HFS Submits COVID-19 Medicaid Waiver to CMS
March 20, 2020
On March 19, the Illinois Dept. of Healthcare and Family Services (HFS) submitted a request to the Centers for Medicare & Medicaid Services (CMS) to waive certain federal Medicaid, Children’s Health Insurance Program (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) regulations during the COVID-19 public health emergency. If approved, this Section 1135 waiver would apply to services provided to Medicaid and CHIP beneficiaries under the fee-for-service and managed care programs.
Highlights of the Section 1135 waiver request include:
- Waiving ordering, referring, and prescribing requirements;
- Extending the 180-day timely filing limit;
- Reimbursing facilities for services provided in alternate settings (e.g., vehicle drive-thru screenings);
- Suspending prior authorization requirements for most services, with the exception of bariatric surgery, gender affirming services, and hospital inpatient utilization review by eQHealth;
- Extending existing prior authorizations indefinitely during the public health emergency;
- Permitting Medicaid payment for hospital outpatient observation services up to 48 hours, if not longer;
- Easing requirements on client signatures required for consent and treatment plans and allowing verbal consents if well documented and witnessed;
- Allowing prescribers not enrolled with Medicaid to write prescriptions for Medicaid patients; and
- Allowing non-HIPAA compliant telehealth modes for telehealth visits or check-ins at the location of the patient and certain waiving HIPAA sanctions and penalties for noncompliance.
Please see the HFS Section 1135 Waiver Letter and related fact sheet for a complete list of waiver requests. These flexibilities are still subject to CMS approval.
Please check HFS’ website for the most current coronavirus updates.