COVID 1135 SNF Waiver Perspectives

Per the President’s and HHS Secretary’s recent declaration of a public health emergency under Section 319 of the Public Health Service Act, the Secretary became authorized to exceed normal statutory authority in response to the current Public Health Emergencies of International Concern. Specifically, COVID-19 triggered section 1135 of the Social Security Act, allowing the Secretary to temporarily waive or modify certain Medicare and Medicaid requirements to ensure sufficient health care items and services are available to meet the needs of individuals enrolled in the Social Security Act programs. 1135 waivers are nearly always defined by event horizons (borders) and durational expectations. Subject to these parameters, providers furnishing “good faith” services may receive supplemental payments, expansion of benefits and exemption from sanctions (absent any determination of fraud or abuse).

1135 Waivers are generally few and far between, but the March 13, 2020 COVID-19 Waiver was extraordinary in terms of size and scope. The “blanket” Waiver applies to the entire nation. Specific to SNFs, HHS granted exceptional Medicare Part A coverage allowances to mitigate financial pressure on providers, but the confluence of a poorly worded document and the persistent, systemic confusion regarding Medicare Part A “Technical” v. “Clinical” eligibility created mass confusion. The situation was exacerbated by PDPM, as the industry remains burdened by 20 years of therapy-centric RUGs serving as proxy for clinical eligibility. As a result, the COVID waiver lays bare the stark difference between “MDS Coordinators” and “Medicare Nurse.” With confusion and risk escalated, the Zimmet team is here to provide guidance.

COVID is a threat of such magnitude that all SNF stakeholders have an obligation to assist the provider community; ZHSG is honored to be in a position to support providers seeking clarity on the matter. While we are in no way authorized to speak on behalf of CMS or any other government official, we are confident that our interpretation of the Waiver captures its true intent in a reasonable, compliant manner.

To that end, we are offering a FREE WEBINAR to providers on Monday, March 23 at 11:30am – 1:00pm. The webinar is one hour, and then open for a Q&A. The one caveat is that space is limited. If necessary, we will repeat the program daily until every facility feels best prepared to face this existential threat in the best possible position.

The English historian Thomas Fuller first committed the notion that ‘the darkest hour is just before the dawn.’ COVID may or may not be the industry’s darkest hour, but Zimmet Healthcare will do whatever it can to ensure every SNF provider and patient sees the sun rise again.

Click here to register