Department of Health & Human Services
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S2-26-12
Baltimore, Maryland 21244-1850
June 15, 2020
Adam Crum
Commissioner
Department of Health and Social Services
3601 C Street, Suite 902
500 Summer Street Northeast, E-1
Anchorage, Alaska 99503-7167
Re: Section 1135 Flexibilities Requested in June 8, 2020 Communication (Third Request)
Dear Commissioner Crum:
The Centers for Medicare & Medicaid Services (CMS) granted an initial approval to the State of Alaska for multiple section 1135 flexibilities on April 2, 2020. Your follow-up communication to CMS on June 8, 2020 detai1ed a number of additional federal requirements that also pose issues or challenges for the health care delivery system in Alaska and requested a waiver or modification of those additional requirements. Attached, please find a response to your request for waiver or modification, pursuant to section 1135 of the Social Security Act (Act), to address the challenges posed by COVID-19. This approval addresses the request related to Medicaid. To the extent the requirements the state requested to waive or modify apply to CHIP, the state may apply the approved flexibilities to CHIP. This applies to the waivers included below, as well as the 1135 waivers granted to the state on April 2, 2020.
On March 13, 2020, the President of the United States issued a proclamation that the COVID-19 outbreak in the United States constitutes a national emergency by the authorities vested in him 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 Act. On March 13, 2020, pursuant to section 1135(b) of the Act, the Secretary of the United States Department of Health and Human Services invoked his authority to waive or modify certain requirements of titles XVIII, XIX, and XXI of the Act as a result of the consequences of the COVID-19 pandemic, to the extent necessary, as determined by CMS, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the respective 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 as a result of the COVID-19 pandemic, 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 6PM Eastern Standard Time on March 15, 2020, with a retroactive effective date of March 1, 2020. The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the public health emergency, including any extensions.
To streamline the section 1135 waiver request and approval process, CMS has issued a number of blanket waivers for many Medicare provisions, which primarily affect requirements for individual facilities, such as hospitals, long term care facilities, home health agencies, and so on. Waiver or modification of these provisions does not require individualized approval, and, therefore, these authorities are not addressed in this letter. Please refer to the current blanket waiver issued by CMS.
This letter is in response to all requests submitted to CMS. If the state/territory determines that it has additional needs, please contact your state lead and CMS will provide the necessary technical assistance for any additional submissions.
Please contact Jackie Glaze, Deputy Director, Medicaid and CHIP Operations Group, at (404) 387-0121 or by email at Jackie.Glaze@cms.hhs.gov if you have any questions or need additional information. We appreciate the efforts of you and your staff in responding to the needs of the residents of the State of Alaska and the health care community.
Sincerely,
Calder Lynch
Deputy Administrator and Director
STATE OF ALASKA
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: June 15, 2020
To the extent applicable, the following waivers and modifications also apply to CHIP.
Use of Representatives to Render 1915(k) Services
Pursuant to section 1135(b)(1)(A) of the Act, CMS approves a waiver of 42 C.F.R. 441.480(b) to temporarily allow payment for 1915(k) attendant services and supports rendered by an individual’s representative provided that the state makes a reasonable assessment that the caregiver is capable of rendering such services. This waiver will ensure that medically necessary services are furnished in the event the traditional provider workforce is diminished or there is inadequate capacity due to the public health emergency.
Duration of Approved Waivers
Unless otherwise specified above, the section 1135 waivers described herein are effective March 1, 2020 and will terminate upon termination of the public health emergency, including any extensions. In no case will any of these waivers extend past the last day of the public health emergency (or any extension thereof).