This page describes the temporary changes to Medicaid-funded programs as part of the federal response and
Oregon's response to the COVID-19 Public Health Emergency (PHE).
Federal Legislation and Regulations
Family First Coronavirus Response Act (HR6201) authorizes these changes, effective 3/18/2020:
- Expands access to Medicaid for those who are uninsured or at risk of losing Medicaid eligibility;
- Adjusts to eligibility and methodology for Medicaid;
- Covers testing for COVID-19; and
- Increases the Medicaid Federal Medical Assistance Percentage (FMAP).
The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (HR6074) expands telehealth services during the emergency declaration, effective 3/6/2020.
2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act (HR748):
- Expands definition of telehealth service providers;
- Authorizes the federal government to send stimulus checks to help families during the COVID-19 emergency;
- Increases unemployment payments; and
- Prohibits states from counting these payments when determining Medicaid eligibility.
The Centers for Medicare & Medicaid Services (CMS) also revised federal regulations as follows:
- Effective March 31, 2020:
42 CFR Parts 400, 405, 409, 410, 412, 414, 415, 417, 418, 421, 422, 423, 425, 440, 482, and 510 in response to the COVID-19 public health emergency. The changes are applicable starting March 1, 2020.
- Effective upon publication in the Federal Register:
42 CFR Parts 409, 410, 412, 413, 414, 415, 424, 425, 440, 483, 484 and 600. See pages 4-5 for the applicability date(s) of each change.
1135 and 1902 Waivers
In the event of a public health emergency, certain Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and Health Insurance Portability and Accountability Act (HIPAA) requirements are waived under Section 1135 of the Social Security Act. These
1135 waivers ensure:
- Sufficient health care items and services for clients, and
- Protections against sanction or nonpayment for providers who cannot comply with certain requirements due to the emergency.
View the list of 1135 blanket waivers from CMS
The current federal authority for 1135 waivers took effect March 15, 2020, with a retroactive effective date of March 1, 2020. Oregon has also submitted requests for additional 1135 waiver flexibilities that are effective March 1, 2020. All 1135 waiver flexibilities end with the COVID-19 PHE.
- Temporarily suspend Medicaid fee-for-service prior authorization requirements
- Extend existing authorizations through the end of the public health emergency
- Suspend Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days
- Extend State Fair Hearing requests and appeal timelines
- Provisionally enroll out-of-state providers who are already enrolled in Medicaid or Medicare
- Provide services in alternative settings
- Suspend public notice and tribal consultation requirements to expedite State Plan Amendment submissions
Section 1902(e)(14)(A) of the Social Security Act allows for waivers “as are necessary to ensure that states establish income and eligibility determination systems that protect beneficiaries.” These 1902 waivers are meant to promote enrollment and retention of eligible individuals by easing the administrative burden states may experience in light of systems limitations and challenges.
1115 Waiver for COVID-19 Disaster Relief Funding
Oregon has also submitted an 1115 Demonstration Application to allow Oregon's Medicaid program to provide disaster relief funding to providers during the COVID-19 emergency.
State Medicaid agencies may submit the
Appendix K to request temporary adjustments to the conditions of their 1915(c) Home and Community Based Services waivers. Oregon's requests are listed below.
State Plan Amendments
Oregon has also submitted State Plan Amendments to request flexibilities that could not be approved using the above options.