SECTION 1135 WAIVERS AID STATES AMID COVID-19

CMS Section 1135 Waivers Medicaid Syrtis Solutions

30 Mar SECTION 1135 WAIVERS AID STATES AMID COVID-19

After COVID-19 was declared a national emergency on March 13th, the Centers for Medicare and Medicaid Services (CMS) was able to waive stipulations in federally funded programs to help States respond to the pandemic. To date, CMS has approved Medicaid Section 1135 Waivers for 23 States that grant them the authority to suspend pre-admission screening for nursing facilities. In addition, Washington, Missouri, North Dakota, and Oregon also have the authority to change Medicaid rates, cost-sharing amounts, and premiums without notifying the public.

According to the Centers for Disease Control (CDC), 122,653 people in the United States have been infected and 2,112 have died. The data includes both confirmed and presumptive positive cases of COVID-19 reports to the CDC or tested at the CDC since January 21, 2020. However, those numbers are likely to increase as a result of the lack of available testing.

Aside from the Medicaid waivers, the Department of Health and Human Services (HHS) and CMS are also responding to the situation by expanding Medicare. Their efforts are geared at removing regulatory barriers for States and Medicare restrictions. CMS is also requiring Medicare Part D and Advantage prescription plans to waive cost-sharing for COVID-19 testing and treatment. Additionally, CMS is requesting that hospitals postpone elective surgeries to conserve resources.

Click here to see Syrtis Solution’s most recent COVID-19 announcement.

Section 1135 Waiver Flexibilities

CMS has approved the most lenient Medicaid waivers to New Hampshire, New Jersey, Illinois, and Mississippi. Their waivers include the following provisions:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements. Section 1135(b)(1)(C) allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.

  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.

  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.

  • Allow modification to the timeframe for State fair hearing requests and appeals.

  • Temporarily enroll providers who are enrolled with another State Medicaid Agency and/or Medicare for the duration of the public health emergency.

  • Provision of services in alternative settings allowing facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

North Carolina requested all of the Section 1135 Waiver provisions above except extending pre-existing authorizations. California, New Mexico, Louisiana, and Arizona also made similar requests.

Currently, CMS is still working on additional waiver requests from New Hampshire, California, Illinois, Arizona, Louisiana, New Jersey, Mississippi, North Carolina, New Mexico, and Virginia.

California’s governor, Gavin Newsom, has also requested federal assistance to supplement temporary housing for the homeless in the event that they are exposed to or test positive for COVID-19 and flexibilities to waive the cost of testing and treatment for specific Medi-Cal beneficiaries.

Due to the significant impact of COVID-19, federal departments and agencies are working to reduce regulation and barriers through Section 1135 Waivers to help States respond to the pandemic. These waivers are effective as of March 1 and last for the duration of the public health emergency or any extension thereof.