Leaders of North Carolina’s state Medicaid agency submitted the waiver to the federal Centers for Medicare and Medicaid Services on March 17 “to ensure that sufficient health care items and services are available to meet the needs of our state residents and providers,” according to the state. “These waivers will give North Carolina the flexibility to implement changes, as needed, to address any urgent health care needs of our residents.”

The waiver falls under Section 1135 of the Social Security Act. Section 1135 waivers are available when the president declares a major disaster or an emergency under the Stafford Act, which President Donald Trump did on March 13.

CMS approved the following requested items for North Carolina:

• Allowing reimbursement to out-of-state providers for multiple instances of care to multiple participants by waiving certain claim criteria.
• Making it easier for providers to enroll in Medicaid, including waiving the application fee.
• Allowing facilities, including nursing facilities and psychiatric residential treatment facilities (PRTFs), to be fully reimbursed for services rendered to an unlicensed facility during the emergency, provided the facility meets minimum standards.
• Suspending Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
• Temporarily suspending Medicaid fee-for-service prior authorization requirements.
• Providing flexibility to temporarily delay the scheduling of Medicaid fair hearings and the issuing of fair hearings decisions during the emergency period.
• Waiving the cap on beds and length of stay for critical access hospitals.

​​​​North Carolina’s request included the following outstanding items that have not yet been approved:

• Reducing the face mask requirements for certain laboratory operations in order to “conserve scarce face mask supplies which will help with the impending shortage of personal protective equipment.”
• Relaxing certain privacy requirements under HIPAA so that providers can gather information faster.
• Waiving some requirements for the Emergency Medical Treatment and Labor Act (EMTALA), which would allow providers to redirect potential COVID-19 patients to designated places for testing.
• Waiving requirements that could get in the way of telehealth services, including for home health providers.
• Allowing the state to draw additional federal funding to help providers “who suffer extreme disruptions to their standard business model and/or revenue streams as a result of the public health emergency.”

CMS has approved waiver requests from 12 other states as well.