Erik Kanter, Hoven Consulting

The Wisconsin Department of Health Services (DHS) has drafted an 1135 waiver to submit to CMS requesting the federal government make allowances for the state to comprehensively address COVID-19. While the contents of the full waiver can be found in the link above, Tim and I wanted to share the following highlights:

·  13.1 42 C.F.R. § 484.55(a). Allow home health agencies to perform certifications, initial assessments and determine patients’ homebound status remotely or by record review.

·  2.2  Waive pre-enrollment criminal background checks for Medicare-enrolled providers to temporarily enroll a provider for ninety (90) days or until the termination of the novel COVID-19 declaration of emergency, whichever is longer. (42 C.F.R. § 455.434); Following this temporary enrollment, DHS will complete the complete enrollment process, including conducting a criminal background check, within 90 days of this temporary enrollment.

·  2.3  Waive site visits to temporarily enroll a provider for ninety (90) days or until the termination of the novel COVID-19 declaration of emergency, whichever is longer. (42 C.F.R. § 455.432).

·  2.5  Waive the requirement that physicians and other health care professionals be licensed in the state in which they are providing services, so long as they have equivalent licensing in another state or are enrolled with Medicare (42 C.F.R.§ 455.412).

·  2.6  Allow providers to receive payments for services provided to affected beneficiaries in alternative physical settings, such as mobile testing sites, temporary shelters or other care facilities, including but not limited to, commandeered hotels, other places of temporary residence, and other facilities that are suitable for use as places of temporary residence or medical facilities as necessary for quarantining, isolating or treating individuals who test positive for COVID-19 or who have had a high-risk exposure and are thought to be in the incubation period or to expand overall capacity to meet high demand.

·  4.1  Suspend cost sharing for all Wisconsin Medicaid participants for the duration of the declared emergency.

·  4.2  Broadly waive any face-to-face requirements.

·  6.5  Waiver CMS Payment Error Rate Measurement (PERM) and Quality Control (QC) requirements to allow some flexibility regarding errors during the duration of the declared emergency.

·  6.6  Allow flexibility for the submission of electronic signatures on behalf of a member by application assistors if a signature cannot be captured in person. This would be in the case of individuals who are non-merit staff assisting individuals through the application process over the phone (who normally would be doing this assistance in-person).

·  8.8  Allow the State to waive requirements prohibiting the provision of home and community-based services to affected beneficiaries who are being served in an inpatient setting in order to enable direct care workers or other home and community-based providers to accompany individuals to any setting necessary (42 C.F.R. § 441(b)(1)(ii)).

·  8.13  Allow the State to restrict freedom of choice of provider (§ 1902(a)(23)(A)).

·  10.2.1.1 Approve the use of technology and physical barriers that limit exposure and potential spread of the virus, such as use of video and audio resources for limiting direct contact between physicians and other providers in the same clinical facility.

·  10.2.1.2 Permit treatment to occur in patient vehicles, assuming patient safety and comfort. Many facilities are standing up drive through specimen collection sites, we’d like to request basic evaluation and treatment be allowed in patient vehicles in order to prevent potential spread of the virus to the facility.

·  10.2.6  Medical Staff. 42 C.F.R. § 482.22(a); A-0341 So that physicians whose privileges will expire and new physicians can practice before full medical staff/governing body review and approval. This will keep clinicians on the front line and allow hospitals and health systems to prioritize patient care needs during the emergency.

·  10.3  Physician referral. Waive sanctions under section 1877(g) of the Social Security Act (relating to limitations on physician referral). This will allow hospitals to compensate physicians for unexpected or burdensome work demands (e.g., hazard pay), encourage multi-state systems to recruit additional practitioners from out-of- state, and eliminate a barrier to efficient placement of patients in care settings.

DHS has submitted the waiver to the legislature's Joint Committee on Finance for its approval, which is the normal process for submitting an 1135 waiver. We're trying to gain some information on the legislature's timeline. It is our understanding that due to certain requirements in statute, it may take a bill to actually allow DHS to submit the waiver, rather than just approval by the Joint Committee on Finance. We're doing our best to understand the full scope of the situation and will provide updates when we know more.

Any questions or follow-up on this or any other COVID-19 issues can be sent to wiahc@badgerbay.co.