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COVID-19 MARCH 25, 2020

Posted Mar 25, 20204 min Read

Regulatory & Clinical Workforce

CMS Approves Indiana’s 1135 Waiver 

The following waivers have been approved by the CMS:

  • Temporarily suspend Medicaid fee-for-service prior authorization requirements.
  • Extend pre-existing fee-for-service authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.\
    • All new admissions can be treated like exempted hospital discharges.
    • After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) should receive a Resident Review as soon as resources become available.
    • Reminder, under current law Level I and Level II screens are not required for residents who are being transferred between nursing facilities (NF).
  • Modification of State Fair Hearing and Appeal Timelines
    • Modifies the timeframe for managed care entities to resolve appeals under 42 C.F.R. §438.408(f)(1) before an enrollee may request a State fair hearing to no less than one day in accordance with the requirements specified below; this allows managed care enrollees to proceed almost immediately to a state fair hearing without having a managed care plan resolve the appeal first by permitting the state to modify the timeline for managed care plans to resolve appeals to one day so the impacted appeals satisfy the exhaustion requirements.
    • CMS authorizes the state to modify the time line for managed care plans to resolve appeals to no less than one day.
    • If the state uses this authority, it would mean that all appeals filed between March 1, 2020 and the end of the public health emergency are deemed to satisfy the exhaustion requirement in 42 C.F.R. §438.408(f)(1) after one day (or more if that is the timeline elected by the state) and allow enrollees to file an appeal to the state fair hearing level.
  • Provider Enrollment
    • Indiana currently has the authority to rely upon provider screening that is performed by other State Medicaid Agencies (SMAs) and/or Medicare and enroll out of state providers, and will waive one existing criteria for that process so that Indiana may reimburse out-of-state providers for multiple instances of care to multiple participants.
    • Indiana may also temporarily enroll without an application fee, criminal background checks associated with fingerprint-based checks in federal code, site visits, and in-state licensure requirements.  Other enrollment flexibilities are listed as well.
    • Revalidations may be paused.
  • Provision of Services in Alternative Settings
    • Nursing facilities, and other facilities, can be fully reimbursed for services in an unlicensed facility, during an emergency evacuation or due to other need to relocate residents where the placing facility continues to render services.
    • The State must make a reasonable assessment that the facility meets minimum standards, consistent with reasonable expectations in the context of the current public health emergency, to ensure the health, safety and comfort of beneficiaries and staff.
    • The placing facility would be responsible for determining how to reimburse the unlicensed facility.
    • This arrangement would only be effective for the duration of the section 1135 waiver.
  • Duration
    • 1135 waivers described are effective March 1, 2020 and will terminate upon termination of the public health emergency, including any extensions.

ISDH Surveyors Visits to LTC Facilities 

The IHCA/INCAL will be in touch with Indiana Government to obtain and provide guidance on operationalizing these waivers. These are all authorities for the state to act on and implement and require further state action to implement.

By now many of you have likely had a visit from a LTC Nurse Surveyor.  These are not regulatory visits and are also not Strike team visits. Instead surveyors are delivering a version of this packet of cumulative guidance documents from ISDH, CDC, and other sources.  The surveyors are intending to meet with the Administrator to discuss the guidance document and inquire as to infection control assistance and needs.  The surveyors should not be roaming the facility and should only be in the foyer or administrators office.