State Requests Additional Section 1135 Waiver Flexibilities

On March 19, the California Department of Health Care Services sent a formal letter to the Centers for Medicare and Medicaid Services (CMS) requesting additional flexibilities to assist in California’s COVID-19 response efforts. DHCS requested the following flexibilities to be granted for fee-for-service Medi-Cal beneficiaries and providers, and various federally approved delivery systems such as Medi-Cal managed care plans, county organized health systems, county mental health plans and the Drug Medi-Cal organized delivery systems and to the state’s Children’s Health Insurance Program:

  • Service authorization and utilization controls, with specific programs listed.
  • Eligibility flexibility including allowing hospital presumptive eligibility to cover more than one period in a 12-month timeframe.
  • Payment and HIPAA flexibility during the COVID-19 emergency.
  • Extensions for administrative activities such as waiving the two-year claiming limit for federal financial participation, the 12-month timeframe for provider claims, cost report deadlines, and financial oversight and medical compliance.
  • Waiving timing requirements for setting interim rates and waiving the statewide maximum allowance rate.

In regard to the Section 1115 Waiver, DHCS requested the ability to allow for Medi-Cal claiming for services provided in jails and prisons for testing, diagnosis and treatment of COVID-19 or ensure care is provided in a safe way without transport to acute care facilities. DHCS also requested the waiver of the IMD exclusion.