On January 10, 2025, Secretary Becerra of the U.S. Department of Health and Human Services (“HHS”) issued a determination titled “Determination That A Public Health Emergency Exists” (the “California PHE Determination”), that decided a public health emergency exists and has existed since January 7, 2025, in the State of California (“California Public Health Emergency”).
Blanket Waivers
On January 12, 2025, the Centers for Medicare & Medicaid Services (“CMS”) issued a fact sheet titled “2025 Southern California Wildfires Available Waivers in the State of California Health Care Providers” that details “blanket” waivers for certain health care providers during the California Public Health Emergency (“California 1135 Waivers”). This CMS fact sheet is the only “blanket” waiver that exists for skilled nursing, home health agencies, critical access hospitals, durable medical equipment and other providers.
Blanket Waiver for Post-Acute Providers and Enrollment
Included in the California 1135 Waivers are the following post-acute provider-specific and enrollment-specific “blanket” waivers:
- Skilled Nursing Facilities
- CMS is waiving the requirement in Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a skilled nursing facility stay providing temporary emergency coverage of (skilled nursing facility services without a qualifying hospital stay), for those people who need to be transferred as a result of the effect of a disaster or emergency. In addition, for certain beneficiaries who recently exhausted their skilled nursing facility benefits, renewed skilled nursing facility coverage is authorized without first having to start a new benefit period.
- CMS is waiving 42 CFR Section 483.20(k), allowing nursing homes to admit new residents who have not received Level 1 or Level 2 Preadmission Screening. Level 1 assessments may be performed postadmission.
- CMS is waiving the requirement at 42 CFR Section 483.20 to provide relief to skilled nursing facilities on the timeframe requirements for Minimum Data Set assessments and transmission.
- CMS is waiving the requirement at 42 CFR Section 483.30 for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.
- CMS is waiving requirements at 42 CFR Section 483.90 to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this purpose include activity rooms, meeting/conference rooms, dining rooms or other rooms, as long as residents can be kept safe and comfortable and other applicable requirements for participation are met.
- Hospice
- CMS is modifying certain requirements at 42 CFR Section 418.54 related to updating comprehensive assessments of patients. This modifies the timeframes for updates to the comprehensive assessment found in Section 418.54(d). Hospices must continue to complete other required assessments (i.e., initial and ad-hoc assessments based on a change in the patient’s condition); however, the timeframes for updating the comprehensive assessment may be extended from 15 to 21 days.
- Home Health Agencies (“HHAs”)
- CMS is providing relief to HHAs on the timeframes related to OASIS Transmission through the following actions: 1) extending the 5-day completion requirement for the comprehensive assessment to 30 days; and 2) modifying the 30-day OASIS submission requirement. Delayed submission is permitted during the PHE.
- CMS is waiving the requirements at 42 CFR Section 484.55(a) to allow HHAs to perform Medicare-covered initial assessments and determine patients’ homebound status remotely or by record review.
- CMS is waiving the requirements at 42 CFR Section 484.55(a)(2) and Section 484.55(b)(3) that rehabilitation skilled professionals may only perform the initial and comprehensive assessment when only therapy services are ordered. This temporary waiver will allow any rehabilitation professional (PT or SLP) to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether or not the service establishes eligibility for the patient to be receiving home care.
- CMS is waiving the requirements at 42 CFR Section 418.76(h)(1) and Section 418.76(h)(2) for Hospice and 42 CFR Section 484.80(h)(1) for HHAs, which require a nurse to conduct an onsite visit every two weeks.
- Provider Enrollment
- Providers and suppliers who have been affected by the emergency in the impacted state, including skilled nursing facilities, will be granted revalidation due date extensions until May 2025.
Next Actions
Providers in the impacted areas should review these blanket waivers to identify what blanket waivers apply to them and will assist their operations.
If a provider needs flexibilities not listed on the blanket waiver document, there is a path to apply for an individual waiver. We can assist post-acute providers across the care continuum on these issues and are available to assist with designing and submitting their Section 1135 waiver requests.
If you have questions or would like additional information about this topic, please contact:
- Sean Fahey at (317) 977-1472 or sfahey@hallrender.com;
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- Todd Selby at (317) 977-1440 or tselby@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
