In a radical departure from governmental bureaucracy and red tape, the Centers for Medicare and Medicaid (CMS) on March 28, 2020 issued guidelines to skilled nursing facilities (SNFs) for the duration of the national COVID-19 Emergency Declaration that prioritize resident welfare over paperwork.

What a concept.

Among the highlights:

1. As long as the safety and comfort of residents and staff can be met, SNFs can utilize non-certified areas or locations to isolate and/or treat patients who are COVID positive, or to relocate non-positive residents to accommodate isolation and/or treatment of positive residents or patients. SNFs can set up beds in rooms that are not certified – for example, rooms in Assisted Living Facilities, activity rooms, offices, or conference areas. SNFs can also add beds to existing rooms. In this way, SNFs can better accommodate overflow from hospitals for either non-positive patients or post-acute care for positive patients.

2. SNFs can transfer residents within the building or to another treatment center to separate or cohort positive and non-positive residents without issuing any room or other transfer notices to the affected residents. If the transfer is to another treatment center under arrangements with that facility, the transferring facility will do the billing and make arrangements to pay the other facility.

3. CMS will make accelerated or advance payments upon application by a SNF. SNFs must submit such applications to their Medicare Administrative Contractor, and will be paid within seven calendar days. SNFs must request a specific amount which can be up to 100 percent of their Medicare payments for a three-month period. SNFs must 'repay' the accelerated or advance payments within 120 days, based on the current claims being made. The 'repayment' will occur by CMS automatically deducting the amount advanced from the claims submitted after the 120-day period.

4. CMS extended cost report deadlines by two months.

5. SNFs can hire nursing assistants who demonstrate the requisite skills and competencies to care for residents, but who have not completed the requirements to be a CNA, for a period not to exceed four months.

6. Physician and non-physician practitioner visits can be conducted via telehealth.

7. The following requirements are waived:

   • The three-day hospital stay

   • MDS reporting

   • PASRR

   • Staffing data submission

   • Resident rights to in-person group meetings

   • Timelines for appeals