Licensing and certification

Attachment-02

Waiver Instructions

Type of Waiver Modification Requested	Criteria to be Reviewed
Hospitals request to set up an alternative screening location for patients away from the hospital's main campus (requiring waiver of the Emergency Medical Treatment an Labor Act-EMTALA)	Has the Hospital initiated its Disaster Response Plan (a necessary pre-condition prior to operating under an EMTALA waiver)? Are other hospitals nearby experiencing similar needs? Does this hospital provide services to a specialized population(such as Children's hospital)? Are other hospitals in the area at or near capacity (verified through hospital or hospital association contacts, electronic trauma tracking systems-such as ASPR's Hospital Available Bed (HAvBED), EMSystems, or other emergency reporting systems). (Much of this information will be provided by the hospital, but can be verified through onsite visits or other direct contact by the state survey agency, accrediting organization (?) and CMS regional office, if necessary)
Critical Access Hospitals requesting waiver of 42 CFR 485.620 which requires a 25-bed limit and average patient stays less than 96 hours	Is the CAH at or near the 25-bed capacity limit? Have any patients exceeded the 96-hour length of stay? How many? Are other hospitals willing to take the patients in transfer? If not, why? (Much of this information will be provided by the CAH but can be verified through onsite visits or other direct contact by the state survey agency, accrediting organization (?) and CMS regional office, if necessary).
Skilled Nursing Facilities requesting a waiver of 42 CFR 483.5, which requires CMS approval prior to increasing the number of certified beds in a distinct part	Is the Skilled Nursing Facility at or near current capacity? Is the Skilled Nursing Facility meeting their staffing requirements? Are hospitals reporting problems with placement of discharged patients? Is there capacity at Skilled Nursing Facilities in the area? (Much of this information will be provided by the Skilled Nursing Facility, but can be verified through onsite visits or other direct contact by the state survey agency and CMS regional office, if necessary).

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