CMS Approves 1135 Waiver in Florida, Granting More Flexibility for COVID-19 Actions

The Centers for Medicare and Medicaid Services (CMS) has granted Florida’s request for an 1135 Medicaid Waiver, allowing the state to waive certain requirements in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).¹

According to the approval letter, Florida Medicare and Medicaid can now enroll providers who are not currently enrolled with another state Medicaid agency or Medicare, as long as the state meets several requirements. Theseinclude collecting minimum data requirements and issuing no new temporary provisional enrollments after the emergency designation is lifted.¹

In addition, Florida is now able to waive prior authorization requirements, streamline provider enrollment processes, allow care to be provided in alternative settings, suspend some nursing home screening requirements, and extend deadlines for appeals and state fair hearing requests.¹

Under the waiver for nursing home pre-admission screening and annual resident review for level I and level II assessments, the approval letter states that Florida can treat all new admissions similarly to exempted hospital discharges.² For patients being transferred between nursing facilities, level I and level II screens are not required. Notably, level I assessments involve determining whether a patient might have a serious mental illness or intellectual disability, whereas level II assessments are a more in-depth screening for patients who tested positive at level I.³

The letter also noted that there is no defined timeframe for when a resident review must be completed, but said that it should be conducted as soon as resources are available.²

Evacuated facilities can also provide services in alternative settings, according to the letter, including a temporary shelter when the provider’s facility in inaccessible. The facilities would also be fully reimbursed for these services rendered during emergency evacuation.²

Finally, CMS modified the timeframes associated with Medicaid appeals and fair hearings. Enrollees exercising the appeal rights can now have an additional 120 days to request a fair hearing if the initial 120-day deadline occurred between March 17 and the expiration of the waiver.²

“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,” CMS said in a statement.¹

Florida was the first state to submit a Section 1135 waiver request following the declaration of a national emergency in response to COVID-19. According to a press release from CMS, more requests are expected from other states.¹

REFERENCES

• CMS Approves First State Request for 1135 Medicaid Waiver in Florida [news release]. Centers for Medicare and Medicaid Services; March 17, 2020. https://www.cms.gov/newsroom/press-releases/cms-approves-first-state-request-1135-medicaid-waiver-florida. Accessed March 18, 2020.
• Section 1135 Flexibilities Requested in March 13, 2020 Communication [Letter]. Centers for Medicare and Medicaid Services; March 16, 2020. https://www.medicaid.gov/state-resource-center/downloads/fl-section-1135-appvl.pdf. Accessed March 18, 2020.
• Preadmission Screening and Resident Review. Medicaid website; https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/preadmission-screening-and-resident-review/index.html. Accessed March 18, 2020.