Section 1135 of the Social Security Act authorizes the Secretary of the Department of Health and Human Services to waive or modify certain Medicare, Medicaid, CHIP, and HIPAA requirements. Two prerequisites must be met before the Secretary may invoke the § 1135 waiver authority. First, the President must have declared an emergency or disaster under either the Stafford Act or the National Emergencies Act. Second, the Secretary must have declared a Public Health Emergency (PHE) under Section 319 of the Public Health Service Act. Then, with respect to the geographic area(s) and time periods provided for in those declarations, the Secretary may elect to authorize waivers/modifications of one or more of the requirements described in Section 1135(b) and summarized below. The implementation of such waivers or modifications is typically delegated to the Administrator of CMS who, in turn, determines whether and the extent to which sufficient grounds exist for waiving such requirements with respect to a particular provider, or to a group or class of providers, or to a geographic area. Waivers authorized by the statute apply to Medicare in the context of the following requirements: • conditions of participation or other certification requirements applicable to providers; • licensure requirements applicable to physicians and other health professionals; • sanctions for violations of certain emergency medical standards under the Emergency Medical Treatment and Labor Act (EMTALA) • sanctions relating to physician self-referral limitations (Stark) • performance deadlines and timetables (modifiable only; not waivable); and • certain payment limitations under the Medicare Advantage program. Medicare fee-for-service requirements, including most particularly (but not limited to) Medicare payment rules and amounts, are not, and cannot be, waived under § 1135. Nevertheless, some of the foregoing waivers, when invoked, may have the effect of making fee-for-service payments possible when, absent a waiver, such payments would not have been permissible.
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Anyone ever used the CR modifier?! (Catastrophe/disaster-related)