost report due dates due to the COVID-19outbreak. We are currently authorizing delay for the following fiscal year end (FYE) dates.CMS will delay the filing deadline of FYE 10/31/2019 cost reports due by March 31, 2020and FYE 11/30/2019 cost reports due by April 30, 2020. The extended cost report due datesfor these October and November FYEs will be June 30, 2020. CMS will also delay the filingdeadline of the FYE 12/31/2019 cost reports due by May 31, 2020. The revised extendedcost report due date for FYE 12/31/2019 will be August 31, 2020. For the FYE 01/31/2020cost report, the extended due date is August 31, 2020. For the FYE 02/29/2020 cost report,the extended due date is September 30, 2020.CMS Facility without Walls (Temporary Expansion Sites) Transfers of COVID -19 Patients: A long term care (LTC) facility can temporarily transfer itsCOVID-19 positive resident(s) to another facility, such as a COVID-19 isolation and treatmentlocation, with the provision of services “under arrangements.” The transferring LTC facilityneed not issue a formal discharge in this situation, as it is still considered the provider andshould bill Medicare normally for each day of care. The transferring LTC facility is thenresponsible for reimbursing the other provider that accepted its resident(s) during theemergency period. This is consistent with recent CDC guidance, and helps residents withCOVID-19 by placing them into facilities that are prepared to care for them. It also helpsresidents without COVID-19 by placing them in facilities without other COVID-19 residents,thus helping to protect them from being infected.If the LTC facility does not intend to provide services under arrangement, the COVID-19isolation and treatment facility is the responsible entity for Medicare billing purposes. TheSNF should follow the procedures described in 40.3.4 of the Medicare Claims ProcessingManual ance/Manuals/Downloads/clm104c06.pdf) to submit a discharge bill to Medicare. The COVID-19 isolation andtreatment facility should then bill Medicare appropriately for the type of care it is providingfor the beneficiary. If the COVID-19 isolation and treatment facility is not yet an enrolledprovider, the facility should enroll through the provider enrollment hotline for the MedicareAdministrative Contractor that services their geographic area to establish temporaryMedicare billing privileges.Resident Transfer and Discharge: CMS is waiving requirements in 42 CFR 483.10(c)(5);483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), (c)(9), and (d); and § 483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) (with some exceptions noted below) to allow a long term care facility to transfer ordischarge residents to another LTC facility solely for the following cohorting purposes:1. Transferring residents with symptoms of a respiratory infection or confirmed diagnosisof COVID-19 to another facility that agrees to accept each specific resident, and isdedicated to the care of such residents;2. Transferring residents without symptoms of a respiratory infection or confirmed to nothave COVID-19 to another facility that agrees to accept each specific resident, and isdedicated to the care of such residents to prevent them from acquiring COVID-19, aswell as providing treatment or therapy for other conditions as required by the resident’s702/01/2021

plan of care; or3. Transferring residents without symptoms of a respiratory infection to another facilitythat agrees to accept each specific resident to observe for any signs or symptoms of arespiratory infection over 14 days.Exceptions:o These requirements are only waived in cases where the transferring facility receivesconfirmation that the receiving facility agrees to accept the resident to be transferredor discharged. Confirmation may be in writing or verbal. If verbal, the transferringfacility needs to document the date, time, and person that the receiving facilitycommunicated agreement.o In § 483.10, we are only waiving the requirement, under § 483.10(c)(5), that afacility provide advance notification of options relating to the transfer or dischargeto another facility. Otherwise, all requirements related to § 483.10 continue to apply.Similarly, in § 483.15, we are only waiving the requirement, under § 483.15(c)(3), (c)(4)(ii), (c)(5)(i) and (iv), and (d), for the written notice of transfer or discharge to beprovided before the transfer or discharge. This notice must be provided as soon aspracticable.o In § 483.21, we are only waiving the timeframes for certain care planningrequirements for residents who are transferred or discharged for the purposesexplained in 1–3 above. Receiving facilities should complete the required care plansas soon as practicable, and we expect receiving facilities to review and use the careplans for residents from the transferring facility, and adjust as necessary to protectthe health and safety of the residents they apply to.o These requirements are also waived when the transferring residents to anotherfacility, such as a COVID-19 isolation and treatment location, with the provisionof services “under arrangements,” as long as it is not inconsistent with a state’semergency preparedness or pandemic plan, or as directed by the local or state healthdepartment. In these cases, the transferring LTC facility need not issue a formaldischarge, as it is still considered the resident’s provider and should bill Medicarenormally for each day of care. The transferring LTC facility is then responsible forreimbursing the other provider that accepted its resident(s) during the emergencyperiod.o If the LTC facility does not intend to provide services under arrangement, theCOVID-19 isolation and treatment facility is the responsible entity for Medicarebilling purposes. The LTC facility should follow the procedures described in 40.3.4of the Medicare Claims Processing Manual nce/Manuals/Downloads/clm104c06.pdf) to submit a discharge billto Medicare. The COVID-19 isolation and treatment facility should then bill Medicareappropriately for the type of care it is providing for the beneficiary. If the COVID-19isolation and treatment facility is not yet an enrolled provider, the facility should802/01/2021

enroll through the provider enrollment hotline for the Medicare AdministrativeContractor that services their geographic area to establish temporary Medicarebilling privileges.We remind LTC facilities that they are responsible for ensuring that any transfers(either within a facility, or to another facility) are conducted in a safe and orderlymanner, and that each resident’s health and safety is protected. We also remindstates that under 42 CFR 488.426(a)(1), in an emergency, the State has the authorityto transfer Medicaid and Medicare residents to another facility. Resident Roommates and Grouping: CMS is waiving the requirements in 42 CFR 483.10(e)(5), (6), and (7) solely for the purposes of grouping or cohorting residents with respiratoryillness symptoms and/or residents with a confirmed diagnosis of COVID-19, and separatingthem from residents who are asymptomatic or tested negative for COVID-19. This actionwaives a facility’s requirements, under 42 CFR 483.10, to provide for a resident to share aroom with his or her roommate of choice in certain circumstances, to provide notice andrationale for changing a resident’s room, and to provide for a resident’s refusal a transfer toanother room in the facility. This aligns with CDC guidance to preferably place residents inlocations designed to care for COVID-19 residents, to prevent the transmission of COVID-19to other residents.Inspection, Testing & Maintenance (ITM) under the Physical Environment Conditions ofParticipation: CMS is waiving certain physical environment requirements for Hospitals, CAHs,inpatient hospice, ICF/IIDs, and SNFs/NFs to reduce disruption of patient care and potentialexposure/transmission of COVID-19. The physical environment regulations require thatfacilities and equipment be maintained to ensure an acceptable level of safety and quality.CMS will permit facilities to adjust scheduled inspection, testing and maintenance (ITM)frequencies and activities for facility and medical equipment.Specific Physical Environment Waiver Information: 42 CFR §482.41(d) for hospitals, §485.623(b) for CAH, §418.110(c)(2)(iv) for inpatienthospice, §483.470(j) for ICF/IID; and §483.90 for SNFs/NFs all require these facilities andtheir equipment to be maintained to ensure an acceptable level of safety and quality. CMS istemporarily modifying these requirements to the extent necessary to permit these facilitiesto adjust scheduled inspection, testing and maintenance (ITM) frequencies and activities forfacility and medical equipment. 42 CFR §482.41(b)(1)(i) and (c) for hospit

Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19 . “SNF Consolidated Billing Provisions”). Through the exercise of that discretion, CMS will allow . coverage of a skilled nursing facility