Source: https://medely.com/blog/covid-news-section-1135-waiver-flexibilities-michigan-coronavirus-disease-2019/
Timestamp: 2020-08-06 22:35:29
Document Index: 657829284

Matched Legal Cases: ['§440', '§455', '§455', '§455', '§455', '§430', '§447', '§447', '§440']

COVID News - Section 1135 Waiver Flexibilities - Michigan Coronavirus Disease 2019 - Medely Blog
COVID News - Section 1135 Waiver Flexibilities - Michigan Coronavirus Disease 2019
|By Khaled Nasr
Capitol View Building, 7th Floor
Your communication to CMS on April 1, 2020, detai1ed a number of federal Medicaid, the Children’s Health Insurance Program (CHIP), and Medicare, requirements that pose issues or challenges for the health care delivery system in all counties in Michigan and requested a waiver or modification of those requirements. Attached, please find a response to your requests for waivers or modifications, pursuant to section 1135 of the Social Security Act, to address the challenges posed by COVID-19. This approval addresses those requests related to Medicaid and CHIP.
Please contact Jackie Glaze, Deputy Director, Medicaid and CHIP Operations Group, at (404) 387-0121 or by email at [email protected] if you have any questions or need additional information. We appreciate the efforts of you and your staff in responding to the needs of the residents of the State of Michigan and the health care community.
CMS Response: April 6, 2020
Prior authorization and medical necessity processes in fee-for-service delivery systems are established, defined and administered at state/territory discretion and may vary depending on the benefit. See 42 C.F.R. §440.230(d). The State of Michigan may have indicated in its approved state plan specific requirements about prior authorization processes for benefits administered through the fee-for-service delivery system. We interpret prior authorization requirements to be a type of pre-approval requirement for which waiver and modification authority under section 1135(b)(1)(C) of the Act is available.
If prior authorization processes are outlined in Michigan’s state plan for particular benefits, CMS is using the flexibilities afforded under section 1135(b)(1)(C) of the Act that allow for waiver or modification of pre-approval requirements to permit services approved to be provided on or after March 1, 2020, to continue to be provided without a requirement for a new or renewed prior authorization, through the termination of the public health emergency, including any extensions (up to the last day of the emergency period under section 1135(e) of the Act), for beneficiaries with a permanent residence in the geographic area of the public health emergency declared by the Secretary.
Michigan currently has the authority to rely upon provider screening that is performed by other State Medicaid Agencies (SMAs) and/or Medicare. As a result, Michigan is authorized to provisionally, temporarily enroll providers who are enrolled with another SMA or Medicare for the duration of the public health emergency.
Under current CMS policy, as explained in the Medicaid Provider Enrollment Compendium (PDF, 586.81 KB) (7/24/18), at pg. 42, Michigan may reimburse otherwise payable claims from out-of-state providers not enrolled in Michigan Medicaid program if the following criteria are met:
For claims for services provided to Medicaid participants enrolled with Michigan Medicaid program, CMS will waive the fifth criterion listed above under section 1135(b)(1) of the Act. Therefore, for the duration of the public health emergency, Michigan may reimburse out-of-state providers for multiple instances of care to multiple participants, so long as the other criteria listed above are met.
If a certified provider is enrolled in Medicare or with a state Medicaid program other than Michigan, Michigan 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.
Payment of the application fee – 42 C.F.R. §455.460
Criminal background checks associated with Fingerprint-based Criminal Background Checks – 42 C.F.R. §455.434
Site visits – 42 C.F.R. §455.432
In-state/territory licensure requirements – 42 C.F.R. §455.412
CMS is granting this waiver authority to allow Michigan to enroll providers who are not currently enrolled with another SMA or Medicare so long as the state meets the following minimum requirements:
Michigan must also:
Cease payment to providers who are temporarily enrolled within six months from the termination of the public health emergency, including any extensions, unless a provider has submitted an application that meets all requirements for Medicaid participation and that application was subsequently reviewed and approved by Michigan before the end of the six month period after the termination of the public health emergency, including any extensions, and
Under section 1135(b)(1)(B), CMS is also approving Michigan’s request to temporarily cease revalidation of providers who are located in Michigan or are otherwise directly impacted by the emergency.
The State of Michigan also requested a modification of the requirement to submit SPAs related to the COVID-19 emergency by March 31, 2020, to obtain a SPA effective date during the first calendar quarter of 2020, pursuant to 42 C.F.R. §430.20. CMS is approving this request pursuant to section 1135(b)(5) of the Act. This approval applies only with respect to SPAs that provide or increase beneficiary access to items and services related to COVID-19 (such as cost sharing waivers, payment rate increases, or amendments to alternative benefit plans (ABPs) to add services or providers) and that would not restrict or limit payment or services or otherwise burden beneficiaries and providers, and that are temporary, with a specified sunset date that is not later than the last day of the declared COVID-19 emergency (or any extension thereof).
The State of Michigan also requested a waiver of public notice requirements applicable to the state plan amendment (SPA) submission process. Public notice for SPAs is required under 42 C.F.R §447.205 for changes in statewide methods and standards for setting Medicaid payment rates, 42 C.F.R. §447.57 for changes to premiums and cost sharing, and 42 C.F.R. §440.386 for changes to ABPs. These requirements help to ensure that the affected public has reasonable opportunity to comment on these SPAs.
CMS recognizes that during this public health emergency, Michigan must act expeditiously to protect and serve the general public. Therefore, under section 1135(b)(1)(C) and 1135(b)(5) of the Act, CMS is approving the state’s request to waive these notice requirements applicable to SPA submissions. This approval applies only with respect to SPAs that provide or increase beneficiary access to items and services related to COVID-19 (such as cost sharing waivers, payment rate increases, or amendments to ABPs to add services or providers) and that would not restrict or limit payment or services or otherwise burden beneficiaries and providers, and that are temporary, with a specified sunset date that is not later than the last day of the declared COVID-19 emergency (or any extension thereof). Even though CMS is approving this waiver, we encourage the state to make all relevant information available to the public so they are aware of the changes.
Under section 1135(b)(5) of the Act, CMS is also approving the State of Michigan’s request for flexibility to modify the timeframes associated with tribal consultation required under section 1902(a)(73) of the Act, including shortening the number of days before submission or conducting consultation after submission of the SPA. Again, this approval applies only with respect to SPAs that provide or increase beneficiary access to items and services related to COVID-19 (such as cost sharing waivers, payment rate increases, or amendments to ABPs to add services or providers) and that would not restrict or limit payment or services or otherwise burden beneficiaries and providers, and that are temporary, with a specified sunset date that is not later than the last day of the declared COVID-19 emergency (or any extension thereof).