The Centers for Medicare & Medicaid Services (CMS) granted an initial approval to the Commonwealth of Kentucky for multiple section 1135 flexibilities on March 25, 2020. Your follow-up communication to CMS on January 14, 2021 indicated Kentucky’s response to the COVID-19 pandemic has delayed its ability to submit a state plan amendment (SPA) to fulfill the requirements outlined in section 1006(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (“SUPPORT Act”).

The Centers for Medicare & Medicaid Services (CMS) granted an initial approval to the District of Columbia (DC) for multiple section 1135 flexibilities on April 3, 2020. Your follow-up communication to CMS on January 13, 2021 indicated DC’s response to the COVID-19 pandemic has delayed its ability to submit a state plan amendment (SPA) to fulfill the requirements outlined in section 1006(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (“SUPPORT Act”).

The Centers for Medicare & Medicaid Services (CMS) granted initial approval to the State of California for multiple section 1135 flexibilities on March 23, 2020, and subsequent approvals on May 8, 2020, and August 19, 2020. Your follow-up communication to CMS on December 24, 2020, detailed additional federal requirements that also pose issues or challenges for California's health care delivery system and requested a waiver or modification of those other requirements.