Gov. Wolf: State Receives Waiver to Facilitate Greater Flexibility in Medicaid, CHIP Programs During COVID-19 Mitigation Efforts

Harrisburg Capitol steps

HARRISBURG, PA — Governor Tom Wolf announced that Pennsylvania, through the Department of Human Services, received approval from the federal Centers for Medicare & Medicaid Services (CMS) to temporarily grant flexibility of requirements for providers of Medicaid and Children’s Health Insurance Program (CHIP) to ensure availability and access to health care and public assistance programs for people who need them in light of COVID-19 mitigation efforts.

“My administration will do everything in its power to ensure that people have access to health care coverage to protect themselves and their family during this unprecedented time,” Gov. Wolf said. “We are grateful that the federal government quickly granted us flexibility to ensure human services programs are able to make critical adjustments necessary to fighting this public health crisis.”

“This waiver will help us build capacity in our Medicaid and CHIP systems to help us as we face this public health crisis and should ease processes for providers and recipients of public assistance programs,” said DHS Secretary Teresa Miller.

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When the President declares a disaster or emergency under the Stafford or National Emergencies Act and the Secretary of Health and Human Services (HHS) declares a public health emergency under Section 319 of the Public Health Service Act, the HHS Secretary is granted additional authority.

Under section 1135 of the Social Security Act, this authority permits changes to Medicare, Medicaid, and the Children’s Health Insurance Program to ensure the needs of people covered by these programs are met during an emergency.

The waiver also allows Pennsylvania flexibility to pay providers for health care services to ensure they are able to adequately respond to and adjust care in light of a public health emergency.

The waiver allows DHS the temporary flexibility under Medicaid and, in some instances, CHIP, to:

  • Suspend Medicaid fee-for-service prior authorization requirements and extend pre-existing authorizations through the end of the public health emergency;
  • Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and II assessments for 30 days;
  • Extend the timeframes for beneficiaries to file an appeal;
  • Temporarily waive provider enrollment and screening requirements, including:
    • Payment of an application fee;
    • Criminal background checks and fingerprinting;
    • Site visits; and
    • State licensure, if the provider is licensed in good standing in another state.
  • Provide payment to out-of-state providers for services rendered to Pennsylvania Medicaid recipients in another state; and
  • Provide payment for facility services rendered in alternative settings.
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The approval letter issued by CMS did not address each request that Pennsylvania included in its waiver application, which may be read in full here. In its approval letter, CMS committed to coordinate with DHS to determine the steps that must be taken to gain approval for those other flexibilities requested. The full 1135 waiver request submitted by Pennsylvania may be found here.

Now that the waiver request is partially approved, DHS will work with providers and stakeholders to issue guidance to implement these approved temporary changes.

Visit the PA Department of Health’s dedicated Coronavirus webpage for the most up-to-date information regarding COVID-19.

Guidance to DHS providers related to COVID-19 and more information regarding the 1135 waiver request is available here.

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