What Is the 1135 Waiver and What Does It Mean for My Hospice?

During these historic times, many healthcare providers are struggling to provide care in the same ways they did before COVID-19 disrupted everyday lives. To alleviate these pressures and to facilitate continued support to fight COVID-19, the President instituted protocols to give governmental agencies, like the Centers for Medicare and Medicaid Services, the authority to invoke proactive methods to ease the strains being faced by providers without compromising care delivery. The emergency declarations were made on March 13, 2020, and a new set of blanket 1135 waivers inclusive of hospice was released March 30, 2020. 

Acclivity Health answers some of the questions you may have about this waiver and its impact on your hospice.

What is an 1135 waiver?

In the event of an emergency or disaster, CMS has a pre-identified list of policies and procedures that may be waived or altered for specific geographical areas, groups or classes of providers, or a particular provider. Most often, 1135 waivers temporarily modify or provide flexibility in some Medicare, Medicaid, and CHIP requirements. This ensures that the needs of patients under these programs can be sufficiently met during emergencies and allows providers administering these services in good faith to be retroactively reimbursed. 

What kinds of Medicare requirements can be waived or modified in hospice and palliative practices?

• Program participation
• Preapproval requirements
• Performance deadlines and timetables (may be adjusted, not waived)
• Conditions of participation
• HIPAA
• State licensure requirements for health care professionals who have an equivalent licensure in a different state (only for Medicare, Medicaid, and CHIP reimbursement for state licensed healthcare professionals who may be practicing in another state — state laws govern whether a non-Federal provider is authorized to provide services in a state without a state licensure)

Does the current public health emergency cover hospices under an 1135 waiver?

Originally, no. At the urging of organizations such as NHPCO, requests for blanket waivers for hospice were finally addressed Monday, March 30, 2020. CMS issued a set of blanket 1135 waivers to apply to various Medicare provider types, including hospices. These waivers will be retroactive, with an effective date of March 1, 2020. 

What are the hospice-specific waivers?

CMS has provided many flexibilities and waivers, which can be used immediately, without having to apply. These include:

• Waiving requirements for hospices to use volunteers
• Waiving certain requirements for updating comprehensive assessments of patients. This waiver extends the timeframe for updating the assessments from 15 to 21 days.
• Waiving non-core services, including physical therapy, occupational therapy, and speech-language pathology
• Waiving onsite visits for hospice aide supervision. This waives the requirement for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan.
• Face-to-face encounters for recertification of patients on the Medicare hospice benefit can be conducted via telehealth
• Hospice providers can provide routine home care to Medicare patients via telehealth where it is appropriate

You can read the full summary of waivers from CMS here. 

If you have any additional questions related to the 1135 waivers, please feel free to email us at info@8kw.3ce.myftpupload.com.