CMS Approves New Section 1135 Waivers & HCBS Waiver Modifications

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Courtesy of Justice in Aging

In response to the COVID-19 emergency, the Centers for Medicare & Medicaid Services (CMS) has approved several home and community-based services (HCBS) waiver modifications under Appendix K authority, including programs for older adults in Alaska, Kentucky, Rhode Island, Washington, and West Virginia. Justice in Aging is reviewing and summarizing the approvals pertaining to aging-focused HCBS waivers to help advocates identify both useful and problematic or unwanted modifications.

This week, CMS approved more state applications under Section 1135 of the Social Security Act to temporarily waive or modify certain Medicare, Medicaid, and CHIP requirements as outlined in this CMS FAQ. To date, CMS has approved 29 states’ 1135 waivers: AL, AZ, CA, CO, FL, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MO, MS, NC, ND, NH, NJ, NM, NY, OK, OR, RI, SD, VA, WA. 

Congress Passes Third COVID-19 Response Bill Including Individual Stimulus Payments

This week, Congress passed a third coronavirus response package, the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act (H.R. 748). This includes a historic $2 trillion dollars in spending, including direct individual stimulus payments, expanded unemployment insurance, and investments in health care, housing, nutrition programs, and legal services. This Q&A from The Arc discusses who is eligible for the CARES Act stimulus payments.

Unfortunately, neither the CARES Act nor the Families First Act (H.R. 6201) passed last week directly address the most pressing needs for older adults and others who are at greatest risk from COVID-19, as outlined in our letter to Congress. As Congress moves to the next response package, Justice in Aging will continue to push for measures to expand SSI, Medicaid, Medicare, and other programs to meet the needs of low-income seniors whose lives are at stake.

Federal Court Orders Appeal Rights for Certain Medicare Beneficiaries on Hospital Observation Status 

Earlier this week, a federal court issued a decision in Alexander v. Azar, finding that certain Medicare beneficiaries who are placed on “observation status” at hospitals, rather than being admitted as “inpatients,” have the right to appeal to Medicare to challenge that status. The case is a nationwide class action that Justice in Aging co-counsels with Center for Medicare Advocacy and pro bono law firm Wilson Sonsini Goodrich & Rosati. Read more on the decision from the Center for Medicare Advocacy.

As a reminder, CMS has waived the 3-day inpatient hospital stay requirement to qualify for Medicare coverage of a nursing facility stay for those individuals who need to be transferred as a result of the effect of the COVID-19 emergency.