CMS Approves Additional Medicaid Section 1135 Waivers in Light of COVID-19
CMS Approves Additional Medicaid Section 1135 Waivers in Light of COVID-19
California is fighting for more flexibility in treatment options to best assist the healthcare providers in the state to battle the COVID-19 outbreak and get the best care to those in need. Part of that fight is to seek additional waivers from the Centers for Medicare and Medicaid Services (“CMS”). CMS has granted the following additional waivers in California:
Medicaid Fee-For-Service Prior Authorization Requirements: California may waive or modify the state plan prior authorization requirements and processes for benefits through the fee-for-service delivery system and can extend prior authorizations, which a beneficiary has already received through the fee-for-service delivery system, through the end of the declared public health emergency.
State Fair Hearing Requests and Appeal Timelines: California may provide managed care entities with no less than one day to resolve appeals before an enrollee may request a State fair hearing, which allows enrollees to proceed with a hearing request almost immediately. In addition, enrollees have more than 90 days, up to an additional 120 days, to request a hearing for an eligibility or fee for service appeal.
Provider Enrollment: California may provisionally, temporarily enroll providers who are enrolled with another State Medicaid Agency or Medicare. California may also reimburse out-of-state providers for multiple instances of care to multiple participants, so long as specific requirements are met.
For providers not already enrolled, CMS will waive specific screening requirements (e.g., payment of application fee, fingerprint-based Criminal Background Checks, site visits, and in-state licensure requirements).
Provision of Services in Alternative Settings: California may permit facilities, including nursing facilities, intermediate care facilities for individuals with intellectual and developmental disabilities, psychiatric residential treatment facilities, and hospital nursing facilities, to be fully reimbursed for services rendered to an unlicensed facility, under specific conditions.
Find the complete CMS announcement and full details here, and more information on the specific waivers here.
About the Authors
Rachael A. Harrington
Rachael provides counsel to hospitals, medical staffs, and physician groups with a focus on bylaw and policy review and development, corrective action, medical staff credentialing and privileging, and fair hearing procedures. Rachael assists medical staffs in their corrective action and peer review processes and represents medical staffs in judicial review hearings. She also provides guidance on compliance with EMTALA and emergency department call panel policy and enforcement.
Rachael further provides legal advice to hospitals, medical staffs, physician groups, and providers on a range of legal issues including industry-specific laws related to state and federal reporting requirements, patient privacy rights, organized health care arrangements, and balance billing. Rachael represents her clients against regulatory agency investigations and assists in the navigation of document production and responding to regulatory subpoenas.
In addition, Rachael defends hospitals in whistleblower claims and litigation under Health and Safety Code section 1278.5, and defends health care facilities and workers subpoenaed in the capacity of third-party witnesses.
Prior to joining Procopio, Rachael practiced Common Interest Development Law, representing homeowner associations as general counsel. Rachael continues to provide legal advice on various matters related to association governance, board authority and procedure, governing document interpretation, CC&Rs enforcement and amendment, and homeowner disputes.
Rachael provides counsel to hospitals, medical staffs, and physician groups with a focus on bylaw and policy review and development, corrective action, medical staff credentialing and privileging, and fair hearing procedures. Rachael assists medical staffs in their corrective action and peer review processes and represents medical staffs in judicial review hearings. She also provides guidance on compliance with EMTALA and emergency department call panel policy and enforcement.
Rachael further provides legal advice to hospitals, medical staffs, physician groups, and providers on a range of legal issues including industry-specific laws related to state and federal reporting requirements, patient privacy rights, organized health care arrangements, and balance billing. Rachael represents her clients against regulatory agency investigations and assists in the navigation of document production and responding to regulatory subpoenas.
In addition, Rachael defends hospitals in whistleblower claims and litigation under Health and Safety Code section 1278.5, and defends health care facilities and workers subpoenaed in the capacity of third-party witnesses.
Prior to joining Procopio, Rachael practiced Common Interest Development Law, representing homeowner associations as general counsel. Rachael continues to provide legal advice on various matters related to association governance, board authority and procedure, governing document interpretation, CC&Rs enforcement and amendment, and homeowner disputes.
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