CMS Clears Nurse Practitioners to Perform Some Medical Exams in SNFs in Response to COVID-19

The Centers for Medicare & Medicaid Services (CMS) on Thursday suspended several rules with the goal of maximizing the frontline healthcare workforce during the COVID-19 emergency, with the result that nurse practitioners can now perform some medical exams in the skilled nursing setting.

“It’s all hands on deck during this crisis,” CMS Administrator Seema Verma said in a press release announcing the emergency declaration blanket waivers. “All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic.”

The rule suspensions are designed to let clinicians practice under the full scope of their licenses, according to the press release. The waivers do not require a request to CMS or notification to its regional offices.


As a result of the changes, the requirement that keeps a physician from delegating a task when regulations require it to be performed personally no longer applies. Physicians can now delegate any tasks to an appropriately licensed nurse practitioner, physician assistant or clinical nurse specialist. The tasks delegated under the waiver do have to continue under physician supervision, however.

In addition, CMS waived the requirement that all mandated physician visits, with some exceptions, be made by the physician personally. Now any required physician visit can be delegated to a nurse practitioner, physician assistant or clinical nurse specialist who is not employed by the facility, is working in collaboration with a physician, and is appropriately licensed in the state and working in the state’s scope of practice laws.

The agency noted that the requirements for the frequency of physician visits have not changed, nor have the requirements for physician supervision and for the facility to provide physician services 24 hours a day in case of emergency.


“As set out above, we have only modified the requirement to allow for the requirement to be met by an NP, physician assistant, or clinical nurse specialist, and via telehealth or other remote communication options, as appropriate,” the waiver list notes.

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