First 1135 Waiver Response To COVID-19 Approved: Florida Highlight

Per an announcement today, the Centers for Medicare & Medicaid Services approved the first state request for an 1135 Medicaid Waiver due to COVID-19. On March 13, 2020, President Trump declared the rapidly evolving COVID-19 situation a national emergency.  This action enabled 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 among other flexibilities for CMS approval that will remove administrative burdens and expand access to needed services.

 There are several key areas to highlight in Florida’s submission for consideration by other state I/DD systems considering an 1135 waiver.  A summary of areas to note on Florida’s submission are below:

  • Removes limit on instances of care or number of participants served when reimbursing claims from out-of-state Medicaid or Medicare providers not enrolled in Florida’s Medicaid
  • Waives the following screening requirements so the state may provisionally, temporarily enroll new providers:
    • Payment of the application fee
    • Criminal background checks associated with Fingerprint-based Criminal Background Checks
    • Site visits
    • In-state/territory licensure requirements
  • Florida may also temporarily cease revalidation of providers who are located in Florida or are otherwise directly impacted by the emergency.
  • Waiver of Service Prior Authorization (PA) Requirements for services provided on or after March 1, 2020 through the termination of the emergency declaration for at least 90 days and up to 180 days
  • Waiver for Pre-Admission Screening and Annual Resident Review (PASRR) Level I Level II Assessments for 30 Days
  • Waiver to allow evacuating institutional facilities, including ICF/IDDs, to provide services in alternative settings, such as a temporary shelter when a provider’s facility is inaccessible
  • Modification of the timeframe for managed care entities to resolve appeals before an enrollee may request a State fair hearing to zero days.
  • Modification of the timeframe for enrollees to exercise their appeal rights to allow an additional 120 days to request a fair hearing when the initial 120th day deadline for an enrollee occurred during the period of this Section 1135 waiver
  • Modification of the timeframes to allow beneficiaries to have more than 90 days to request a state fair hearing for eligibility or fee-for-service issues.
  • In the approval letter, CMS clarifies that no waiver is required to allow the state to suspend adverse actions for individuals for whom the state has completed a determination but has not yet sent the notice or for individuals the state believes likely did not receive the notice. Similarly, the state may delay scheduling fair hearings and issuing fair hearing decisions when there is an emergency beyond the agency’s control.

 Link to the approval letter:

You can find the press release here: