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
May 08, 2026
George Cruz
Director
Commonwealth Medicaid Agency
Office of the Governor
Caller Box 10007
Saipan, MP 96950
Re: Section 1135 Flexibilities Requested on May 07, 2026
Dear Director Cruz:
On April 11, 2026, the President of the United States issued a proclamation that the 2026 Super Typhoon
Sinlaku 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 April 17, 2026, 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 April 17, 2026, with a retroactive effective date of April 11, 2026. 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 May 07, 2026, detailed federal Medicaid requirements that pose issues or
challenges for the health care delivery system in Northern Mariana Islands. Below, please find a response
to each of your requests for waivers or modifications, pursuant to section 1135 of the Act, to address the
challenges posed by the 2026 Super Typhoon Sinlaku. To the extent the requirements the state requested
to waive or 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 Northern Mariana Islands. Please contact your state lead if you have any questions or need
additional information.
Sincerely,
Courtney Miller
Director
cc:
Dan Brillman
Caprice Knapp
Anne Marie Costello
Courtney Miller
Barbara Richards
NORTHERN MARIANA ISLANDS
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: May 08, 2026
To the extent applicable, the following waivers and modifications also apply to CHIP.
Provider Enrollment
With respect to providers not already enrolled with another State Medicaid Agency (SMA) or Medicare,
pursuant to section 1135(b)(1) and (b)(2) of the Act, CMS waives the following screening requirements:
licensing requirements, so the state may provisionally, temporarily enroll the providers for the duration of
the PHE.
CMS is granting this waiver authority to allow the state to temporarily enroll providers who are not currently
enrolled with another SMA or Medicare so long as the state meets the following minimum requirements:
- Must collect minimum data requirements in order to file and process claims, including, but not
limited to NPI. - Must collect Social Security Number, Employer Identification Number, and Taxpayer Identification
Number (SSN/EIN/TIN), as applicable, in order to perform the following screening requirements:
a. OIG exclusion list
b. State licensure – provider must be licensed, and legally authorized to practice or deliver the
services for which they file claims, in at least one state/territory - The state must also:
a. Issue no new temporary provisional enrollments after the date that the PHE is lifted,
b. Cease payment to providers who are temporarily enrolled within six months from the
termination of the PHE, including any extensions, unless a provider has submitted an
application that meets all requirements for Medicaid participation and that application was
subsequently reviewed and approved by the state before the end of the six-month period after
the termination of the PHE, including any extensions, and
c. Allow a retroactive effective date for provisional temporary enrollments that is no earlier than
April 11, 2026.
Pause revalidation deadlines
Pursuant to section 1135(b)(1)(B) of the Act, CMS is approving the state’s request to temporarily pause
revalidation for providers located in the state or are otherwise directly impacted by the emergency.
If the state pauses revalidation for providers with revalidation due dates that fall during the PHE, the state
would recalculate the provider’s revalidation due date by adding six months plus the length of the PHE to
the provider’s original revalidation due date. For instance, if the provider’s revalidation due date was April 1,
2021 and the PHE lasted 12 months, the provider’s new revalidation due date would be October 1, 2022
(April 1, 2021 + six months + 12 months).