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Temporary Waivers and Flexibilities during the COVID-19 Emergency Declaration

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). Many of these changes ended with the May 11, 2023 end of the COVID-19 PHE. Learn more about changes that ended or are continuing after the end of the COVID-19 PHE.

Federal Legislation and Regulations

The 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.

The 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:

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.

CMS Approval of PACE Contractor Updates to Beneficiary Contact Information, Issued 10-24-2022
CMS Approval of Assuming No Beneficiary Asset Changes when AVS Does Not Return Information within a Reasonable Timeframe - Issued 10-24-2022
CMS Approval of FFS Contractor Updates to Beneficiary Contact Information, Issued 9-6-2022
CMS Approval of MCO Updates to Beneficiary Contact Information, Issued 9-6-2022
CMS Approval of September 23 Request, Issued 12-2-2020
Oregon Request for 1135 Waiver Flexibilities, Submitted 9-23-2020
CMS Approval of March 20 Request, Issued 05-08-2020
CMS Approval of March 20 Request, Issued 3-26-2020
CMS Approval of OAHHS Request for 1135 Waiver Flexibilities, Issued 3-26-2020
Oregon Request for 1135 Waiver Flexibilities, Submitted 3-20-2020

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.

Request for COVID-19 Disaster Relief 1115 Demonstration Project - Submitted 4-17-2020

Appendix K

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.

CMS Approval of Appendix K for Aging and People with Disabilities Programs, issued 06-23-2020
Amended Appendix K for Aging and People with Disabilities Program, submitted 06-23-2020
Additions to Appendix K, submitted 05-21-2020
Combined CMS Approval of Additions to Appendix K, issued 05-22-2020
Amended Appendix K for 1915(i) and ODDS Programs, submitted 04-28-2020
Amended Appendix K for Aging and People with Disabilities Programs, submitted 04-28-2020
Combined CMS Approval of Appendix K for 1915(i), APD and ODDS Programs, issued 04-28-2020
Appendix K for 1915(i) HCBS State Plan Option, submitted 04-03-2020
Responses to CMS Questions About Oregon Appendix K Submissions, submitted 04-02-2020
Appendix K for Office of Developmental Disabilities Programs, submitted 04-02-2020
Appendix K for Aging and People with Disabilities Program, submitted 04-02-2020

State Plan Amendments

Oregon has also submitted State Plan Amendments to request flexibilities that could not be approved using the above options.

20-0006 Telehealth - Approved 04-10-2020
20-0007 Nursing Facility Ventilator Assistance Program Rate - Approved 04-10-2020
20-0008 Temporary Changes to 1915(k) Community First Choice Program - Approved 06-03-2020
20-0009 Temporary Changes to 1915(j) Independent Choices Program - Approved 06-03-2020
20-0010 Temporary Changes to Eligibility, HPE, Payment Requirements - Approved 06-18-2020
20-0011 Temporary Changes to 1915(i) Home and Community-Based Services Program - Approved 06-17-2020
20-0013 New 1915(i) Provider Types During COVID-19 Emergency - Approved 07-16-2020
20-0014 Ambulance rate during COVID-19 public health emergency - Approved 07-30-2020
20-0015 1915(k) retainer payments during COVID-19 public health emergency - Approved 08-04-02020
20-0017 Reimbursement for interpreter services during the COVID-19 public health emergency - Approved 11-17-2020
20-0018 Allow licensed practitioners to order Medicaid home health services; pay for COVID-19 vaccine administration at 100% of Medicare rates - Approved 03-16-2021
20-0019 Continued Stability Payment Rate for Tribal 638 Clinics and Urban Indian Health Programs - Approved 01-14-2021
21-0005 Additional 1915(k) Changes - Approved 05/05/2021
21-0006 Rate Increase for Behavioral Health Residential Programs - Approved 04/08/2021
21-0009 Reimbursement for NEMT trips to drive-through COVID-19 vaccination clinics - Approved 05-07-2021
21-0014 COVID-19 Disaster Relief - Coverage of monoclonal antibody treatment or any drug treatment authorized under FDA EUA - Approved 10/14/2021
22-0001 COVID-19 Disaster Relief - 10% BRS Rate Increase - Approved 2/11/2022
22-0004 COVID-19 Disaster Relief - 5% increase for ODDS services and settings - Approved 3/30/2022
22-0011 Mandatory coverage of COVID-19 vaccine administration, testing, treatments - Approved 7/22/2022
22-0014 COVID-19 Disaster Relief - ODDS 5% rate increase extended to 9/30/2022 - Approved 9/23/2022
22-0020 COVID-19 Disaster Relief - 5% rate increase for nursing facilities, assisted living facilities and residential care facilities - Approved 11/14/2022
22-0022 COVID-19 Disaster Relief - Rate increase for K-plan services - Approved 12/9/2022
22-0023 COVID-19 Disaster Relief - Extend ODDS 5% rate increase to 12/31/2022 - Approved 12/9/2022
22-0026 COVID-19 Disaster Relief - Discharge incentive payments for nursing facilities and community-based settings - Approved 1/27/2023
22-0028 COVID-19 Disaster Relief - ODDS 5% rate increase extended to 6/30/2023 - Approved 2/24/2023
22-0029 Continue some 1915(j) flexibilities from SPA 20-0009 - Approved 3/6/2023
23-0001 COVID-19 Disaster Relief - IHS MOU Rate for Tribal FQHCs - Approved 3/24/2023
23-0005 Add provider type to list of providers eligible for Enhanced Wage Add-On Program - Approved 4/6/2023
23-0017 Continue 1915(k) rates approved in SPA 22-0022 beyond the COVID-19 PHE - Approved 8/17/2023