Skip to Main Content
Don't have an account? Create Account

Wash. Receives 1135 Waiver Approval

The Centers for Medicare & Medicaid Services (CMS) on March 19 approved a targeted Section 1135 waiver for Washington to remove Medicare and Medicaid barriers for the state’s response to the COVID-19 outbreak.

Under Section 1135 of the Social Security Act, CMS can waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements and conditions of participation. This authority is granted when the president declares an emergency under the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988 (the Stafford Act) or the National Emergencies Act and the HHS Secretary issues a public health emergency.

CMS earlier this month approved a Section 1135 waiver request from Florida and issued several blanket waivers.

Under Washington’s waiver, the state has the authority to:

  • waive screening requirements to temporarily, provisionally enroll providers not screened by another state’s Medicaid agency or Medicare;
  • allow out-of-state providers to offer care to Medicaid beneficiaries without having to enroll in Washington’s Medicaid program if certain criteria are met;
  • expedite enrollment of out-of-state facilities providing services for patients displaced by the emergency;
  • waive Medicaid prior authorization requirements for beneficiaries receiving coverage under the fee-for-service delivery system;
  • waive pre-admission screening and annual resident review assessments for Medicaid-certified nursing facilities for 30 days;
  • allow facilities to provide services to patients in alternative settings, such as temporary shelters, during an emergency evacuation; and
  • extend deadlines for Medicaid fair hearing requests and appeals at the state level.

The state also requested relief from public notice and tribal consultation requirements for changes to state plan amendments (SPAs). CMS is allowing the state waive these requirements only for SPAs that will provide or increase access to diagnosis and treatment related to COVID-19. The agency encourages Washington to make all relevant information public and use existing flexibility to modify tribal consultation timelines.

CMS denied the state’s request for relief from Drug Enforcement Administration (DEA) medication requirements on the grounds that such relief is outside of CMS’ authority. In the approval letter, the agency said it will consult with the DEA to identify what requirements can be waived during a public health emergency.

America’s Essential Hospitals has created a coronavirus resource page that provides up-to-date information about the outbreak.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

Share

About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.

Previous Next
Close
Test Caption
Test Description goes like this