Public Health Emergency - Leading a Nation Prepared
The Secretary is authorized to take certain actions (in addition to his regular authorities) under section 1135 of the Social Security Act:
Waivers or modifications may be issued to ensure that in an emergency area, during an emergency period, sufficient health care items and services are available to the maximum possible extent to meet the needs of individuals enrolled in Social Security Act (SSA) programs and that providers of such services in good faith who are unable to comply with certain statutory requirements are reimbursed and exempted from sanctions for noncompliance other than fraud or abuse.
The Secretary may waive or modify certain Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Health Insurance Portability and Accountability Act (HIPAA), and Emergency Medical Treatment and Labor Act (EMTALA) requirements as necessary.
Conditions of Participation
certain conditions of participation, certification requirements, program participation or similar requirements for individual health care providers or types of health care providers
requirements that physicians and other health care professionals hold licenses in the State in which they provide services if they have a license from another State (and are not affirmatively barred from practice in that State or any State in the emergency area) for purposes of Medicare, Medicaid, and CHIP reimbursement only
deadlines and time tables for performance of required activities to allow timing of such deadlines to be modified;
limitations on payments for healthcare items and services to permit Medicare Advantage Plan enrollees to use out-of-network providers in an emergency situation. To the extent possible, the Secretary must reconcile payments so that enrollees do not pay additional charges and so that the plan pays for services included in the capitation payment;
At least two days before formally exercising the waiver authority, the Secretary must provide a certification and notice to Congress that describes the specific provision to be waived or modified, the health care providers to whom the waiver will apply, the geographic area in which the waiver or modification will apply, the period of time the modification will be in effect, and a statement that the waiver or modification is necessary to achieve the purposes of the SSA. The Secretary must report to Congress within one year after the end of the emergency period evaluating the approaches used and making recommendations for improvements.
Waivers or modifications
EMTALA Waivers (for other than a pandemic disease) or HIPAA requirements
Note, however, that a particular waiver or modification will terminate prior to the ultimate termination date described above if the Secretary determines that as of an earlier date, the waiver or modification is no longer necessary to accomplish the purposes set forth in Section 1135(a).
View all existing and past waivers or modifications of requirements under section 1135 of the Social Security Act
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Assistant Secretary for Preparedness and Response (ASPR), 200 Independence Ave., SW, Washington, DC 20201
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