Pennsylvania has gained permission to circumvent certain federal Medicaid regulations and requirements for the duration of the COVID-19 public health emergency.

Bookshelf with law booksUnder the declaration of a national state of emergency, the Department of Health and Human Services is authorized to waive or modify Medicare and Medicaid regulations; these are known as section 1135 waivers.  In this case, the federal Centers for Medicare & Medicaid Services has issued a section 1135 waiver to Pennsylvania for its Medicaid program to:

  • Extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
  • Suspend pre-admission screening and annual resident review (PASRR) level I and level II assessments for 30 days
  • Temporarily suspend Medicaid fee-for-service prior authorization requirements.
  • Delay state fair hearings and appeal timelines.
  • Enroll new providers in the state’s Medicaid program if they are enrolled by Medicare or by another state Medicaid program
  • Pay nursing facilities, intermediate care facilities, and others for the delivery of services outside of their walls, at unlicensed facilities, if COVID-19 necessitated the evacuation of their own facilities.

These waivers will last until the end of the declared public health emergency.

Learn more by reading the state’s application for the section 1135 Medicaid waiver and the federal government’s response to that request.