CMS Issues Emergency Medicaid Waivers in Two States, Hospice Left Out

The U.S. Centers for Medicare & Medicaid Services (CMS) has issued the first two state-specific 1135 waivers in Washington state and Florida. This follows a series of blanket waivers applicable to most health providers nationwide in an attempt to reduce administrative burden to allow providers to focus on their response to the coronavirus pandemic.

To the frustration of many stakeholders, few provisions in the waivers to date have been tailored to the particular needs of hospice providers. CMS has not responded to Hospice News’ requests regarding current or future hospice-specific actions, having been inundated with requests for information from providers, the press and the public.

The content of the Washington and Florida waivers is based on those states’ particular requests. The lack of hospice-specific provisions could indicate a lack of awareness among state leaders of hospice needs, making communication with state governments a key part of advocacy efforts.

“I recognize that Gov. [Jay] Inslee and his team are working around the clock to respond to the escalating crisis in Washington State,” said CMS Administrator Seema Verma about the second waiver the agency issued. “We are committed to stripping away any red tape that gets in the way of states or providers effectively managing this public health emergency.”

Though the agency relaxed some telehealth rules earlier this week and indicated that they would reimburse for those services, CMS remains mum on whether it will permit hospices to conduct recertification encounters remotely rather than face-to-face — a burning question in the minds of many providers. The agency has indicated that further expansion of telehealth may be forthcoming, but specifics on future action are scarce. 

In addition to the blanket waivers, states can request further considerations from CMS based on their own specific needs. CMS developed an online application toolkit for state requests. The agency indicated that waivers for additional states would be forthcoming.

The approval process for the waivers has been relatively quick to date. Washington made its request on March 15. CMS approved it on March 19. The waiver is retroactive to March 1. Florida’s request, which occurred earlier than Washington’s, was processed along a similar timeline.

The waivers remain in effect for a minimum of 90 days and a maximum of 180 days.

The Florida and Washington waivers pertain primarily to Medicaid and address reduction of administrative steps related to provider enrollment, the reimbursement of out-of-state providers not currently enrolled in the states’ Medicaid programs and suspension of some prior authorization requirements, among other provisions. The states’ approval letters from CMS made no mention of hospice.

A coalition of industry organizations earlier this week appealed to Congress to help ease the unprecedented challenges that the pandemic is having on hospices, including a request for face-to-face encounters via telehealth. 

Signatories on the letter included the National Hospice and Palliative Care Organization (NHPCO), the National Association for Home Care and Hospice, National Partnership for Hospice Innovation, the Visiting Nurse Associations of America/ElevatingHOME, and LeadingAge.

“America’s hospice providers deeply appreciate Congress’s swift and effective efforts to combat the COVID-19 crisis,” the coalition stated in the letter. “Hospice providers stand ready to continue to offer expert advice on how to support to patients and families in the community during this public health crisis, and we look forward to continued collaboration with Congress to ensure quality serious-illness and end-of-life care for all Americans, and a robust Medicare Hospice Benefit for years to come.”