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Greensense Billing > Blog > Blogs > 1135 Waivers and Other Regulatory Flexibilities during COVID – 19
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1135 Waivers and Other Regulatory Flexibilities during COVID – 19

The economic, social, financial and psychological effects of the corona virus pandemic have taken the world by storm. A global call for quarantine to neutralize the risk of spreading this life-threatening disease has become quintessential. The need for relentless healthcare assistance has pushed the US Department of Health and Human Services to temporarily waive off certain Medicare, Medicaid, CHIP (Children’s Health Insurance Policy) and HIPAA requirements to help fight the global pandemic.

 Regulatory Flexibilities during COVID19

The CMS(Centers for Medicare and Medicaid) have provided flexibility in the accessibility of quality health through expedited 1135 waivers. These have been mandated in 34 states as a measure to meet the increasing demands for valuable health care. It has ushered greater support for Medicare beneficiaries in emergency disaster management. The US has observed a shortage of providers to assist in urgent care due to the huge influx of corona virus patients.

This will greatly help all medical billing and coding practices to collect Medicare and Medicaid related reimbursements promptly.  Section 1135 waivers are intended to ensure that enough healthcare items and services are available to meet the needs of individuals enrolled in Medicare, Medicaid, CHIP and other healthcare programs.  Also, providers who provide these services in good faith can be reimbursed and exempted from sanctions absent fraud or abuse of the healthcare system. Medicare Waivers and Medicaid Flexibilities under the 1135 Waivers are effective March 1, 2020, and will continue until the end of the public health hazard. According to CMS Administrator Seema Verma, these 1135 waivers would be providing a broad range of regulatory health care relief and sustenance to most vulnerable patients. Hence the need for connected health through telemedicine software is highly prevalent.

What is an 1135 Waiver?

1135 waivers also coined as “blanket waivers” are opportunities for health care providers to offer essential medical help in good faith, with the assurance of getting their reimbursements. These apply to the time limit of a specific emergency and geographical location according to state requirements. These waivers expedite the process of enrollments with prior authorizations for doctors, health care items or services. These waivers are paramount for medical billing and coding service practices.

Integral 1135 Waivers due to the COVID-19 pandemic

The waiver has incorporated a 3-day rule for SNFS (Skilled Nursing Facilities). It would require three days before authorization for hospital coverage of a skilled nursing facility stay. It further includes rules for face to face encounters, health care orders, and new medical necessity paperwork for DME (Durable Medical Equipment). Long-Term Care Hospitals (LTCH) may exclude from the 25-day average length of stay requirement those patient stays resulting from the admission or discharge necessitated by COVID-19 response. The medical record must clearly reflect when an admission or discharge is made to meet the demands of the COVID-19 emergency.

Momentary Relaxation in Preauthorization for Medicaid fee structures 

The current waivers will increase health care rehabilitation on various levels. It can include provider enrollment processes, prior authorization, suspension of certain preadmission policies, and facilitation for providers to gain reimbursements for the health care provided during the pandemic period. It will also aid in the course of action for integrated medical billing services in the US.

Benefits for Patients through Temporary suspension of prior authorizations 

Temporarily suspending prior authorization requirements for Medicare beneficiaries is greatly helping providers in giving care. Extension in health care authorizations during the corona virus is impacting providers positively. Modification of timeline requirements for state hearings and appeals is also greatly molding the providers. Relaxation in provider enrollment requirements to help fasten the process of state provider’s requirements. This would certainly ease the limitations of people residing in different states and prove to be an expansive health care regime. There will also be a relaxation for COVID-19 focused Medicare state-plan amendments and relaxation in Medicare and Medicaid submission deadlines for this pandemic situation. This would enable different states to improvise and amend healthcare plans to elevate patient care throughout the public health emergency. The White House has announced the 1135 waivers as actionable enforcement for the accessibility of best health care possible across all states of the US.

States that have Approval for 1135 Waivers

The latest waiver requests from providers have led the CMS to approve and align the 1135 waivers for urgent medical attention for all policyholders in the states of California; Washington Missouri; Arizona, Colorado, Connecticut, Delaware, Idaho, Illinois, Indiana, Kansas, Maryland, Massachusetts, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, and West Virginia. With the announcement of CMS, these waivers have been released for usage with immediate effect. 

Emergency Medical Treatment and Labor Act (EMTALA) Waiver

The 1135 waivers under the Social Security Act imposed by the Secretary of HHS usually last during the emergency period or at least two months from the date the modified waiver is published. The 1135 waivers are in place to assist long term intensive care for Medicare beneficiaries. This newly introduced waiver will prove to comfort both the providers and medical billing companies. Section 1867 of the EMTALA waiver (the Emergency Medical Treatment and Labor Act) have been approved by the Department of Health and Human Services (HHS) for the placement of a patient to another health care facility to receive medical treatment keeping in mind the medical health emergency crisis at hand.  EMTALA is a federal law and part of the social security Act that requires hospital dealing with Medicare patients to perform necessary medical screenings for emergency health situations.

The Impact of COVID 19 and 1135 waivers on Revenue Cycle Management

The Coronavirus pandemic has over flooded hospitals and health care facilities with patients experiencing the same common symptoms caused by the Coronavirus to get themselves screened. Millions of Medicare and Medicaid patients with preexisting medical conditions could miss out on timely medical checkups. In the hopes of providing quality health care the US Government has removed prime barriers through waivers. Providers will operate and provide services while still billing and receiving reimbursement under the Medicare, Medicaid, and CHIP programs for provided services on or after March 1, 2020, that fall under the umbrella of the 1135 waivers. This will assist the Medical Billing and coding services companies to abide by the regulations and effectively streamline physician billing. In times of strict self-isolation, or health care facility to bring on added staff members to their teams. Thus creating a huge need and opportunity for medical billing specialists to manage the revenue cycle management for most providers and large hospitals. The need for outsourcing medical coding and billing has grown by epic proportions. Medical billing and coding services strongly help to prevent any medical billing errors and integrate automated billing processes for speedy collections.

We at Green Sense Billing are geared towards providing skilled and resourceful medical billing and coding services. Ensuring that all medical billing and coding practices are fully HIPPA compliant and in line with the latest CMS (Centers for Medicare and Medicaid) Regulations.   

We stand in unity with all healthcare professionals and extend a heartfelt thank you for all your hard work!


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