Waivers under Section 1135 of the
Social Security Act (the Act) and certain flexibilities allow the
CMS to relax certain requirements, known as the Conditions of
Participation (CoPs) or Conditions of Coverage to promote the
health and safety of beneficiaries. Under Section 1135 of the Act,
the Secretary may temporarily waive or modify certain Medicare,
Medicaid, and Children’s Health Insurance Program (CHIP)
requirements to ensure that sufficient health care services are
available to meet the needs of individuals enrolled in Social
Security Act programs in the emergency area and time periods. These
waivers ensure that providers who provide such services in good
faith can be reimbursed and exempted from sanctions. During
emergencies, such as the current COVID-19 public health emergency
(PHE), CMS must be able to apply program waivers and flexibilities
under section 1135 of the Social Security Act, in a timely manner
to respond quickly to unfolding events. In a disaster or emergency,
waivers and flexibilities assist health care providers/suppliers in
providing timely healthcare and services to people who have been
affected and enables states, Federal districts, and U.S.
territories to ensure Medicare and/or Medicaid beneficiaries have
continued access to care. During disasters and emergencies, it is
not uncommon to evacuate Medicare-participating facilities and
relocate patients/residents to other provider settings or across
state lines, especially, during hurricane and tornado events. CMS
must collect relevant information for which a provider is
requesting a waiver or flexibility to make proper decisions about
approving or denying such requests. Collection of this data aids in
the prevention of gaps in access to care and services before,
during, and after an emergency. CMS must also respond to inquiries
related to a PHE from providers and beneficiaries. CMS is not
collecting information from these inquiries; we are merely
responding to them.
When the President
declares a disaster or emergency under the Stafford Act or National
Emergencies Act and the HHS Secretary declares a public health
emergency under Section 319 of the Public Health Service Act, the
Secretary is authorized to temporarily waive or modify certain
Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and
Health Insurance Portability and Accountability Act (HIPAA)
requirements. This will ensure that sufficient health care services
are available to meet the needs of individuals enrolled in Social
Security Act programs in the emergency area and time periods, and
to reimburse and exempt from sanctions providers who provide such
services in good faith. During emergencies, such as the current
COVID-19 public health emergency (PHE), CMS must be able to apply
program waivers and flexibilities under section 1135 of the Social
Security Act, in a timely manner, to respond quickly to unfolding
events. When there is a disaster or emergency, waivers and
flexibilities assist health care providers to give timely
healthcare services to people who have been affected by the
emergency event or disaster and enable states, Federal districts,
and U.S. territories to ensure Medicare and/or Medicaid
beneficiaries have continued access to care. During disasters and
emergencies, it is not uncommon to evacuate provider facilities and
relocate patients to other provider settings or across state lines,
especially, during hurricane and tornado events. The waivers and
flexibilities allow the Agency to relax certain Conditions of
Participation and Conditions of Coverage to promote the health and
safety of Medicare and Medicaid covered persons. The statutory
authority that allows for the implementation of waivers and
flexibilities are Section 1812(f) of the Social Security Act,
Section 1135 of the Social Security Act and Section 319 of the
Public Health Service Act.
US Code:
42
USC 1320b-5 Name of Law: Social Security Act
US Code: 42
USC 1135 Name of Law: Social Security Act
US Code: 42
USC 1812(f) Name of Law: Social Security Act
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-10752 1135 Waiver Request Automated Process
CMS-10752 1135 Waiver Web Form Emergency Justification 9-30-20.pdf
CMS 10752 Supporting Statement Clean 10-7-20.docx
1135 Waiver Request Automated Process