By: Andrew Eills
March 23, 2020
Expedited healthcare provider enrollment in Medicare is crucial to increasing the availability of physicians and non-physician practitioners. CMS has issued, as of March 23, 2020, responses to questions concerning new flexible Medicare enrollment procedures occasioned by the COVID-19 national emergency. CMS is employing its authority under Section 1135 of the Social Security Act to make Medicare provider enrollment faster and easier.
In order to facilitate enrollment CMS has established hotlines for providers to initiate temporary Medicare billing privileges. CMS is also waiving certain screening requirements.
The FAQs can be found here: https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf.
For out-of-state physicians and non-physician practitioners, the 1135 waiver is only available if all four of the following conditions are met: 1) the physician or non-physician practitioner must be enrolled in the Medicare program, 2) the physician or non-physician practitioner must possess a valid license to practice in the State which relates to his or her Medicare enrollment, 3) the physician or non-physician practitioner is furnishing services – whether in person or via telehealth – in a State in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity, and 4) the physician or non-physician practitioner is not affirmatively excluded from practice in the State or any other State that is part of the 1135 emergency area.
CMS notes that “in order for the physician or non-physician practitioner to avail him- or herself of the 1135 waiver under the conditions described above, the State also would have to waive its licensure requirements, either individually or categorically, for the type of practice for which the physician or non-physician practitioner is licensed in his or her home State.” As of today, Massachusetts and New Hampshire have issued declarations and guidance regarding these waivers. See, https://www.sheehan.com/news/health-professional-licensing-update-practicing-medicine-across-state-lines-without-a-license-to-respond-to-covid-19/.