Emergency Medicaid Waivers Expand to 13 States, Eliminating Prior Auth and Approving Alternate Care Sites

The Centers for Medicare & Medicaid Services (CMS) late Monday approved 11 new state Medicaid waivers, opening the door for a host of emergency solutions to the COVID-19 pandemic — from an elimination of prior authorization requirements to the potential provision of care at unlicensed facilities.

After Florida and Washington state landed the first 1135 waivers under the federal government’s emergency declaration last week, CMS this week finalized approval for 11 more states:

As in Florida and Washington, the waivers generally suspend a host of rules governing Medicaid providers in those states, including the temporary removal of pre-admission screening and annual resident review assessment requirements for nursing homes — as well as pre-authorization rules for fee-for-service Medicaid beneficiaries.

Advertisement

In addition, the waivers generally allow states to temporarily approve out-of-state providers so long as they have been cleared to participate in Medicare or another state’s Medicaid program.

For instance, New Jersey’s waiver reads: “If a certified provider is enrolled in Medicare or with a state Medicaid program other than New Jersey, New Jersey may provisionally, temporarily enroll the out-of-state provider for the duration of the public health emergency in order to accommodate participants who were displaced by the emergency.”

The state licensure issue has become particularly prominent in states with metropolitan areas that span across borders, with New Jersey as a prime example. Gov. J.B. Pritzker of Illinois had also called for the flexibility in order to ease the health care workforce strain on the St. Louis and Quad Cities regions.

Some of the waivers also include a provision that would allow operators to continue receiving reimbursements for care provided at alternate, unlicensed sites. These exceptions would apply in cases where a nursing facility was forced to either completely evacuate or relocate some residents, presumably due to the need to separate COVID-19 patients from those without the infection.

Not all of the waivers are made equal, however: Virginia’s, for instance, does not include the alternate-site or cross-border provisions. Providers with a presence in the 1135 waiver states should read each waiver thoroughly to avoid running afoul of Medicaid regulations that may remain in force in a particular market.

All of the waivers are retroactive to March 1, and will remain in force until the end of the federal government’s official coronavirus emergency declaration.

CMS continues to accept applications for the waivers — which the agency stressed can be approved within days — from state governments.

“Thanks to the decisive leadership of President Trump during this emergency, CMS has been able to swiftly remove barriers and cut red tape for our state partners,” CMS administrator Seema Verma said in a statement. “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.”