On March 22, 2020, CMS announced a suite of four new tools intended to help states combat the coronavirus by allowing states to streamline enrollment into long-term care and home-based services and by expediting application processes for waivers and temporary amendments to state Medicaid plans. States may request that these authorities be applied retroactively, to March 1, 2020—the effective date of the national emergency declared by President Trump. The CMS press release announcing these tools is available here. A summary of these four new tools is below.

1115 Waiver Opportunity and Application Checklist

CMS released a new Section 1115 demonstration opportunity to allow states to waive requirements for home and community-based services for beneficiaries receiving long-term supports and services under Medicaid. CMS will expedite its review process, so states applying for a COVID-19 Section 1115 demonstration waiver are not required to conduct the public notice and input process that is normally required. CMS also provided a template for states to request a Section 1115 waiver demonstration project. The 1115 Application Process announcement is available here. The State Medicaid Director Letter providing additional detail on the application process and template is available here.

1135 Waiver Checklist

As previously reported, the President’s national emergency declaration, coupled with Secretary Azar’s earlier declaration of a public health emergency under Section 319 of the Public Health Service Act, authorized the Secretary to waive certain Medicare, Medicaid and CHIP requirements under Section 1135 of the Social Security Act. Pursuant to this authority, CMS activated blanket waivers of several Medicare and Medicaid requirements to provide healthcare providers more flexibility in responding to the pandemic.

CMS has now created a Section 1135 waiver checklist and template with commonly requested 1135 waivers relevant to COVID-19, such as temporarily suspending prior authorization requirements, granting beneficiaries more time for appeals and hearings, relaxing rules to enroll providers, and allowing providers to bill for services provided out of state. The Section 1135 checklist and template is available here.

1915(c) Appendix K Template

Section 1915(c) Appendix K may be utilized by states to request amendments to Section 1915(c) home and community-based services waivers and to request amendments in times of emergency. CMS has developed an Appendix K template that is pre-populated with flexibilities that states have begun requesting to address COVID-19, such as adding an electronic method of service delivery for certain services and addressing needs of waiver recipients during the time of emergency through additional services. The Section 1915(c) template and toolkit is available here.

Medicaid Disaster State Plan Amendment Template

To respond to a state of emergency or a natural disaster, a state may change its Medicaid state plan—the document that describes the state’s eligibility, benefits, and payment rules—through temporary amendments. To streamline the application process for review of temporary amendments, CMS developed a Disaster State Plan Amendment template that will allow a state to submit one document with all its requested amendments. These amendments may include temporarily expanding temporary coverage, adding specialized benefits, expanding telehealth coverage, and increasing provider reimbursement. The template and instructions are available here.