Late last week, the Oregon Health Authority (OHA) received word from the Centers on Medicare & Medicaid Services (CMS) that most of our state’s 1135 waiver has been approved. This federal document allows flexibility in our Medicaid delivery system during times of crisis, in order to allow providers and coordinated care organizations (CCOs) to pivot from providing preventive care to playing a role in hampering the effects of the novel coronavirus.
CMS’s approval letter details the changes that are allowed through the waiver and creates a timeline for the increased flexibility, as well as mentioning that more flexibility may be coming soon from the remainder of the waiver. With a retroactive start date of March 1, 2020, our 1135 waiver will allow OHA several areas of flexibility that will increase access to providers, prescriptions, and other health-related services. As we know, needs for health care and basic resources are at an all-time high for many Oregonians.
OHA will temporarily suspend Medicaid fee-for service prior authorization requirements, extend pre-existing authorizations, and suspend pre-admission screenings and Annual Resident Review Level I and II Assessments for 30 days. In a time when many people are being laid off without access to health insurance, this decrease in “red tape” will allow people to access needed prescriptions.
In order to increase our state’s capacity to care for those in need, the waiver also authorizes Oregon to enroll health care providers that are enrolled with other State Medicaid Agencies and outlines criteria to reimburse out-of-state providers. This change, combined with Oregon’s initiative to fast-track licensing doctors and other providers who have retired, will increase capacity in our health care system.
In order to increase our state’s number of health care facility beds, the waiver also allows facilities that don’t normally provide Medicaid services to be fully reimbursed for services provided during the public health emergency, provided they meet minimum standards. These types of facilities may include nursing facilities, psychiatric residential treatment facilities, or intermediate care facilities for individuals with intellectual or developmental disabilities.
CMS has also issued a blanket emergency declaration for the entire country, which clarifies procedures in specific instances.
On Tuesday this week, OHA announced that they had received even more flexibility from this waiver and sent a press release discussing the changes. According to OHA, all members who are currently enrolled in OHP will not lose coverage through this crisis, and individuals signing up for new coverage will not have to verify their income, which will allow Oregonians access to OHP coverage much more quickly. OHA also mentioned that stimulus payments and increased unemployment benefits will not affect OHP eligibility, as income will not be counted during the application process.
These regulatory changes will allow Oregonians access to much-needed services, as well as create flexibility for our providers so they can fully focus on the task ahead. We applaud OHA’s work on this waiver and hope OHA will continue to work with Oregon CCOs on next steps in hampering the effects of this virus.