Florida Lands Sweeping Medicaid Waiver for Nursing Homes During COVID-19 Emergency

Florida became the first state to land an emergency Medicaid waiver amid the ongoing spread of the novel coronavirus, granting nursing homes in the Sunshine State a variety of exceptions intended to help providers weather the crisis — and more states could soon follow suit.

Under the Section 1135 waiver approved this week by the Centers for Medicare & Medicaid Services (CMS), nursing facility operators in Florida will not have to perform certain pre-admission screenings for 30 days, while providers can also continue to receive Medicaid reimbursements for services if they must evacuate residents to a building not licensed for nursing home care.

The federal government invited states to apply for the waivers as part of the blanket state of emergency that the president declared last Friday. All states are able to submit applications for similar Section 1135 waivers, CMS administrator Seema Verma reaffirmed Tuesday; Florida Gov. Ron DeSantis was the first to submit a request.

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“I want to thank Gov. DeSantis for his leadership in Medicaid and for taking full advantage of federal flexibilities,” Verma said in a statement. “CMS is committed to removing all unnecessary administrative and bureaucratic barriers that may hinder an effective response to this public health emergency, and I have directed my team to expeditiously process these requests.”

Under Florida’s waiver, all pre-authorization requirements will be waived, while nursing homes will also receive a 30-day freeze on pre-admission screening and annual resident review Level I and II assessments.

“Level 1 and Level 2 assessments can be waived for 30 days. All new admissions can be treated like exempted hospital discharges,” CMS wrote in its guidance. “After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) should receive a Resident Review as soon as resources become available.”

In addition, should a nursing facility be forced to evacuate to an alternate site without a current license for nursing care, it will still be reimbursed for the care provided.

“The facility would be responsible for determining how to reimburse the unlicensed facility,” according to CMS. “This arrangement would only be effective for the duration of the Section 1135 waiver.”

After 30 days, should the emergency declaration still be in effect, those non-licensed sites will be required to either receive licenses, or the original nursing facility must find alternate placement for those residents.

Finally, the guidance removes wait periods for beneficiaries to request fair hearings regarding benefit denials by managed care organizations and other insurers.

The waiver process for the Sunshine State took just days, according to the federal government, and similar emergency suspensions of key Medicaid rules could begin rolling in over the coming week.

“While Florida is the first state to apply for this waiver authority, CMS expects more states will also submit similar requests,” the agency noted.

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