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CMS releases guidance for temporary ASC-to-hospital conversions

Apr 6, 2020

The Centers for Medicare & Medicaid Services has recently announced an unprecedented “Hospitals Without Walls” program to aid in the fight against COVID-19. 

The goal of this program is to ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites including other, non-affiliated healthcare providers and even unlicensed locations such as community centers and schools. 

Included in the array of regulatory waivers is a temporary condition of participation waivers that would allow Ambulatory Surgery Centers (ASCs) to convert to hospital status and provide hospital services in order to aid in the fight against the pandemic so long as such conversions would not be inconsistent with applicable state emergency response plans. The original, limited guidance called for ASCs to complete the conversion by reaching out to their Medicare Administrative Contractor (MAC) and completing an attestation. 

On April 3, CMS released new, more detailed conversion guidance to the State Survey Agencies.  The conversion process as set forth in the new guidance is as follows:

Medicare-certified ASCs wishing to enroll as a hospital must first notify the MAC serving its jurisdiction of the ASC’s intention to convert to hospital status.

  • The ASC will be asked by the MAC to submit the signed attestation statement included with the guidance and attached here.
  • The MAC will forward the signed attestation statement to the appropriate CMS Regional Office.
  • Within two days, the CMS Regional Office will review survey information to determine whether the ASC was placed on Immediate Jeopardy (IJ) status within the previous three years.
  • If no IJ-level deficiencies were found in the previous three years, or if IJ-level deficiencies were found but subsequently removed through the normal survey process, the CMS Regional Office will: (1) review and approve the attestation statement; (2) create a new facility profile and certification kit in the Automated Survey Process Environment (ASPEN) and assign a hospital CMS Certification Number (CCN); and (3) send a tie-in notice as a hospital to the MAC. The effective date of enrollment is the date when the attestation was accepted by the MAC.  An on-site survey is not required for approval.

As noted in the guidance, an ASC cannot be certified/enrolled as a hospital and an ASC at the same time.  Therefore, ASCs enrolling as hospitals will have their ASC provider status and their ASC billing privileges de-activated during the period they are enrolled as hospitals.  Once the Secretary of the Department of Health and Human Services declares the COVID-19 Public Health Emergency has ended, or upon written notice from the converted ASC to its MAC that it no longer wishes to be enrolled as a hospital, the Regional Office will terminate the hospital CCN and send a tie-out notice to the MAC.  The MAC will deactivate the hospital billing privileges and reinstate the ASC billing privileges effective on the date the ASC terminates its hospital status.

Note that the CMS guidance does not require the ASC to obtain a state hospital license in order to complete the conversion.  The only state requirement is that conversion not be in conflict with state emergency preparedness or pandemic plan. If the ASC chooses to enroll as a hospital, it must meet the hospital conditions of participation to the extent those conditions are not waived in connection with the program.  Once the emergency has ended and the facility transitions back to an ASC, it must come back into compliance with all applicable ASC federal participation requirements. 

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