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CMS 1135 Waiver Now Available Until April 2022

On Friday, January 14, 2022, the Secretary of Health and Human Services, Xavier Becerra, declared a renewal of the Public Health Emergency declaration, effective January 16, 2022. For an additional 90 days, this allows for access to waiver or modification of requirements under Section 1135 of the Social Security Act. The new expiration date is set for April 16, 2022. CMS has committed to provide notice of the PHE end prior to the expiration date, with a 60-day notice promised. The link to view this declaration: https://aspr.hhs.gov/legal/PHE/Pages/COVID19-14Jan2022.aspx  

The surge in cases across the country is more than likely the rationale for this 8th extension.  The use of the Section 1135 waiver has become our most frequently asked question on the HPH TeleMDS hotline. We encourage the use of the updated recommendations below to help steer your resident advocacy for access to Medicare benefits.

With the staffing shortages in many counties, the acute Hospitals and Home Health Agencies must have reliable SNF partners with the volume of complex patients being admitted and treated daily to each of those settings. Learn more about the Choose Home Care Act of 2021 with a move towards home-based care services HERE.

SNF-based services along the continuum of care are essential for safe transitioning between care settings. Here are highly recommended steps to incorporate into your daily regime to navigate the ongoing access to services under the 1135 Wavier allowance.

  • Daily Waiver Discussions: Daily team meetings are conducted to discuss any changes in resident conditions. Be sure to include a discussion of why residents may meet the criteria for skilled care.
  • Direct ER Admissions: Continue frequent touchpoints with upstream hospitals in your area, emphasizing your ability to admit residents directly from the ER or without a qualifying hospital stay.
  • Discharge Planners + Case Managers: Get the word out - to hospital discharge planners so they are fully aware of your clinical capabilities! Consider participation in an Emergency Department diversion program.
  • Community Relations: Engage with downstream partners such as community physicians, specialty clinics + home health agencies. Confirm these partners are aware you can directly admit residents in need of skilled nursing services.
  • Waiver access is NOT diagnosis dependent: Most relevant is that residents must meet the SNF criteria for daily skilled care under Medicare guidelines. Residents do NOT have to have a diagnosis of COVID-19 to utilize the 3 Day Waiver. For additional details, please reference our CMS Waiver Skilling Guide here.
Be an advocate for any residents who are eligible and entitled to utilize their Medicare benefits!