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.