Hurricane Sandy – 1135 Waiver Reference

Abstract:  The Centers for Medicare and Medicaid Services guidance on 1135 waivers.

Section 1135 of the Social Security Act authorizes the Secretary of the Department of Health and Human Services to waive or modify certain Medicare, Medicaid, CHIP, and HIPAA requirements.  In declared federal disaster areas, the 1135 waiver allows exceptions to certain federal requirements, including special provisions for how admissions are processed and exceptions to documentation requirements.  Attached is an 1135 waiver guidance document from CMS that members may find helpful.

For example, one issue addressed by the Q&A (page 20) guidance is:

Q. Can CMS waive the skilled nursing facility (SNF) benefit’s 3-day qualifying hospital stay requirement for those beneficiaries affected by the emergency situation?

A. Yes.

Two prerequisites must be met before the Secretary may invoke the 1135 waiver authority. First, the President must have declared an emergency or disaster under either the Stafford Act or the National Emergencies Act. Second, the Secretary must have declared a Public Health Emergency under Section 319 of the Public Health Service Act. Then, with respect to the geographic area(s) and time periods provided for in those declarations, the Secretary may elect to authorize waivers/modifications of one or more of the requirements described in Section 1135(b). The implementation of such waivers or modifications is typically delegated to the Administrator of CMS who, in turn, determines whether and the extent to which sufficient grounds exist for waiving such requirements with respect to a particular provider, to a group or class of providers, or to a geographic area.

LeadingAge NY is now seeking to confirm how and where the authority of the 1135 waiver will apply to areas impacted by Hurricane Sandy.   State officials are requesting a variety of waiver authorizations at this time.  In anticipation of 1135 waiver authority being officially declared please keep the attached guidance as a reference.

LeadingAge NY will advise members immediately as official waiver requests are implemented.

Please contact me with any questions at: pcucinelli@leadingageny.org, 518-867-8827.