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REGULATORY REVIEW


THURSDAY, MARCH 19 ASCA releases guidance for ASCs on necessary surgeries: As concerns about PPE, staffing, hospital bed and ventilator shortages ramped up, ASCA put out a public release again indicating when it would be appropriate and desirable for ASCs to step up and serve their communities. While many states were beginning to impose restrictions on facilities remaining open, most were still allowing ASCs to remain open to provide urgent or emergent care. According to ASCA, “Examples of cases that might still need to proceed


with surgery at this time include: ■


Acute infection


Acute trauma that would signifi- cantly worsen without surgery ■ Potential malignancy


■ ■ ■


Uncontrollable pain that would oth- erwise require a hospital admission


A condition where prognosis would significantly worsen with a delay in treatment.”


ASCA sends letter to CMS Administrator Seema Verma requesting resources to help ASCs continue to serve patients now and


in the long term. Requests included: ■


Funding for the labor-related por- tion of care as staffing is impacted by needs of other providers and required sick leave.


■ ■ ■


Suspending payroll and other taxes for healthcare providers.


Waiving Medicare sequestration reductions.


Waiving budget neutrality require- ments of facility and physician Medicare fee schedules.


FRIDAY, MARCH 20 ASCA sends guidance to Trump administration outlining ASC surge capacity. As discussions were taking place to determine where overflow patients could go. ASCA wanted to make clear that ASCs were





happy to help but that they are best equipped to take on more urgent and needed outpatient care. Although discussions were taking place about commandeering facilities and turning them into COVID-19 wards, or taking equipment, such as anesthesia machines, and using them for ventilators, ASCA advocated that these be used only as an absolute last resort.


SUNDAY, MARCH 22 US Food & Drug Administration (FDA) releases ventilator supply mitigation strategies: letter to healthcare providers. Among other recommendations, the FDA guidance allowed for anesthesia machines to be repurposed as ventilators when needed.


FRIDAY, MARCH 27 Coronavirus Aid Relief and Economic Security (CARES) Act enacted. President Trump signed H.R. 748, the third and most expensive package of legislation to provide relief and support in response to the COVID-19 pandemic. The CARES Act suspended sequestration reductions from May 1–December 31, 2020, as ASCA had requested earlier in the month. In addition, three possible sources of financial assistance became available


to ASCs: ■


$350 billion in Paycheck Protection Program (PPP) loans for small busi- nesses designed to provide stability in light of the uncertain economic conditions caused by COVID-19; fully forgivable if certain conditions are met;


$450 billion in loans, loan guar- antees and other investments for businesses;





$100 billion reserved for health- care providers to make up lost rev- enue or support additional costs that are attributable to the coronavirus. Administered by HHS and subject to guidance and requirements issued by HHS.


SATURDAY, MARCH 28 CMS announces the expansion of the advanced and accelerated payment program. This provided ASCs with access to funding based on fee-for-service (FFS) Medicare volume to address cash flow issues due to a disruption in operations. CMS would begin recoupment of funds through claims submissions after a 120-day grace period.


MONDAY, MARCH 30 CMS announces sweeping regulatory changes to address the surge that is expected due to the COVID-19 pandemic. After many discussions with White House and HHS staff as to the role ASCs could play during the COVID-19 pandemic, CMS used its authority, including Section 1135 waivers, to create the hospital without walls (HWOW) program. ASCs were provided two options for participation


in the HWOW program: ■


1) contract with local healthcare sys- tems to provide hospital services, or





2) enroll and bill as hospitals during the emergency declaration if it is not inconsistent with their state’s emergency preparedness or pan- demic plan. ASCs that chose to enroll to receive temporary billing privileges as a hospital could call the COVID-19 provider enrollment hotline to reach the contractor that serves their jurisdiction and com- plete and sign an attestation form specific to the COVID-19 PHE.


Although this program was not as successful or as widely adopted as CMS had envisioned, it was critical as the industry played defense against ASCs being converted into COVID-19 wards or having their equipment seized.


Kara Newbury is ASCA’s director of Govern- ment Affairs and regulatory counsel. Write her at knewbury@ascassociation.org.


ASC FOCUS NOVEMBER/DECEMBER 2020| ascfocus.org 21


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