CMS Updates Guidance for Providers: Public Health Emergency 1135 Waivers

On February 9, the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 will end on May 11, 2023. During the PHE, the Centers for Medicare & Medicaid Services (CMS) used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care during the PHE for healthcare providers and their beneficiaries.

Some of the flexibilities that were created during the pandemic were recently expanded by the Consolidated Appropriations Act, 2023. Others, while critical during the initial response to COVID-19, are no longer needed. CMS has made further updates to their CMS Emergencies Page with useful information for providers — specifically around major telehealth and individual waivers — that were initiated during the PHE.

CMS will be hosting stakeholder calls and office hours in the coming weeks to provide additional information. Providers should continue to visit the CMS Emergencies Page for continuous updates regarding PHE sunsetting guidance as information becomes available to the public.

Provider-specific fact sheets about COVID-19 Public Health Emergency (PHE) waivers and flexibilities can be accessed here.

The HHS fact sheet can be accessed here.

Compliance Perspective

Issue

In certain circumstances, the Secretary of HHS, using section 1135 of the Social Security Act (SSA), can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers. There are different kinds of 1135 waivers, including Medicare blanket waivers. When there’s an emergency, sections 1135 or 1812(f) of the SSA allow CMS to issue blanket waivers to help beneficiaries access care. When a blanket waiver is issued, providers don’t have to apply for an individual 1135 waiver. All facilities that participate and receive federal and/or state funds from Medicare or Medicaid must adhere to the rules of participation. It is essential that all facility policies and procedures that may have been suspended during the pandemic due to blanket waivers be made effective as soon as possible or no later than May 11, 2023.

Discussion Points

    • Review your policies and procedures that were suspended due to the emergency declaration blanket waivers. Update policies as needed, including the effective date.
    • Train all appropriate staff on the termination of the emergency waivers and provide retraining on all updated policies and procedures. Document that the trainings occurred and file the signed document in each employee’s education file.
    • Audit to ensure that all policies that were affected by the emergency blanket waivers have been reestablished and are being adhered to by all staff members.

*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*

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