CMS-10752 Non-Sup Change Justification

Non-Substantive Change Request to 0938-1384: Submissions of 1135 Waiver Request
Automated Process
September 20, 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.
Within the last few days, Hurricane Fiona negatively impacted Puerto Rico. As a result, the
Secretary of Health and Human Services is in the process of review for a “Public Health
Emergency” (PHE) declaration for this area. Therefore, CMS is requesting approval of the
following update to allow the agency to quickly provide necessary assistance to those impacted
by this hurricane (effective date as defined by the Secretary’s PHE declaration):
CMS 1135 Waiver/Flexibility Request, CMS 1135 Inquiry and CMS 1135
Waiver/Flexibility Request (MEDICAID PORTION) web pages
•

Update the Public Health Emergency (PHE) portion, such that “Hurricane Fiona” is
added in the drop-down values for the “Select a Public Health Emergency” section of the
web form

These changes have no impact on the previously stated burden associated with this collection.

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