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CMS 1135 Waiver Information for Providers

By March 19, 2020On the Radar

On March 13, 2020, President Trump declared the rapidly evolving COVID-19 situation a national emergency activating the Stafford Act. This bold action enables the Centers for Medicare and Medicaid Services (CMS) to waive certain requirements in Medicare, Medicaid, and CHIP under Section 1135 authority. Centers for Medicare and Medicaid Services (CMS) has issued broad waivers to assist in the national COVID-19 response. This recent action is being referred to as “blanket” waivers – they can be found at: https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf

Emergency Management Operations:

Organizations should all be functioning with their Emergency Management Incident Command centers open. This allows for better and more cohesive communications across the leadership structure of an organization. Communication internally, as well as with Local/State/Federal agencies is vital in our response to the Covid-19 outbreak.

The 1135 wavier process is normally used when an organization needs to evacuate a facility, but this waiver process also allows for CMS, Regional Offices and State Agencies to relax Regulations to remove the burden or ‘red tape’ that is normally applied in day to day operations.

If you are a healthcare provider and need certain ‘restrictions’ removed in order to respond effectively to the current outbreak – talk with your State Agency (Department of Health) and initiate an 1135 waiver request to get special relief during this period.

1135 waivers are for a given period of time and requires the organization to keep exceptional records on the patients treated during the waiver process and track expenses for future reimbursement purposes.

How Do I Request an 1135 Waiver?

Contact the specific State Department of Health for your location and provide responses to the following basic questions for any impacted provider seeking a potential 1135 waiver:

• Provider Name/Type

• Full Address (including county/city/town/state)

• CCN (Medicare provider number)

• Contact person and his or her contact information for follow-up questions should the Region need additional clarification

• Brief summary of why the waiver is needed. For example: CAH is sole community provider without reasonable transfer options at this point during the specified emergent event (e.g. flooding, tornado, fires, or flu outbreak). CAH needs a waiver to exceed its bed limit by X number of beds for Y days/weeks (be specific).

• Consideration – Type of relief you are seeking or regulatory requirements or regulatory reference that the requestor is seeking to be waived.

• There is no specific form or format that is required to submit the information, but it is helpful to clearly state the scope of the issue and the impact. If a waiver is requested, the information should come directly from the impacted provider to the appropriate Regional Office mailbox with a copy to the appropriate State Agency for Health Care Administration to make sure the waiver request does not conflict with any State requirements and all concerns are addressed timely.

Email Addresses for CMS Regional Offices:

ROATLHSQ@cms.hhs.gov (Atlanta RO): Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

RODALDSC@cms.hhs.gov (Dallas RO): Arkansas, Louisiana, New Mexico, Oklahoma, Texas

ROPHIDSC@cms.hhs.gov (Northeast Consortium): Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, New York, New Jersey, Puerto Rico, Virgin Islands, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

ROCHISC@cms.hhs.gov (Midwest Consortium): Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin, Iowa, Kansas, Missouri, Nebraska

ROSFOSO@cms.hhs.gov (Western Consortium): Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming, Alaska, Idaho, Oregon, Washington, Arizona, California, Hawaii, Nevada, Pacific Territories.

Resources and Links:

CMS 1135 Waivers
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/1135-Waivers

Requesting an 1135 Waiver 101
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/Requesting-an-1135-Waiver-101.pdf

1135 Waiver Authority
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/1135-Waivers-Authority.pdf

Disaster Response Toolkit
https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/index.html

Stafford Act
https://www.fema.gov/robert-t-stafford-disaster-relief-and-emergency-assistance-act-public-law-93-288-amended

James Ballard

Author James Ballard

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