CMS: NEW – Waivers & flexibilities for health care providers 6.25.20

Click here for the CMS Corona Virus Waivers & Flexibilities.

Coronavirus Waivers & Flexibilities

In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers.  There are different kinds of 1135 waivers, including Medicare blanket waivers.  When there's an emergency, sections 1135 or 1812(f) of the SSA allow us to issue blanket waivers to help beneficiaries access care.  When a blanket waiver is issued, providers don't have to apply for an individual 1135 waiver.  When there's an emergency, we can also offer health care providers other flexibilities to make sure Americans continue to have access to the health care they need.

NEW – Waivers & flexibilities for health care providers

Learn how we're easing burden and helping providers care for Americans by offering new waivers and flexibilities:

• COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) UPDATED (6/25/20)
• Blanket waivers of Section 1877(g) of the Social Security Act (3/30/20)
• Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-5531 IFC) (PDF) (4/30/20)
  • IFC Federal Register Announcement (5/4/20)
  • PRA Disclosure Statement (PDF) (5/21/20)
• List of Hospital Outpatient Services and List of Partial Hospitalization Program Services Accompanying the 4/30/2020 IFC (ZIP) (4/30/20)
• Innovation Model COVID-19 Adjustments (PDF) (6/3/20)
• List of lab test codes for COVID-19, Influenza, RSV (PDF) (5/12/20)
• Medicare IFC: Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC) (PDF) (3/30/20)
  • IFC Federal Register Announcement (4/1/20)
• COVID-19 Regulations & Waivers To Enable Health System Expansion (PDF) (5/4/20)
• Graphic Overview of Flexibilities (PDF) (3/30/20)
• Frequently Asked Questions to Assist Medicare Providers (PDF) UPDATED (6/19/20)
• Provider Burden Relief Frequently Asked Questions (PDF) UPDATED (4/23/20)
• Provider Enrollment Relief Frequently Asked Questions (PDF) (3/30/20)
• Updates for State Surveyors and Accrediting Organizations (EMTALA and Infection Control) (3/30/20)
• Reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment Data Validation (RADV) Audit Activities (HPMS Memo) (3/30/20)

Read our provider-specific fact sheets on new waivers and flexibilities:

• Home Health Agencies (PDF) UPDATED (5/15/20)
• Physicians and Other Practitioners (PDF) UPDATED (4/30/20)
• Ambulances (PDF) UPDATED (5/15/20)
• Hospitals (PDF) UPDATED (6/15/20)
• Teaching Hospitals, Teaching Physicians and Medical Residents (PDF) UPDATED (6/15/20)
• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities) (PDF) UPDATED (6/15/20)
• Hospices (PDF) UPDATED (5/15/20)
• Inpatient Rehabilitation Facilities (PDF) UPDATED (4/30/20)
• Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals (PDF) UPDATED (4/30/20)
• Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) (PDF) UPDATED (4/30/20)
• Laboratories (PDF) UPDATED (4/30/20)
• End Stage Renal Disease (ESRD) Facilities (PDF) UPDATED (5/15/20)
• Durable Medical Equipment (PDF) UPDATED (4/30/20)
• Participants in the Medicare Diabetes Prevention Program (PDF)-UPDATED (5/14/20)
• Medicare Advantage and Part D Plans (PDF) UPDATED (4/30/20)
• State Medicaid & Basic Health Programs (4/30/20)
• Medicare Shared Savings Program Participants (PDF) (4/30/20)

1135 blanket waivers

What do I need to know about 1135 blanket waivers?

If you're an entity in the declared emergency area, you can apply for an 1135 waiver. You'll usually hear back from us within 2-3 days, but if your request is more complicated, it may take up to a week.  If your waiver request has 1 or 2 items, we may get back to you within 24 hours.

Once approved, waivers have a retroactive effective date of March 1, 2020 and will end no later than when the emergency declaration's ended.

Waivers don't offer grants or financial assistance.  They also don't allow you to be paid for services that aren't usually covered or for people to be eligible for Medicare who aren't otherwise eligible.  You also shouldn't base your response decisions, like evacuations, on waivers.  Once your waiver's approved, as always to be reimbursed accurately, be sure to keep careful records about the services you provide and the beneficiaries you provide them to.  

1812(f) waiver

Approved Coronavirus 1812(f) waiver (PDF)

Other 1135 waivers & 1915(c) waivers

Waiver resources

• Section 1135 Waiver Checklist (3/22/20)
• Section 1915 Waiver, Appendix K Template (3/22/20)

Approved states' other Coronavirus 1135 waivers

States' other Coronavirus 1135 waivers

• Alabama-1st request; 2nd request
• Alaska-1st request; updated 1st request; updated 1st request (2nd); 2nd request; 3rd request
• Arizona-1st request; 2nd request; 8th request
• Arkansas-1st request; 2nd request
• California-1st request; 2nd request
• Colorado-1st request
• Commonwealth of Northern Mariana Islands
• Connecticut-1st request; updated 1st request; 2nd request
• Delaware-1st request; 2nd request
• District of Columbia-1st request; 3rd request
• Florida
• Georgia-1st request; 2nd request
• Hawaii
• Idaho
• Illinois
• Indiana-1st request; updated 1st request
• Iowa-1st request; 2nd request
• Kansas
• Kentucky
• Louisiana-1st request; 2nd & 3rd requests
• Maine-1st request; 3rd request
• Maryland-1st request; 2nd request
• Massachusetts-1st request; 3rd request
• Michigan
• Minnesota-1st request; 2nd request
• Mississippi-1st request; 2nd request
• Missouri-1st request; updated 1st request
• Montana-1st request; 2nd request
• Nebraska-1st request; 2nd request
• Nevada
• New Hampshire-1st request; 2nd request
• New Jersey-1st request; 2nd & 3rd request
• New Mexico
• New York-1st request; 2nd request; 3/23/20 communication; 3/23/20 communication
• North Carolina
• North Dakota-1st request; 2nd request
• Ohio-1st request; initial & 3rd communication
• Oklahoma-1st request; 2nd request
• Oregon-1st request; 2nd request
• Pennsylvania-1st request; 3/23/20 communication
• Puerto Rico
• Rhode Island-1st request; 2nd, 3rd, & 4th requests
• South Carolina-1st request; 3/27/20 communication
• South Dakota
• Tennessee-1st request; 3/27/20 communication
• Texas-1st request; 2nd & 3rd requests
• U.S. Virgin Islands
• Utah-1st request; 4/5/20 communication
• Vermont-1st request; 2nd & 3rd request
• Virginia-1st request; updated 1st request
• Washington-1st request; 2nd request; 3/15/20 communication
• West Virginia-1st request; 3/23/20 communication
• Wisconsin-1st request; 2nd request
• Wyoming

Approved states' Coronavirus Home & Community Based (HCBS) 1915(c) Appendix K waivers

States' Coronavirus Emergency Preparedness and Response for HCBS 1915(c) Appendix K waivers

Approved states’ 1115 demonstrations

States' Medicaid Coronavirus 1115 demonstrations

Medicaid State Plan amendments

States' Medicaid State Plan amendments

CHIP State Plan amendments

States' CHIP Plan amendments

Learn more about:

• Flexibilities with 1135 waivers (PDF) 
• Flexibilities without 1135 waivers (PDF)

Find general information about waivers and flexibilities.

Page Last Modified: 06/25/2020 04:03 PM