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Florida Medicaid Request for Relief under Section 1135 Authority due to Hurricane Michael

Department of Health & Human Services
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S2-26-12
Baltimore, MD 21244-1850

October 11, 2018

Beth Kidder
Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, Mailstop #20
Tallahassee, FL 32308

Dear Ms. Kidder:

RE: Florida Medicaid Request for Relief under Section 1135 Authority due to Hurricane Michael

This letter is in response to your October 10, 2018 request for flexibility with respect to the federal requirements that posed issues for the Florida health care delivery system in the region most effected by Hurricane Michael.

The Secretary of the Department of Health and Human Services, Alex M. Azar II, has declared a public health emergency for the affected geographic area, and has authorized the Centers for Medicare & Medicaid Services (CMS) to exercise authority under Section 1135 of the Social Security Act (SSA) to waive certain requirements of the Medicare, Medicaid, and Children’s Health Insurance program during the emergency period.

Below, we have addressed the flexibilities available for the requirements that you requested:

Waive Pre-Admission Screening and Annual Resident Review (PASRR) Level 1 and Level II Assessments for 30 days:

Per CFR 483.106(b) (4), Level 1 screens are not required for residents who are being transferred between nursing facilities (NF) and federal financial participation (FFP) should not be affected for transferees. If the NF is not certain whether a Level 1 has 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 the intake. If there isn’t enough information to complete a Level I, this can be documented in the resident’s file.

Level II evaluations and determinations are also not required preadmission when residents are being transferred between NFs. The 7-9 day timeframe that is referenced is an annual average for all preadmission screens, not individual assessments, and only applies to the preadmission screens (42 CFR 483.112(c)). Residents who are transferred should receive a post admission Resident Review. There isn’t a set timeframe for when a Resident Review must be completed but is should be conducted as resources become available.

Provide flexibility to Temporarily Delay Scheduling of Medicaid Fair Hearings and Issuing Fair Hearing Decisions during the Disaster Period:

42 CFR 431.244(f)(4)(i)(B) allows the agency to take final administrative action outside of timelines set in regulation when there is an administrative or other emergency beyond the agency’s control. The state should document the reason for delay in the recipient’s case record and document that the policy is in compliance with state’s record keeping practices and seek concurrence from CMS. If this exception is for general fair hearing timeliness standards, the state should prioritize completing hearings requested by beneficiaries who stand to suffer the most harm from delay, specifically those who meet the standard for an expedited fair hearing under 42 CFR 431.224.   

Please contact Trina Roberts, Associate Regional Administrator for Region IV at (404) 562-7418 or by e-mail Shantrina.Roberts@cms.hhs.gov if you have any questions or need additional information. We appreciate the efforts that you and your staff in responding to the needs of the Florida health care community.


Timothy Hill
Acting Center Director 

cc:  Trina Roberts

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