Department of Health & Human Services
Centers for Medicare & Medicaid Services
601 East 12th Street, Room 355
Kansas City, Missouri 64106-2898
Medicaid and CHIP Operations Group
September 18, 2024
Kimberly Sullivan, J.D.
Medicaid Executive Director
Louisiana Department of Health
628 North 4th Street
Baton Rouge, Louisiana, 70802
Re: Section 1135 Flexibilities Requested on September 13, 2024
Dear Medicaid Executive Director Kimberly Sullivan:
On September 10, 2024, the President of the United States issued a proclamation that 2024 Hurricane Francine constitutes an emergency by the authorities vested in the President by the Constitution and the laws of the United States, including sections 201 and 301 of the National Emergencies Act (50 U.S.C. 1601 et seq.), and consistent with section 1135 of the Social Security Act (the Act). On September 12, 2024, pursuant to section 1135(b) of the Act, the Secretary of the United States Department of Health and Human Services (HHS) declared a public health emergency (PHE), invoking the authority to waive or modify certain requirements of titles XVIII, XIX, and XXI of the Act. During a PHE, the Centers for Medicare and Medicaid Services (CMS) may approve the use of section 1135 authority to help ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in CMS programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of such requirements, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse. This authority took effect as of September 12, 2024, with a retroactive effective date of September 10, 2024. The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the PHE, including any extensions.
Your submission to CMS on September 13, 2024 detailed federal Medicaid requirements that pose issues or challenges for the health care delivery system in Louisiana. Below, please find a response your request for waivers or modifications, pursuant to section 1135 of the Act, to address the challenges posed by 2024 Hurricane Francine. To the extent the requirements the state requested to modify apply to the Children's Health Insurance Program (CHIP), the state may apply the approved flexibilities to CHIP.
We appreciate the efforts of you and your staff in responding to the needs of the residents and health care community in Louisiana. Please contact your state lead if you have any questions or need additional information.
Sincerely,
Courtney Miller
Director
cc: Courtney Miller, Anne Marie Costello, Daniel Tsai
STATE OF LOUISIANA
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: September 20, 2024
To the extent applicable, the following waivers and modifications also apply to CHIP.
Long Term Services and Supports (LTSS)
PASRR
Pursuant to section 1135(b)(5) of the Act, CMS approves a modification of Section 1919(e)(7) and 42 C.F.R. § 483.112to allow Level I and Level II assessments to be waived by the state for 30 days from admission. After 30 days, Level I assessments should be conducted with reasonable promptness and Level II assessments should be coordinated with the resident review.
Additionally, please note that per 42 C.F.R. § 483.106(b)(4), new preadmission Level I and Level II screens are not required for residents who are being transferred between nursing facilities (NF). If the NF is not certain whether a Level I had been conducted at the resident's evacuating facility, a Level I can be conducted by the admitting facility during the first few days of admission as part of intake and transfers. Positive Level I screens necessitate a Resident Review.