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Surge Capacity Without the Need for a Waiver

Monday, February 12, 2018   (0 Comments)
Posted by: TCAA Staff
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Many facilities are experiencing significant patient surge due to seasonal illness. There are currently no federal-level declarations of emergency from either the President or the Secretary of Health and Human Services, therefore waivers to section 1135 of the Social Security Act are not possible at this time. The Centers for Medicare & Medicaid Services (CMS) has considerable information from similar past events, on ways to increase inpatient and outpatient capacity without the need for 1135 waivers. Inpatient surge activities include early discharge planning, opening already certified beds or units, and the use of remote locations. Outpatient surge activities include the use of tents or mobile facilities located on/within the hospitals’ campus as a temporary means of allowing for the management of outpatient surge. These facilities must meet all the conditions of participation for CMS AND must comply with all State and county licensure and life safety code requirements. This information is described in detail in the Fact Sheet, “Hospital Alternative Care Sites during H1N1 Public Health Emergency”, starting on page 7 of 14 for inpatient surge, and page 9 of 14 for outpatient surge actions permissible without waivers. As always, when using surge strategies, notify your State licensing agency and CMS Regional Offices.


With regards to conditions of participation, the CMS Fact Sheet includes the following language on page 9: (excerpt below)

“Such alternative care sites on a hospital or CAH’s main campus could include tents, parked mobile units, or other facility-based treatment areas. Use of tents would be expected to be a temporary rather than a permanent measure, but would be permissible. Hospitals and CAHs must ensure that all care locations comply with State licensure rules and the applicable Medicare hospital or CAH CoPs. When the alternative care sites are off the hospital’s or CAH’s main campus, the hospital must also comply with Medicare rules governing off-campus departments that are treated as part of the hospital (the provider-based rules).”


With regards to life safety code, the CMS Fact Sheet discusses degraded but safe conditions on page 13 and 14: (excerpt below)

“Additionally, for facilities subject to the Life Safety Code (LSC), past experience has demonstrated that many facilities, even when functioning in a degraded status, or in the case of the establishment of alternative care sites, may continue to meet the LSC by implementing reasonable and prudent measures. For example, there were several hospitals that were damaged by Hurricane Katrina which continued to comply with the LSC by implementing reasonable and prudent measures, and therefore were able to continue operations in a degraded but safe environment for weeks or months until repairs could be completed.”

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