On January 30, 2023, the White House announced that the COVID-19 national emergency and public health emergency will end on May 11, 2023.

As part of the emergency preparedness cycle, returning to normal operations is the “Recovery Phase.” Although recovery begins immediately after the disaster response or public health emergency has subsided, preparation for this phase should begin now.

Pursuant to the administration’s announcement, it is expected that the Centers for Medicare & Medicaid Services’ (CMS) COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers will expire as well. Unless otherwise noted, these waivers are written to terminate at the end of the public health emergency (PHE). Organizations should begin intentionally transitioning any altered operations to standard operations as May 11 approaches.

Key Points

• Throughout the COVID-19 PHE, CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance.
• Many hospitals adopted portions of the CMS waivers for treatment area modifications, modified patient care processes, and alterations to inspection, testing, and maintenance (ITM) of medical equipment and plant equipment.
• Tracking changes to operations would normally be performed by the Planning Chief in the Incident Command Structure, so assessing what needs to change back may be an easy process. Organizations that did not track these changes should perform an internal gap analysis to identify modifications and plan for the return to normal operations.
• Common waivers applied by healthcare organizations have included:
  • Overflow space or capacity expansion that did not meet minimum design requirements to manage a surge of infectious patients.
  • Supplies and resources: alcohol-based hand rub (ABHR) volumes, placement, and storage; ITM on diagnostic imaging equipment, medical equipment and plant equipment, and medical gas and vacuum systems.
  • Limitations on patient rights for visitation and access to medical record information.
  • Requirements for interior finishes, such as temporary walls and barriers, obstructions to exiting.
  • Suspension of activities such as fire drill procedures, fit testing N95 masks.
  • Acceptance of temporary agreements for telehealth; emergency processes for medical staff credentialing, recredentialing, privileging.
    • Note: Flexibility for Medicare Telehealth Services will end 151 days after the conclusion of the PHE. Refer to the published CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers.
  • ITM for fire protection, such as fire alarm systems, fire sprinkler systems, fire extinguishers, fire and smoke dampers, smoke control systems.
  • ITM for Emergency Power Systems.
  • Acceptance of ventilation modifications including temporary negative pressure rooms and temporary negative pressure units.
  • Adjustments to patient management: nursing care plans; use of verbal orders; timeliness of medical record completion; restraints and seclusion; protocol orders; utilization services; use of swing beds.

Many organizations have been slowly reverting back to normal over the past several months. However, some areas of the country may shift from a pandemic response to an endemic response. Hospitals must continue to monitor local declarations and guidance from CMS regarding waivers in effect and those that have lapsed. ACHC expects the CMS waivers to expire as soon as the national emergency is no longer in effect, so organizations should plan accordingly.

The CMS information website for current emergencies, including the COVID-19 list of Blanket Waivers, is found here: