News & Events

CMS Grants Additional Mississippi and Louisiana 1135 Waivers

As we reported in another item posted here, on March 13, 2020, pursuant to section 1135(b) of the Social Security Act, the Secretary of the United States Department of Health and Human Services (HHS) invoked his authority to waive or modify certain requirements as a result of the consequences of the COVID-19 pandemic, as determined by the Centers for Medicare & Medicaid Services (CMS).  In addition to the blanket waivers issued by CMS on March 13 for many Medicare provisions, on March 23 CMS granted the following waivers requested by Mississippi and Louisiana related to Medicaid:

  • Suspension of PASRR Level I and II assessments
    • Allows Pre-Admission Screening and Annual Resident Review (PASRR) Level I and II assessments to be waived for 30 days.
    • Allows all new admissions to be treated like exempted hospital discharges.
    • Provides that after 30 days, new admissions with mental illness or intellectual disability should receive a resident review as soon as resources become available.
  • State Fair Hearing Requests and Appeal Timelines
    • Permits enrollees to have more than 90 days, and up to an additional 120 days, to request a fair hearing in connection with an eligibility or fee for service appeal.
    • Allows modification of the timeline for Managed Care Organizations (MCOs) to resolve enrollee appeals to no less than one (1) day, thereby allowing satisfaction of the exhaustion requirement within one (1) day (or the timeline selected by the state), such that enrollees may proceed almost immediately to a fair hearing.
    • Permits MCO enrollees to have an additional 120 days to request a fair hearing (if the original 120-deadline to request a fair hearing occurred between March 1 and the end of the public health emergency).
  • Provider Enrollment
    • Allows reimbursement of otherwise payable claims submitted by out-of-state providers not enrolled in the Medicaid program of Mississippi or Louisiana, as applicable, provided that the following current CMS requirements are met for such reimbursement: (1) the services for which reimbursement is sought is provided outside the applicable state, (2) the National Provider Identifier is on the claim, (3) the provider is approved under Medicare or another state Medicaid plan, and (4) the claim is for services furnished. Significantly, for the duration of the public health emergency, CMS has waived its current requirement for such reimbursement that the claim represents either (a) a single instance of care furnished over a 180-day period or (b) multiple instances of care furnished to a single participant, over a 180-day period. The practical effect of this waiver is that, during the declared emergency, Mississippi and Louisiana may reimburse any single out-of-state provider not enrolled in the Medicaid program of Mississippi or Louisiana, as applicable, for multiple instances of care provided to multiple Medicaid participants even if furnished within the same 180 day period, provided that the other CMS requirements for such reimbursement are met (effectively, permitting any number of Medicaid patients to be moved, or evacuated, out of state for treatment).
    • Allows provisional, temporary enrollment of providers enrolled with another state Medicaid agency (SMA) or Medicare.
    • Allows provisional, temporary enrollment of providers not already enrolled with another SMA or Medicare without having to satisfy an array of screening requirements provided that Mississippi or Louisiana, as applicable, meet various other requirements, all as further described in the waiver letters issued to Mississippi and Louisiana.
    • Allows discontinuance of provider revalidation.
  • Provision of Services in Alternative Settings. Allows facilities, including NFs, ICF/IDDs, PRTFs and hospital NFs, to be fully reimbursed for services rendered to patients relocated to an unlicensed facility if the placing facility continues to render services and Mississippi or Louisiana, as applicable, determines that the unlicensed facility meets minimum standards and relocation was done to ensure the health, safety and comfort of beneficiaries and staff.

In addition, Mississippi asked for and received additional waivers to suspend certain prior authorization requirements and extension of those granted through the end of the public health emergency.

This authority is retroactive to March 1, 2020.  The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the public health emergency, including any extensions.  The state Medicaid agencies are expected to quickly issue emergency policy updates to implement these changes to their respective state programs.

Mississippi Waiver: https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/?entry=54037

Louisiana Waiver: https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/?entry=54038