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Northeast Times | October 2, 2022

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1135 Medicaid Waiver Approved by CMS

1135 Medicaid Waiver Approved by CMS

The Center for Medicaid and Medicare Services (CMS) approved the Section 1135 Medicaid Waiver submitted by the Texas Health and Human Services Commission (HHSC) on March 25th, 2020. This approval grants Texas flexibility in administering Medicaid while continuing to respond to COVID-19. 

This waiver allows: 

  • Extension of prior authorizations approved on or after March 1st;
  • Suspension of Level I and Level II PASRR assessments: All new nursing facility admissions may be treated as an exempted hospital discharge for 30 days. After 30 days, new admissions with a mental health or intellectual disability diagnosis should be reviewed as soon as resources are available;
  • Fair hearings and appeals: fair hearings may be extended up to 120 days (an increase from 90) and Texas may choose to allow up to 90 days for an enrollee to file an appeal

This waiver also allows additional flexibility surrounding provider enrollment, including: 

  • Texas may reimburse an out-of-state provider if the service is provided out of state, the provider has an NPI on the claim, and the provider is enrolled in Medicare or another state’s Medicaid program;
  • Texas may provisionally or temporarily enroll an out-of-state provider not enrolled in Medicare or another state’s Medicaid program and waive the application fee, finger print criminal background check, site visit, and in-state license requirement;
  • Texas must collect information necessary to process claims, screen for licensure in other states, and screen against the OIG exclusion list. Texas must not issue temporary enrollments after the end of the public health emergency, not allow retroactive effective dates earlier than March 1, and must cease payments to temporarily enrolled providers within 6 months of the end of the public health emergency (unless the provider competes a Texas Medicaid enrollment);
  • Provider revalidation can temporarily be ceased;
  • The above flexibilities are also granted for CHIP.

Texas has also been granted a temporary waiver of public notice requirements by CMS. HHSC continues to work with CMS on additional flexibility requests related to those approved on Monday.