Non-substantive change request justification

Non-Substantive Change Request to 0938-1384: Submissions of 1135 Waiver Request
Automated Process
May 6, 2022
This is a non-substantive change request to the CMS 1135 Waiver/Flexibility Request from the
‘Submission of 1135 Waiver Request Automated Process’ that was approved as OMB number
0938-1384. CMS must be able to apply waivers and flexibilities to assist health care
providers/suppliers in providing timely healthcare and services as well as ensure beneficiaries
have continued access to care during a disaster or emergency. Accordingly, CMS developed a
publically-accessible web based form to create a standardized, user-friendly submission that’s a
more efficient processing of 1135 waiver requests.
Last month (April 2022), two wildfires began in New Mexico (Hermit Peaks Wildfires began 4/6/22
Due to recent gusty winds, these wildfires have grown out
of control and have negatively impacted the State. As a result, the Secretary of Health and
Human Services is in the process of review for a “Public Health Emergency” (PHE) declaration
the New Mexico Wildfires. Therefore, CMS is requesting approval of the following update to
allow the agency to quickly provide necessary assistance to those impacted by the New Mexico
Wildfires (effective date as defined by the Secretary’s PHE declaration):

and Calf Canyon Wildfires began 4/19/22).

CMS 1135 Waiver/Flexibility Request web page
• Update the Public Health Emergency (PHE) on pages 2 and 3, such that “New Mexico
Wildfires” is added in the drop-down values for the “Select a Public Health Emergency”
section of the web form
• Add a note in the footer section of the web form on page 2, such that users have guidance
for contacting the appropriate areas for any issues (if applicable)
CMS 1135 Inquiry web page
• Update the Public Health Emergency (PHE) on pages 5 and 7, such that “New Mexico
Wildfires” is added in the drop-down values for the “Select a Public Health Emergency”
section of the web form
• Add a note in the footer section of the web form on pages 5 and 7, such that users have
guidance for contacting the appropriate areas for any issues (if applicable)
CMS 1135 Waiver/Flexibility Request (MEDICAID PORTIONs) web page
• Update the Public Health Emergency (PHE) on pages 9, 11 and 13, such that “New
Mexico Wildfires” is added in the drop-down values for the “Select a Public Health
Emergency” section of the web form
• Add a note in the footer section of the web form on pages 9, 11 and 13, such that users
have guidance for contacting the appropriate areas for any issues (if applicable)
These changes have no impact on the previously stated burden associated with this collection.

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