FEDERAL 1135 WAIVER FLEXIBILITIES REQUESTED BY DHCS Michelle

FEDERAL 1135 WAIVER FLEXIBILITIES REQUESTED BY DHCS Michelle Doty Cabrera & Paula Wilhelm March 20, 2020

DHCS COVID-19 response resources: https: //www. dhcs. ca. gov/Pages/DHCS-COVID%E 2%80%9119 Response. aspx 2/12/2022 2

1135 WAIVER AUTHORITY States can request waiver of existing Medicaid rules for the duration of a national emergency As of March 19, DHCS has submitted two 1135 requests to CMS. DHCS has requested that all flexibilities approved by CMS be retroactive to January 27, 2020 3

HIPAA flexibility: Requests authority for state to decline to impost penalties for HIPAA noncompliance, consistent with existing federal guidance (p. 3) Administrative activity timelines (p. 3): MARCH 19 1135 REQUEST Waive two-year claim submission limit to receive FFP Waive 42 CFR requirement for providers to submit claims within 12 months of service Extend cost report deadlines by at least six months Waive required timeframe for fiscal and compliance audits for PIHPS (SMH & DMC-ODS) and state plan Drug Medi-Cal counties 2/12/2022 4

Payment rates (p. 4): Waive interim rate setting methodology for SMH and DMCODS. Allow DHCS to use alternative methods as needed to temporarily increase county interim rates. MARCH 19 1135 REQUEST Waive SMA and “usual and customary charge” rate limitations for interim and final reimbursement for state plan Drug Medi. Cal counties to allow for temporary rate increases. Allow payments to network providers for telephone or telehealth at same rates as for in-person services (p. 3) Clarification of previous requests – DMC State Plan (p. 5): Allow individual counseling in lieu of group visit as needed and permit all services to be conducted by telephone or telehealth 2/12/2022 5

Flexibilities requiring 1115 waiver authority (p. 5): Waive inmate exclusion to allow Medi-Cal reimbursement for select services provided in custody MARCH 19 1135 REQUEST Services include testing, diagnosis and treatment for COVID-19 or other services as needed to ensure can be safely provided without transporting individuals to acute care facilities Waive IMD exclusion to temporarily allow reimbursement for services in facilities with more than 16 beds Goal: increase psychiatric bed capacity and allow claiming Evaluation of less restrictive settings would be completed prior to placement 2/12/2022 6

MARCH 16 TH 1135 REQUEST (NOT AN EXHAUSTIVE LIST) Provider enrollment and credentialing flexibility Waive select documentation requirements Waive existing prior authorization requirements Extend timeframe to request state fair hearing Allow telehealth or telephone for covered state plan benefits Waive requirements for face-to-face contact for ART & CRT services Network adequacy extension EQRO suspension/extension Extend timeline to submit MCO or PIHP contracts to CMS 2/12/2022 7

QUESTIONS & DISCUSSION 2/12/2022 8