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.
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