Verbal orders and offsite screening

Allow patient screening at offsite locations and permit extended timing and use of verbal and standing orders; authenticate verbal orders as soon as possible after the fact.

• EMTALA enforcement of section 1867(a) is waived to allow offsite screening consistent with state plans.
• Verbal order authentication may occur later than 48 hours; hospitals and CAHs may use pre-printed/electronic standing orders and order sets.
• A practitioner responsible for the patient must authenticate verbal orders in writing as soon as possible after the fact.

Telemedicine and physician services flexibilities

Permit telemedicine agreements with off-site hospitals and relax the physician requirement so other practitioners may provide care when consistent with state emergency plans.

• Waives telemedicine provisions to allow services furnished through an agreement with an off-site hospital.
• Waives physician-service requirements so hospitals may use other practitioners to the fullest extent possible, subject to state emergency preparedness plans.

CAH staff licensure flexibility

Defer to state licensure rules and allow CAHs to use clinicians as permitted by state law, including flexibility for off‑site locations and non‑rural site establishment.

• Waives 42 CFR §485.608(d) to defer CAH staff licensure, certification, or registration requirements to state law.
• Waives location requirements (§485.610) to allow temporary off-site CAH locations and suspension of rural‑location restrictions.

Practitioner licensure waivers (conditions)

Temporarily waive the requirement that out-of-state practitioners be licensed in the emergency state when four conditions are met; state-level licensure waivers are still required for the practitioner to rely on the CMS waiver.

• Conditions: (1) enrolled in Medicare; (2) valid license in home state tied to Medicare enrollment; (3) furnishing services in the emergency state to contribute to relief efforts (in person or via telehealth); (4) not affirmatively excluded from practice in any state in the 1135 emergency area.
• CMS waiver does not waive state or local licensure requirements—state must also waive its requirements for the practitioner to avail themselves of the CMS waiver.

Provider enrollment flexibilities

Allow expedited enrollment and temporary Medicare billing privileges, waive certain screening requirements, postpone revalidation, and permit rendering services outside state of enrollment.

• Waive application fees, fingerprint-based criminal background checks (to the extent applicable), and site visits.
• Postpone all revalidation actions and expedite pending or new applications.
• Allow licensed providers to render services outside their state of enrollment and to provide telehealth from home without reporting their home address on Medicare enrollment.
• Toll-free hotline available for temporary enrollment and billing privileges; allow early termination of opt-out to enroll in Medicare.

Claims submission coding for blanket waivers

When submitting claims covered by blanket waivers, identify disaster-related services using the DR condition code for institutional claims and the CR modifier for Part B/professional claims (pharmacies: NCPDP format).

• Use condition code 'DR' for institutional claims (ASC X12 837 institutional or CMS-1450).
• Use modifier 'CR' for Part B billing (ASC X12 837 professional, CMS-1500, or NCPDP for pharmacies).
• This coding requirement does not apply for compliance with physician self-referral law waiver submissions.