Louisiana Among States to Receive Approval from CMS for Medicaid Section 1135 Waivers

By Taylor Porter Health Care and Medicare Secondary Payer and MMSEA (Section 111) Compliance Practice Groups

Click here to read official press release

The Centers for Medicare & Medicaid Services (CMS) approved Medicaid waiver requests under Section 1135 of the Social Security Act to offer states, including Louisiana, new flexibilities to focus their resources on combatting the Coronavirus pandemic outbreak and providing the best possible care to Medicaid beneficiaries in their states.

The waivers provide relief from prior authorization and provider enrollment requirements, suspending certain nursing home pre-admission reviews, and facilitating reimbursement to providers for care delivered in alternative settings due to facility evacuations. The Section 1135 waivers will end upon termination of the public health emergency, including any extensions.

Examples of waivers available under section 1135 of the Act include:

  • Temporarily suspend prior authorization requirements;
  • Extend existing authorizations for services through the end of the public health emergency;
  • Modify certain timeline requirements for state fair hearings and appeals;
  • Relax provider enrollment requirements to allow states to more quickly enroll out-of-state or other new providers to expand access to care, and
  • Relax public notice and submission deadlines for certain COVID-19 focused Medicaid state plan amendments, enabling states to make changes faster and ensure they can be retroactive to the beginning of the emergency.

In addition to Louisiana, the states receiving waiver requests include Alabama, Arizona, California, Illinois, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina, and Virginia. On March 13, 2020, U.S. President Donald Trump declared the rapidly evolving COVID-19 situation a national emergency, enabling CMS to waive certain requirements in Medicare, Medicaid, and CHIP under section 1135 emergency authority. CMS immediately began accepting and approving state section 1135 Medicaid waiver requests and on March 22, 2020, CMS released an 1135 Medicaid & CHIP Checklist to assist states with their requests.

For further guidance on this waiver and advice pertaining to the dynamic challenges that are being presented to the health care system as a result of the COVID-19 pandemic, please contact Taylor Porter partners Cindy Amedee and Barrye Miyagi. Taylor Porter will continue to provide COVID-19 news and updates in our legal blog section.