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CMS Approves First State
Request for 1135 Medicaid Waiver in Florida
Action gives state greater
flexibility for its COVID-19 response efforts
On March 13, 2020, President Trump
declared the rapidly evolving COVID-19 situation a national
emergency. 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. This includes the ability
to grant state and territorial Medicaid agencies a wider range of
flexibilities, and states may now submit Section 1135 waiver requests for
CMS approval that will remove administrative burdens and expand access to
needed services.
Shortly after the President’s
declaration, Florida became the first state to submit a Section 1135 waiver
request in response to the COVID-19 national emergency. In keeping
with CMS’s commitment to ensure our state partners have the tools they need
to combat COVID-19, the agency acted within days to approve a wide variety
of appropriate Medicaid flexibilities.
“I want to thank Governor DeSantis
for his leadership in Medicaid and for taking full advantage of federal
flexibilities,” said CMS Administrator Seema Verma. “CMS is committed to
removing all unnecessary administrative and bureaucratic barriers that may
hinder an effective response to this public health emergency, and I have
directed my team to expeditiously process these requests.”
The state’s approval letter can be
found here, and includes flexibilities that enable the
state to waive prior authorization requirements to remove barriers to needed
services, streamline provider enrollment processes to ensure access to care
for beneficiaries, allow care to be provided in alternative settings in the
event a facility is evacuated to an unlicensed facility, suspend certain
nursing home screening requirements to provide necessary administrative
relief, and extend deadlines for appeals and state fair hearing requests.
These flexibilities will enable the state to focus its resources on
combatting this outbreak and provide the best possible care to Medicaid
beneficiaries in their state.
“Florida is acutely focused on
eliminating unnecessary barriers on our health care providers who are on
the front lines serving our communities most impacted by COVID-19,” said
Florida Governor Ron DeSantis. “President Trump recognizes this need
and Administrator Seema Verma is providing Florida the critical flexibility
for our state’s Medicaid program by waiving prior authorization
requirements for essential health care services and expedited provider
enrollment.”
CMS provides guidance to states on
how to apply for Section 1135 waivers through the Medicaid Disaster
Response Tool Kit, which can be found here. CMS will continue to expeditiously review
and approve as appropriate all Section 1135 waivers and other requests that
the agency receives to ensure that we are providing our state partners with
the maximum flexibility they need to care for their Medicaid beneficiaries
during the public health emergency. To support these efforts, CMS is
developing checklists and tools to expedite requests and approvals for
waivers and other commonly requested flexibilities.
While Florida is the first state to
apply for this waiver authority, CMS expects more states will also submit
similar requests. Additional Section 1135 approval letters will be
posted here as they are issued.
This action, and earlier CMS actions
in response to the COVID-19 virus, are part of the ongoing White House Task
Force efforts. To keep up with the important work the Task Force is doing
in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please
visit the Current
Emergencies Website.
Here is a summary of CMS Public Health Action on COVID-19 to
date:
March 13, 2020: CMS announced a series of blanket waivers
and action taken across the agency’s programs following the President’s
declaration of a national emergency. https://www.cms.gov/newsroom/press-releases/cms-takes-action-nationwide-aggressively-respond-coronavirus-national-emergency
March 13: CMS announced new measures
to protect nursing home residents by significantly restricting visitors and
nonessential personnel. https://www.cms.gov/newsroom/press-releases/cms-announces-new-measures-protect-nursing-home-residents-covid-19
March 13, 2020: CMS issued Frequently Asked Questions (FAQs)
on Essential Health Benefits (EHB)
Coverage in response to the 2019 Novel Coronavirus (COVID-19) outbreak. The
FAQs detail existing federal rules governing health coverage provided
through the individual and small group insurance markets that apply to the
diagnosis and treatment of COVID-19. https://www.cms.gov/newsroom/press-releases/cms-publishes-faqs-ensure-individuals-issuers-and-states-have-clear-information-coverage-benefits
March 12, 2020: CMS issued Frequently
Asked Questions (FAQs) to aid state Medicaid and Children’s Health
Insurance Program (CHIP) agencies in their response to the 2019 Novel
Coronavirus (COVID-19) outbreak. https://www.cms.gov/newsroom/press-releases/cms-publishes-first-set-covid-19-frequently-asked-questions-faqs-state-medicaid-and-childrens-health
March 12, 2020: CMS posted the
payment amounts determined by Local Medicare Administrative Contractors (MACs)
for claims they receive for COVID-19 Test Pricing in their respective
jurisdictions until Medicare establishes national payment rates. https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf
March 10, 2020: CMS issued guidance
to home health agencies and dialysis facilities with actionable information
for healthcare workers on screening, treatment and transfer procedures to
follow when interacting with patients in response to the 2019 Novel
Coronavirus (COVID-19) outbreak. https://www.cms.gov/newsroom/press-releases/cms-sends-more-detailed-guidance-providers-about-covid-19
March 10, 2020: CMS issued a
frequently asked questions to ensure State Survey Agencies and accrediting
organizations charged with inspecting nursing homes and other health care
facilities, understand that non-emergency survey inspections are suspended.
https://www.cms.gov/newsroom/press-releases/covid-19-response-news-alert-cms-issues-frequently-asked-questions-guidance-state-survey-agencies
March 10, 2020: CMS issued guidance
on Medicare Advantage (MA) and Part D health and prescription drug plans
informing them of the flexibilities they have to provide healthcare
coverage for testing, treatments, and prevention of 2019 Novel Coronavirus
Disease (COVID-19). https://www.cms.gov/newsroom/press-releases/cms-issues-guidance-help-medicare-advantage-and-part-d-plans-respond-covid-19
March 10, 2020: CMS issued guidance
on the range of facemasks that can be temporarily used based on recent
changes to CDC and FDA facemask and respirator guidance in light of
COVID-19 and supply demands. https://www.cms.gov/newsroom/press-releases/covid-19-response-news-alert-cms-issues-key-protective-mask-guidance-healthcare-workers
On March 9, 2020: CMS delivered
detailed guidance on the screening, treatment and transfer procedures
healthcare workers must follow when interacting with patients to prevent
the spread of COVID-19 in a hospice setting. CMS also issued additional
guidance specific to nursing homes to help control and prevent the spread
of the virus. https://www.cms.gov/newsroom/press-releases/cms-issues-clear-actionable-guidance-providers-about-covid-19-virus
On March 9, 2020: CMS issued a
fact sheet with additional guidance for healthcare providers and patients
about the telehealth benefits in the agency’s Medicare program. Expanded
use of virtual care, such as virtual check-ins, are important tools for
keeping beneficiaries healthy, while helping to contain the community
spread of the COVID-19 virus. https://www.cms.gov/newsroom/press-releases/telehealth-benefits-medicare-are-lifeline-patients-during-coronavirus-outbreak
On March 9, 2020: CMS published
guidance to hospitals with emergency departments (EDs) on patient
screening, treatment and transfer requirements to prevent the spread
of infectious disease and illness, including
COVID-19. Medicare-participating hospitals are to follow both CDC
guidance for infection control and Emergency Medical Treatment and Labor
Act (EMTALA) requirements. https://www.cms.gov/newsroom/press-releases/cms-issues-call-action-hospital-emergency-departments-screen-patients-coronavirus
March 6, 2020: CMS issued frequently
asked questions and answers (FAQs) for healthcare providers regarding
Medicare payment for laboratory test and other services related to the
2019-Novel Coronavirus (COVID-19). https://www.cms.gov/newsroom/press-releases/covid-19-response-news-alert-cms-issues-frequently-asked-questions-assist-medicare-providers
March 5, 2020: CMS issued a second
Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19
laboratory tests, in addition to three fact sheets about coverage and
benefits for medical services related to COVID-19 for CMS programs. https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests
March 4, 2020: CMS issued a call to
action to healthcare providers nationwide and offered important guidance to
help State Survey Agencies and Accrediting Organizations prioritize their
inspections of healthcare. https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus
February 13, 2020: CMS issued a new
HCPCS code for providers and laboratories to test patients for COVID-19.
https://www.cms.gov/newsroom/press-releases/public-health-news-alert-cms-develops-new-code-coronavirus-lab-test
February 6, 2020: CMS gave
CLIA-certified laboratories information about how they can test for
SARS-CoV-2. https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/notification-surveyors-authorization-emergency-use-cdc-2019-novel-coronavirus-2019-ncov-real-time-rt
February 6, 2020: CMS issued a memo
to help the nation’s healthcare facilities take critical steps to prepare
for COVID-19. https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov
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