Following President Trump’s declaration of a national emergency related to COVID-19 on March 13, 2020, CMS has been swiftly approving states’ requests for flexibilities for their Medicaid programs as they continue to battle the virus. Section 1135 of the Social Security Act permits CMS to temporarily waive or modify Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure sufficient healthcare items and services are available during a national and public health emergency such as the COVID-19 pandemic. CMS approved the first two states’ Section 1135 waivers (for Florida and Washington) on March 19, 2020 and followed it with 11 additional waiver approvals for various states on March 23. CMS then approved numerous other Medicaid Section 1135 waiver requests last week, with an average approval time of less than six days, bringing the current total to 34 states. CMS has credited its use of a “streamlined template to facilitate expedited application and approval” of the waivers given the threat of COVID-19. The full and current list of Section 1135 waivers and other details are available here.

In the Medicaid context, Section 1135 waivers give states flexibility to administer their Medicaid programs in a manner that allows healthcare providers who, as a result of a national emergency, are otherwise unable to strictly comply with certain federal Medicaid requirements. Additionally, providers are exempted from sanctions and reimbursement penalties from noncompliance with those Medicaid requirements, absent fraud or bad faith. Examples of “flexibilities” that states may seek through Section 1135 waiver requests include:

• Streamlining processes to ramp up provider enrollment;
• Allowing care to be provided in alternative settings in the event a facility is evacuated or is filled to capacity;
• Extending deadlines for appeals and state fair hearing requests;
• Waving prior authorization requirements in fee-for-service programs;
• Permitting providers located out of state/territory to provide care to another state’s Medicaid enrollees impacted by the emergency;
• Suspending certain provider enrollment and revalidation requirements to increase access to care;
• Waiving requirements that physicians and other healthcare professionals be licensed in the state in which they are providing services, so long as they have equivalent licensing in another state; and
• Suspending requirements for certain pre-admission and annual screenings for nursing home residents.

As King & Spalding previously reported, Florida and Washington were the first states to receive CMS approval for a Section 1135 Medicaid waiver. Since then, a flood of requests have been approved, with the current total reaching 34 states. Most states to date are receiving approvals for their requested flexibilities related to fee-for-service prior authorization requirements, fair hearings and appeals, out-of-state provider enrollment and credentialing requirements, and revalidation processes.

Detailed below are the major features of the Section 1135 Medicaid waiver approvals for particular states. With the COVID-19 virus now affecting all 50 states, CMS expects more states to submit similar 1135 waiver requests. For example, Texas’s Governor Greg Abbott announced on March 26 that the Texas Health and Human Services Commission (HHSC) submitted a Section 1135 Medicaid waiver to CMS for consideration. Georgia’s Governor Brian Kemp and the Georgia Department of Community Health (DCH) also announced on March 28 that Georgia has submitted a waiver request for consideration. Beyond these state-specific approvals, CMS has already issued “blanket” Section 1135 waivers for all providers, described in CMS’s Fact Sheet here. King & Spalding will continue to monitor these developments as additional states seek flexibilities in their Medicaid programs as the COVID-19 response efforts unfold.

Alabama

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. One highlight is that it suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.

Arizona

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Arizona. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Arizona or are otherwise directly impacted by the emergency.

California

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than California. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in California or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Colorado

On March 26, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Colorado. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Colorado or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Allows the State flexibility in its State Plan Amendment (SPA) requirements, including flexibility to modify timeframes associated with tribal consultation.

Connecticut

On March 27, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Connecticut. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Connecticut or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Allows the State flexibility in its State Plan Amendment (SPA) requirements, including flexibility to modify timeframes associated with tribal consultation.

Delaware

On March 27, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions, and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Delaware. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Delaware or are otherwise directly impacted by the emergency.

Hawaii

On March 26, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Hawaii. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Hawaii or are otherwise directly impacted by the emergency.
• Allows the State flexibility in its State Plan Amendment (SPA) requirements, including flexibility to modify timeframes associated with tribal consultation.

Idaho

On March 26, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Idaho. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Idaho or are otherwise directly impacted by the emergency.

Illinois

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Illinois. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Illinois or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Indiana

On March 25, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions, and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Indiana. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Indiana or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Iowa

On March 25, 2020, CMS approved the State’s waiver request. The full text is available here. One highlight includes that it suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.

Kansas

On March 24, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions, and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Kansas. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Kansas or are otherwise directly impacted by the emergency.

Kentucky

On March 25, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Kentucky. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Kentucky or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Louisiana

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Louisiana. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Louisiana or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Maryland

On March 26, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Maryland. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Maryland or are otherwise directly impacted by the emergency.
• Allows the State flexibility in its State Plan Amendment (SPA) requirements, including flexibility to modify timeframes associated with tribal consultation.

Massachusetts

On March 26, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Massachusetts. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Massachusetts or are otherwise directly impacted by the emergency.
• Allows the State flexibility in its State Plan Amendment (SPA) requirements, including flexibility to modify timeframes associated with tribal consultation.

Minnesota

On March 27, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable
• Temporarily suspends Medicaid fee-for-service prior authorization requirements.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Minnesota. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Minnesota or are otherwise directly impacted by the emergency.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions, and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State flexibility in the submission deadline and public notice requirement for State Plan Amendment (SPA) submissions related to beneficiaries’ access to COVID-19-related items and services.

Mississippi

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Mississippi. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Mississippi or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Missouri

On March 25, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Missouri. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Missouri or are otherwise directly impacted by the emergency.
• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State flexibility in the submission deadline and public notice requirement for State Plan Amendment (SPA) submissions related to beneficiaries’ access to COVID-19-related items and services.

New Hampshire

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than New Hampshire. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

New Jersey

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than New Jersey. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in New Jersey or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

New Mexico

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than New Mexico. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in New Mexico or are otherwise directly impacted by the emergency.

New York

On March 26, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions, and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than New York. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in New York or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

North Carolina

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than North Carolina. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in North Carolina or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Temporarily suspends Medicaid fee-for-service prior authorization requirements.

North Dakota

On March 24, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than North Dakota. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in North Dakota or are otherwise directly impacted by the emergency.
• Allows the State flexibility in modifying the timeframes associated with tribal consultation related to State Plan Amendment (SPA).

Oklahoma

On March 24, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Oklahoma. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Oklahoma or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Temporarily suspends Medicaid fee-for-service prior authorization requirements.

Oregon

On March 25, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Oregon. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Oregon or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.
• Allows the State flexibility in the submission deadline and public notice requirement for State Plan Amendment (SPA) submissions related to beneficiaries’ access to COVID-19-related items and services.

Pennsylvania

On March 27, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions, and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Pennsylvania. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Pennsylvania or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Rhode Island

On March 25, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing authorizations for which a beneficiary has previously received prior authorization.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions, and modifies the timeframe for managed care enrollees to exercise their appeal rights.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Rhode Island. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Temporarily ceases revalidation of providers who are located in Rhode Island or are otherwise directly impacted by the emergency.

South Dakota

On March 24, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse otherwise payable claims from out-of-state providers not enrolled in the state Medicaid program if certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than South Dakota. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in South Dakota or are otherwise directly impacted by the emergency.
• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards.

Virginia

On March 23, 2020, CMS approved the State’s waiver request, effective retroactively to March 1. The full text is available here. Highlights include:

• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Temporarily suspends Medicaid fee-for-service prior authorization requirements. Also extends pre-existing prior authorizations for care to be provided without a new or renewed prior authorization through the termination of the emergency.

Wyoming

On March 27, 2020, CMS approved the State’s waiver request. The full text is available here. Highlights include:

• Temporarily suspends Medicaid fee-for-service prior authorization requirements.
• Suspends Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Allows the State flexibility in scheduling Medicaid fair hearings and issuing fair hearings decisions.
• Allows the State to reimburse out-of-state providers for multiple instances of care to multiple participants, so long as certain criteria are met.
• Allows the State to temporarily enroll out-of-state providers that are already enrolled in Medicare or with a state Medicaid program other than Wyoming. Also waives certain screening and enrollment requirements for providers not already enrolled with another state Medicaid program or Medicare.
• Temporarily ceases revalidation of providers who are located in Wyoming or are otherwise directly impacted by the emergency.

• Allow facilities to be fully reimbursed for services rendered to an unlicensed facility provided that the State makes a reasonable assessment that the facility meets minimum standards. The full text is available.