Pennsylvania has gained permission to circumvent certain federal Medicaid regulations and requirements for the duration of the COVID-19 public health emergency.
Under the declaration of a national state of emergency, the Department of Health and Human Services is authorized to waive or modify Medicare and Medicaid regulations; these are known as section 1135 waivers. In this case, the federal Centers for Medicare & Medicaid Services has issued a section 1135 waiver to Pennsylvania for its Medicaid program to:
- 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
- Temporarily suspend Medicaid fee-for-service prior authorization requirements.
- Delay state fair hearings and appeal timelines.
- Enroll new providers in the state’s Medicaid program if they are enrolled by Medicare or by another state Medicaid program
- Pay nursing facilities, intermediate care facilities, and others for the delivery of services outside of their walls, at unlicensed facilities, if COVID-19 necessitated the evacuation of their own facilities.
These waivers will last until the end of the declared public health emergency.