CMS Approves Section 1135 Wavier for 13 States
On March 23, 2020, the Centers for Medicare and Medicaid Services (CMS) approves Section 1135 Wavier for 13 states. The waiver gives states new “flexibility” to provide needed healthcare services during the Coronavirus COVID-19 pandemic. According to CMS Administrator Seema Verma, “These waivers give a broad range of states the regulatory relief and support they need to more quickly and effectively care for their most vulnerable citizens.”
CMS approves waivers in the following 13 states:
- New Jersey
- New Hampshire
- New Mexico
- North Carolina
The Benefits of Section 1135 Waiver
Seema Verma says the 1135 Wavier removes all “unnecessary administrative and bureaucratic barriers that may hinder an effective response to this public health emergency.” In general, the wavier removes red tape that can hamper access to needed health care services.
For example, the wavier streamlines the provider enrollment processes so more providers can care for beneficiaries. As a result, providers who not already enrolled in Medicare may “provisionally, temporarily” enroll, and CMS will waive the following:
- Payment of application fee
- Criminal background checks
- Site visits
- In-State/territory licensure requirements
Section 1135 wavies prior authorization requirements for any “fee-for-service” healthcare plans, including some Medicare Advantage plans. In other words, you do not need pre-approval.
For example, you do not need a primary care physician’s referral to get the health care you need during this COVID-19 pandemic. Furthermore, the waiver allows care in an alternative setting. For instance, a provider’s facility becomes inaccessible due to a large volume of COVID-19 patients. The wavier allows you to get care in a temporary shelter (field hospital).
Overall, the waiver enables states to focus their resources on combatting the COVID-19 pandemic and provide the health care we need.