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BIPA 903 Waiver Requests

Section 903 of the Benefits Improvement and Protection Act (BIPA) of 2000 addresses flexibility in exercising the waiver authority provided under sections 1894(f)(2)(B) and 1934(f)(2)(B) of the Social Security Act. Section 903 of the BIPA allows for specific modifications or waivers of certain regulatory provisions to meet the needs of PACE organizations.

The following provisions may not be waived:

1) The focus on frail elderly qualifying individuals who require the level of care provided in a nursing facility;
2) The delivery of comprehensive, integrated acute and long-term care services;
3) The interdisciplinary team approach to care management and service delivery;
4) Capitated, integrated financing that allows the provider to pool payments received from public and private programs and individuals; and
5) The assumption by the provider of full financial risk.

The CMS advises PACE organizations to engage in dialogue with their State Administering Agency regarding considerations for waiver requests prior to preparing formal requests. This will help to ensure mutual understanding and agreement among parties involved; preventing unnecessary work on the part of the PACE organization.

The two links below contain instructions for both PACE Organizations and State Administering Agencies in submitting BIPA 903 waivers to CMS.