COVID-19 RHC Waivers

The COVID-19 Public Health Emergency (PHE) is concluding on May 11, 2023. For details on what this means for RHCs, please review NARHC's recent webinar materials here.

A variety of waivers and flexibilities were granted to RHCs and health care facilities and providers broadly during the COVID-19 pandemic. These can be found here. For more details on telehealth flexibilities please visit https://www.narhc.org/narhc/Telehealth_Policy.asp.

The following CMS waivers have been in place for RHCs:

Certain Staffing Requirements. 42 CFR 491.8(a)(6).

• During the PHE, CMS waived the requirement that a NP, PA, or CNM be available to furnish patient care services at least 50% of the time the RHC is operating.

Physician Supervision of NPs in RHCs and FQHCs. 42 CFR 491.8(b)(1).

• During the PHE, CMS waived the requirement that physicians provide medical direction for the RHCs’ nurse practitioners, to the extent permitted by state law. This waiver will end on 12/31/2023, not immediately when the PHE concludes.

Temporary Expansion Locations. 42 CFR §491.5(a)(3)(iii).

• During the PHE, CMS waived the requirement that RHCs be separately considered for Medicare survey and certification if services were expanded into more than one permanent location, including areas that would not typically meet RHC location requirements. Upon termination of the PHE, these expanded locations will be subject to location requirements and separate survey and certification.

Bed Count for Provider-Based RHCs

• During the PHE, CMS permitted provider-based RHCs subject to their clinic-specific, grandfathered upper-payment limit to increase their hospital bed count 50+ without losing their grandfathered status. At the conclusion of the PHE, grandfathered RHCs must lower their bed count to 49 or less or lose their grandfathered payment status.

Home Nursing Visits

• During the PHE, CMS removed the requirement that RHCs in an area without a current home health area shortage needed a written request and justification in order to provide home nursing services.

Virtual Communication Services

• During the PHE, CMS allowed for online digital evaluation and management services (99421, 99422, and 99423) to be reimbursed under G0071. After the PHE, G0071 should only be used for G2012 and G2010. This was one of the first telecommunications flexibilities granted to RHCs during COVID, but the passing of the CARES Act allowed many more services to be done via telehealth during the PHE and beyond.

CMS has published additional FAQs on these waivers which can be found here. Please email Sarah Hohman at Sarah.Hohman@narhc.org with any questions.