Waivers & flexibilities
Waivers & flexibilities
How is a disaster or emergency declared?
The President may, under the authority of the Robert T. Stafford Disaster Relief and Emergency Act, declare a major disaster or emergency if:
- Asked by the Governor of an affected state.
- The event is beyond the combined response capabilities of the state and affected local governments.
When can we use waivers & flexibilities?
If there’s a Presidential declaration, the Department of Health and Human Services (HHS) Secretary may, under section 319 of the Public Health Service Act, declare that a Public Health Emergency (PHE) exists in the affected state. Once a PHE is declared, section 1135 of the Social Security Act authorizes the Secretary, among other things, to temporarily modify or waive certain Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) requirements that we find are necessary.
How do waivers & flexibilities help?
When there’s a disaster or emergency, waivers and flexibilities help hospitals and other health care facilities give timely care to as many people who’ve been affected as possible. This means we’re helping states and U.S. territories to make sure people with Medicare and/or Medicaid continue to have access to care.
We’ll use the allowable flexibilities and issue waivers as needed to help those affected by an emergency or disaster. If needed, specific waivers may be retroactive to the beginning of the emergency or disaster. We can also adjust some agency policies or procedures, usually without reprogramming our systems. You can find out about flexibilities and authorities that can be used in an emergency or disaster below and on the Hurricanes page.
What are blanket waivers?
Under Section 1135 or 1812(f) of the Social Security Act, we can issue several blanket waivers when there’s a disaster or emergency. When a blanket waiver’s issued, providers don’t have to apply for an individual waiver. Blanket waivers prevent access to care gaps for beneficiaries affected by the emergency. If there’s no blanket waiver, providers can ask for an individual Section 1135 waiver by following our instructions.
How can I apply for an 1135 waiver?
Apply for an 1135 waiver or submit a public health emergency (PHE)-related inquiry; however, waiver requests related to the Physician Self-Referral Law (commonly referred to as the “Stark Law”) should not be submitted via the web portal. For these requests, please visit the Physician Self-Referral Spotlight Page for additional information.
- Report technical issues by email (Note “Waiver/Flexibility" in the subject line)
Where can I find out more about waivers & flexibilities?
You can find:
- Examples of the most recently approved 1135 waivers from ASPR.
- ASPR, Technical Resources, Assistance Center, and Information Exchange (TRACIE) resources.
- Information about 1135 waivers.
- Frequently asked questions (PDF) about declared health emergencies.
- Medicare Claims During Public Health Emergencies
- Frequently asked questions about Medicare FFS:
- We’ll issue additional guidance to providers on an ongoing basis. You can also find emergency information for people with Medicare.
- Email addresses for our Regional Offices:
- ROATLHSQ@cms.hhs.gov (Atlanta RO): Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.
- RODALDSC@cms.hhs.gov (Dallas RO): Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.
- ROPHIDSC@cms.hhs.gov (Northeast Consortium): Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, New York, New Jersey, Puerto Rico, Virgin Islands, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.
- ROCHISC@cms.hhs.gov (Midwest Consortium): Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin, Iowa, Kansas, Missouri, and Nebraska.
- ROSFOSO@cms.hhs.gov (Western Consortium): Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming, Alaska, Idaho, Oregon, Washington, Arizona, California, Hawaii, Nevada, and the Pacific Territories.