Shortly after the State of New York relaxed its direct physician supervision requirements in response to the rampant spread of Novel Coronavirus 2019 (“COVID-19”), the Centers for Medicare and Medicaid Services (“CMS”) published revised standards for its direct physician supervision requirements on March 30, 2020 and April 9, 2020.

March 30, 2020 CMS Guidance

  • The revised standards allow physicians to conduct their required supervision virtually by using real time audio/visual technology (e.g., Zoom, Skype, phone calls, and text messaging).
  • CMS removed the direct physician supervision requirements for “non-surgical extended duration therapeutic services” so long as the physician provides “general supervision.”
  • In the hospital setting, the March 30th guidance waived the requirement that patients must be under the care of a physician, which allows other practitioners such as physician assistants and nurse practitioners the ability to care for patients “to the fullest extent possible.”

April 9, 2020 CMS Guidance

On April 9, 2020, CMS published the following additional waivers to its direct physician supervision requirements:

  • CMS waived the direct supervision requirements for certificated registered nurse anesthetists. Note, however, that state supervision requirements and hospital policies could still apply.
  • CMS waived the supervision requirements for personnel qualified to perform respiratory care services. Note, however, that state supervision requirements and hospital policies could still apply.
  • CMS modified the supervision requirements for nurse practitioners at Rural Health Clinics (“RHCs”) and Federal Qualified Health Centers (“FQHCs”), but only to the extent permitted by state law.

Related PA Department of State Waivers

On April 13, 2020, the Pennsylvania Department of State followed CMS’ lead by suspending certain rules and regulations pertaining to the direct supervision of occupational therapists, occupational therapy assistants, physical therapists, physical therapy assistants, and speech-language pathologists, audiologists, and their respective assistants, as follows:

  • For the above-mentioned health care practitioners, the Department’s guidance suspends direct supervision or in-person contact and permits in-direct supervision, which includes electronic means, such as phone, video, and text messaging.
  • In instances where the applicable rule or regulation calls for in-direct supervision, the above-mentioned practitioners may act with no supervision, but they are strongly encouraged to have electronic access to their supervising practitioner(s).

Please note that all of the direct supervision waivers by CMS and the PA Department of State are temporary in nature and expire at the conclusion of the COVID-19 pandemic, or as directed by the applicable regulatory body.

If you have any questions regarding the revised direct physician supervision requirements and their applicability to your practice, please do not hesitate to contact us.

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