CMS issues guidance on end of PHE

CMS is ending a requirement that all hospital providers and suppliers be vaccinated against COVID-19 as of the end of the public health emergency (PHE) on May 11, according to new guidance issued on May 1 in the Quality, Safety & Oversight (QS) Group memo to CMS state agencies, “Guidance for the Expiration of the COVID-19 Public Health Emergency,” QSO-23-13-All.

“On May 11, 2023, the COVID-19 public health emergency is expected to expire,” the memo states. Because of that and comments offered to the interim final rule mandating the vaccine, “CMS will soon end the requirement that covered providers and suppliers establish policies and procedures for staff vaccination. CMS will share more details regarding ending this requirement at the anticipated end of the public health emergency. We continue to remind everyone that the strongest protection from COVID-19 is the vaccine.”

The full 23-page memo also identifies other exemptions for hospitals and other provider types that are ending with the PHE. The guidance largely follows information that has been released since the end of the PHE was announced earlier this year. The following are exemptions that are of importance to the medical staff.

Anesthesia Services - 42 CFR §482.52(a)(5), §485.639(c) (2), and §416.42 (b)(2)

CMS waived requirements that a certified registered nurse anesthetist (CRNA) is under the supervision of a physician. The waiver of this requirement ends upon the conclusion of the PHE.


CMS waived the enforcement of section 1867(a) of the Act. This allowed hospitals, psychiatric hospitals, and critical access hospitals (CAH) to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19, as long as it was consistent with a state’s emergency preparedness or pandemic plan. The waiver of this requirement ends upon the conclusion of the PHE.

Medical Staff - 42 CFR §482.22(a)(1)-(4)

CMS waived the requirements at 42 CFR §482.22(a)(1)-(4) to allow for physicians whose privileges will expire to continue practicing at the hospital and for new physicians to be able to practice before full medical staff/governing body review and approval to address workforce concerns related to COVID-19. CMS waived §482.22(a) (1)-(4) regarding details of the credentialing and privileging process. The waiver of this requirement ends upon the conclusion of the PHE.

ASC Medical Staff - 42 CFR 416.45(b)

CMS waived the requirement that medical staff privileges must be periodically reappraised, and the scope of procedures performed in the ASC must be periodically reviewed. The waiver of this requirement ends with the conclusion of the PHE.

Telemedicine - 42 CFR §482.12(a)(8)– (9) and §485.616(c)

CMS waived the requirements for written agreements between those hospitals and CAHs using telemedicine services and the distant-site hospitals or distant-site telemedicine entities furnishing the services. These telemedicine requirements are specific to the credentialing and privileging processes (and their supporting written agreements) used by hospitals and CAHs for the credentialing and privileging of distant-site telemedicine practitioners providing services to patients in the hospital or CAH. The waiver of this requirement ends upon the conclusion of the PHE.