CMS COVID-19 Emergency Preparedness FAQ: State Medicaid Collaborative Disaster Preparedness Flexibility and PHE Authorities
Medicaid Authorities Available in Emergencies Allowed by Existing Regulations
Allow self-attestation to verify eligibility for all criteria except citizenship and immigration status on a case-by-case basis;
verify assets if financial institution unable to verify due to disaster;
verify incurred medical expenses for spend down eligibility
Extend renewal timeframes
Exempt enrollees from premiums
Temporarily suspend periodic data checks on case-by-case basis
Temporarily delay acting on certain changes in circumstances affecting eligibility
Reinstate services or eligibility if discontinued because whereabouts unknown due to evacuation, after whereabouts become known and if still eligible
Consider people evacuated from state as temporarily absent to maintain enrollment
Treat Federally facilitated Marketplace assessments as eligibility determinations or fully delegate eligibility determination authority to Federally facilitated Marketplace
Expand application processing times
Suspend adverse actions for those in disaster area where state has completed determination but has not yet sent notice or state believes notice likely not received
Temporarily increase HCBS waiver service payment rates if no change to rate methodology and no impact on cost neutrality
Amended/Updated Verification Plan –
No CMS Approval Required
Accept self-attestation and conduct post-enrollment verification for eligibility criteria other than citizenship and immigration status (beyond case-by-case basis)
Adopt or increase reasonable compatibility thresholds for income inconsistencies
Allow reasonable explanation of inconsistencies in lieu of paper documentation
Temporarily suspend periodic data checks (case-by-case basis)
State Plan Amendment – Retroactive to 1st Day of Quarter Coverage:
Increase financial eligibility thresholds (e.g., adopt ACA expansion, cover nonelderly MAGI group above 138% FPL).
Cover non-residents or state-defined subset of non-residents, such as those living temporarily in state due to disaster in home state.
Apply host state’s asset limit, or if less restrictive, asset limit from state where individual evacuated (if statewide rule)
Enrollment & Renewal:
Adopt or extend presumptive eligibility for certain populations
Extend hospital presumptive eligibility to non-MAGI groups
Establish state as presumptive eligibility qualified entity to enroll individuals based on preliminary application information
Provide 12-month continuous eligibility for children
Develop simplified paper application for affected areas
Extend reasonable opportunity period to provide documentation for immigration status Benefits:
Temporarily modify copayment requirements to support access to services (if rule applies statewide)
Offer additional benefits (if comparable for all categorically needy groups and statewide with free choice of provider, or via alternative benefit plan with free choice of provider)
Change amount, duration, or scope of covered benefits
Amend payment methodology to account for increased cost of personal protective equipment for home care workers
Health Plan Contract/Oversight
Temporarily suspend out of network requirements for managed care enrollees
Require health plans to expedite processing of new prior authorization requests and allow flexibility in documentation (e.g., physician signature) Section 1115
Waiver – state is deemed to meet budget neutrality if federally declared disaster, waiver can be retroactive to date of Secretary-declared public health emergency, exemptions from public notice in emergencies
Coverage:
Increase eligibility limits for specific categories in specific geographic regions
Enrollment & Renewal:
Provide 12-month continuous eligibility for adults or for a subset of children
Allow self-attestation for citizenship and immigration status if unable to verify by data sources and individual unable to document due to disaster
Benefits:
Provide benefits to targeted group of enrollees impacted by disaster
Temporarily modify copayment requirements to support access to services (less than statewide)
Authorize off-island coverage for those in territories eligible for FEMA transitional shelter assistance who are temporarily relocated to a state
Long-Term Services and Supports:
Temporarily suspend requirement to be institutionalized at least 30 days and have income below 300% SSI to be eligible for special income group
Temporarily suspend asset transfer rules for those placed in nursing homes
Apply host state’s asset limit, or if less restrictive, asset limit from state where individual evacuated (if less than statewide)
Do not reduce institutional provider payments by post-eligibility treatment of income
Section 1135
Waiver – if President declares national emergency and HHS Secretary declares public health emergency Benefits:
Temporarily suspend fee-for-service prior authorization requirements and/or require providers to extend prior authorization through the termination of emergency declaration
Covered Providers:
Temporarily waive requirements for out-of-state providers to be licensed in state where they are providing services if provider is licensed by another state
Medicaid agency or Medicare
Temporarily waive provider screening requirements, such as application fees, criminal background checks, and site visits, to ensure sufficient number of providers
Temporarily cease revalidation of providers in state or who are otherwise directly impacted by disaster
Temporarily suspend pending enforcement or termination actions or payment denial sanction to specific provider
Allow facilities to provide services in alternative settings such as temporary shelters when provider facility is inaccessible
Temporarily allow non-emergency ambulance providers
Long-Term Services and Supports:
Provide nursing home care to evacuees in host state for less than 30 days if individual is Medicaid-eligible in home state
Temporarily suspend pre-admission screening and annual resident review assessments for 30 days
Extend minimum data set authorizations for nursing home and skilled nursing facility residents
Temporarily suspend requirement that home health agency aides be supervised for 2 weeks by registered nurse
Temporarily suspend requirement that hospice aides be supervised by registered nurse every 14 days
Modify or suspend certain state survey agency activities Appeals:
Allow direct access to fair hearing without first exhausting managed care appeal
Extend timeframes for individuals to request managed care appeals or state fair hearings Section 1915 (c)
Home and Community-based
Services Waiver Appendix K – can be submitted before or during emergency, can be retroactive to date of event
Eligibility:
Increase number of unduplicated waiver enrollees
Temporarily increase individual cost limit to assure health and welfare
Modify eligibility targeting criteria to serve more enrollees and forestall institutionalization in emergency
Extend level of care authorizations for 12 months Benefits:
Add covered services not expressly authorized in statute if necessary to assist waiver enrollees to avoid institutionalization
Modify scope of covered services and temporarily exceed individual service limits to ensure health and welfare
Institute or expand self-direction
Temporarily suspend prior authorization and extend medical necessity authorizations
Modify person-centered planning process, including qualifications of individuals required to develop plan Providers:
Temporarily increase payment rates with a temporary change in rate methodology and/or impact on cost neutrality
Amend payment methodology to account for increased cost of personal protective equipment for home care workers
Allow payment for services provided by family caregivers or legally responsible relatives
Temporarily modify provider types, qualifications, and licensure or other setting requirements
Include retainer payments to personal care assistants when waiver enrollee is hospitalized or absent from home up to 30 days
Expand covered settings to include out-of-state
Temporarily allow payment for waiver services up to 30 days to support enrollees in acute care hospital or short-term institutional stay when services are required for communication and behavioral stabilization and not provided by institution
MORPHOLEX VP Text Untitled, Level k-1, Framework nfl7, Word tokens 1044 LEVEL 2 (inflections)
leaders 7 making 4 scientists 4 happened 3 mentioned 3 used 3 concerning 2 does 2 following 2 posts 2 words 2 appeared 1 avengers 1 broken2 1 checks 1 concerned 1 continued 1 continuing 1 dinosaurs 1 driven2 1 during 1 fears 1 fighting 1 guardians 1 happens 1 hearing 1 institutes 1 killed 1 later2 1 listening 1 living 1 loads 1 looked 1 lots 1 movies 1 nursing 1 offered 1 others 1 photos 1 presented 1 reading 1 returns 1 scripps 1 shots 1 shows 1 sporting 1 stoking 1 students 1 studies 1 suggesting 1 suggests 1 taken2
1 takes 1 taking 1 teams 1 telling 1 terms 1 touching 1 trained 1 trying 1 wanted 1 wants 1 LEVEL 3 (derivations) leader 8 twitter 5 really 3 completely 2 simply 2 spreader 2 absolutely 1 actually 1 daily 1 exactly 1 fully 1 governor 1 hammer 1 happiness 1 keith 1 sickness 1 slightly 1 tony 1 totally 1 truly 1 tucker 1 avenger 1 LEVEL 4 scientists 4 scientist 4 additional 2 management 2 reality 2 government 1 national 1 LEVEL 5 situation 1 suggestion 1 guardian 1 LEVEL 6 information 4 addition 2 reese 1 returns 1 situation 1
DERIVATIONS SUMMARY Number of derivative affixations (Levels 3-6) is 62 Derivs.
62/1044=5.94% of text lex
Number of different derivational affixes is 16 18 ~er 15 ~ly 5 ~ation 4 ~ists 4 ~ist 3 ~al 3 ~ment 2 ~ness 2 ~ity 2 ~ion 2 re~ 1 ~or 1 ~th 1 ~y 1 ~ian 1 ~ition
