Key points:

CMS waivers adopted under the 1135 emergency waiver authority create additional flexibilities to allow enrolled ASCs to temporarily enroll as hospitals and to provide hospital services to help address the urgent need to care for patients.

This memorandum outlines the steps for processing attestations and certification kits for existing Medicare certified ASCs that choose to temporarily enroll as a hospital during the COVID-19 Public Health Emergency (PHE).

ASCs have been identified as a critical resource to assist in expanding capacity for inpatient and outpatient hospital services for patients requiring care. Consistent with the Hospitals without Walls strategy announced by the CMS Administrator, interested ASCs are to coordinate with their local healthcare systems and/or their state and local health departments operating under their state’s emergency preparedness or pandemic plan during this PHE to help meet surge needs in their community.

Additional guidance provided in CMS QSO 20-24 include:

  1. CMS is allowing all Medicare-enrolled ASCs to enroll as hospitals and provide inpatient and outpatient hospital services to help the urgent need to care for patients.
  2. Any Medicare-certified ASC wishing to enroll as a hospital during the COVID-19 PHE should notify the Medicare Administrative Contractor (MAC) that serves their jurisdiction by calling the MAC’s provider enrollment hotline. Follow the instructions noted in the 2019- Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs) document.
  3. The ASC will be asked by the MAC to submit a signed attestation statement (attached to memo).
  4. The provider cannot be certified/enrolled both as an ASC and hospital at the same time. If an ASC enrolls as a hospital, it must meet the hospital Conditions of Participation, to the extent not waived, and would receive hospital payments, not ASC payments. Therefore, any ASC that is enrolled as a hospital will have its ASC billing privileges deactivated for the duration of the time it is enrolled as a hospital.
  5. The MAC will review and forward the signed attestation to the CMS RO for review. Within two business days, the CMS Regional Office (RO) will review all survey activity of the facility from the previous three years (recertification and/or complaint), to determine if Immediate Jeopardy (IJ)-level deficiencies were cited. If no IJ-level deficiencies were found in the previous three years, or if IJ-level deficiencies were found but subsequently removed through the normal survey process, the CMS RO will assign a hospital CMS Certification Number (CCN). Note that an onsite survey is not required for approval.
  6. Once there is no longer a need for the ASC to be a hospital under their state’s emergency preparedness or pandemic plan, the ASC should come back into compliance with all applicable ASC federal participation requirements, including the Conditions for Coverage.

Are any HFAP Standards affected? This is provided for information only.

Effective date: April 3, 2020

Read the entire memo.