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CMS Response to Florida's Hurricane Dorian Waiver Request

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

September 17, 2019

Ms. 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 Dorian

This letter is in response to your August 31, 2019 request for flexibility with respect to the federal requirements that posed issues for the Florida health care delivery system in the regions most effected by Hurricane Dorian.

The Secretary of the Department of Health and Human Services, Alex Azar II, has declared a public health emergency for Florida, and has authorized the Centers for Medicare & Medicaid Services (CMS) to exercise authority under section 1135 of the Social Security Act to waive certain requirements of the Medicare, Medicaid and Children's Health Insurance programs during the emergency period. Attached you will find responses to your requests for waiver authorities pursuant to CMS authority under Sections 1135 of the Social Security Act, to the extent needed to respond to the challenges posed by Hurricane Dorian. CMS has posted information to its website that include flexibilities, blanket waivers, waivers with 1135 authority and waivers without 1135 authority. This information is located on the: Current Emergencies page.

Under Section 1135 waiver authority, we are able to grant your requests. The language below outlines the 1135 waiver provisions and additional program flexibilities CMS is granting:

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

    CMS Response: 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 1 can be conducted by the admitting facility during the first few days of admission as part of the intake process. If there isn't enough information to complete a Level 1, 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.l 12(c)). Residents who are transferred should receive a post admission Resident Review. There is no set timeframe for when a Resident Review must be completed but it should be conducted as resources become available.
  2. Provide Flexibility to Waive Service Authorization requirement for Fee-For-Service

    CMS Response: Prior authorization and medical necessity processes in fee-for-service delivery systems are established, defined and administered at state/territory discretion and may vary depending on the benefit. The State of Florida may have indicated in their approved state plan specific requirements about prior authorization processes (42 CFR 440.230(c)) for benefits administered through the fee-for-service delivery system. We interpret prior authorization requirements to be a type of pre-approval requirement for which waiver and modification authority under Section I 135(b)(l)(C) is available.

Please contact Shantrina Roberts, Deputy Director of Regional Operations Group, South at 404-562-7418 or email at Shantrina.Roberts@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 Florida health care community.


Karen Shields
Deputy Center Director

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