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Indiana's 1135 Waiver Request Approved

Thursday, March 26, 2020   (0 Comments)
Posted by: LeadingAge
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Indiana’s 1135 waiver has been approved (see link to the approval letter). Upon implementation by State agencies, the waivers will:
Temporarily suspend Medicaid fee-for-service prior authorization requirements. Section 1135(b)(1)(C) allows for a waiver or modification of pre-approval requirements, including prior authorization processes required under the State Plan for particular benefits.
Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
  • 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 with positive Level I screens would require a Resident Review.
  • The 7-9-day timeframe for Level II completion is an annual average for all preadmission screens, not individual assessments, and only applies to the preadmission screens (42 C.F.R. §483.112(c)). There is not a set timeframe for when a Resident Review must be completed, but it should be conducted as resources become available.
State Fair Hearing Requests and Appeal Timelines
  • CMS approves a waiver under section 1135 that allows enrollees to have more than 90 days, up to an additional 120 days for an eligibility or fee for service appeal to request a fair hearing. The timeframes in 42 C.F.R. §431.221(d) provides that states can choose a reasonable timeframe for individuals to request a fair hearing not to exceed 90 days for eligibility or fee-for-service issues. 
Provider Enrollment 
  • Indiana currently has the authority to rely upon provider screening that is performed by other State Medicaid Agencies (SMAs) and/or Medicare. As a result, Indiana is authorized to provisionally, temporarily enroll providers who are enrolled with another SMA or Medicare for the duration of the public health emergency.
    • Under current CMS policy, as explained in the Medicaid Provider Enrollment Compendium (PDF 586.81 KB) (7/24/18), at pg. 42, Indiana may reimburse otherwise payable claims from out-of-state providers not enrolled in Indiana Medicaid program if additional criteria are met. 
    • Indiana may also temporarily enroll without an application fee, criminal background checks associated with fingerprint-based checks in federal code, site visits, and in-state licensure requirements. Other enrollment flexibilities are listed as well.
    Provision of Services in Alternative Settings
    • CMS approves a waiver under section 1135(b)(1) of the Act to allow facilities, including NFs, intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDDs), psychiatric residential treatment facilities (PRTFs), and hospital NFs, to be fully reimbursed for services rendered to an unlicensed facility (during an emergency evacuation or due to other need to relocate residents where the placing facility continues to render services) provided that the State makes a reasonable assessment that the facility meets minimum standards, consistent with reasonable expectations in the context of the current public health emergency, to ensure the health, safety and comfort of beneficiaries and staff. The placing facility would be responsible for determining how to reimburse the unlicensed facility. This arrangement would only be effective for the duration of the section 1135 waiver.
    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).

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