April 21, 2020

CMS Allows Independent Free-standing Emergency Departments to Temporarily Participate in Medicare and Medicaid

Currently, independent free-standing emergency departments (IFEDs) are not eligible to enroll in Medicare and Medicaid.  Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance allowing licensed IFEDs in Colorado, Delaware, Rhode Island, and Texas to temporarily provide care to Medicare and Medicaid patients. This is part of CMS’ COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, where CMS waived certain Conditions of Participation (CoPs) for hospitals to expand their ability to provide care for patients during this public health emergency (PHE). 

Under the guidance, IFEDs may participate in Medicare and Medicaid in one of three ways:

  • Becoming affiliated with a Medicare/Medicaid-certified hospital under the temporary expansion 1135 emergency waiver;
  • Participating in Medicaid under the clinic benefit if permitted by the state; or
  • Enrolling temporarily as a Medicare/Medicaid-certified hospital to provide hospital services.

Any of these options must be implemented in a manner that is consistent with the state emergency and pandemic plan for patient surges during the COVID-19 PHE. Prior to seeking participation in Medicare or Medicaid, IFEDs should contact their State health department and State Survey Agency to determine the role of these facilities can play during the PHE.

Licensed IFEDs choosing to enroll as a hospital during the COVID-19 PHE must initially meet and continue to meet the Medicare hospital COPs, to the extent not waived.  The IFEDs will receive hospital facility payments from Medicare based on the care provided. They may also provide both inpatient and outpatient care, as needed during the PHE.

To enroll as a temporary hospital during the COVID-19 PHE, the licensed IFED must contact its local Medicare Administrative Contractor (MAC) by calling the MAC’s provider enrollment hotline and following these instructions. Once the Secretary of the Department of Health and Human Services (HHS) determines there is no longer a PHE due to COVID-19, the IFED would lose its hospital billing privileges. If a licensed IFED wishes to become a certified hospital after the PHE has ended, it must begin the process of enrollment and initial certification as a certified hospital under the regular processes. An initial survey, either done by the State Agency or Accreditation Organization (like the Joint Commission), will be conducted to determine compliance with all applicable hospital COPs.

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