Get Ready: 1135 Waivers, Licensing Extensions Ending Soon

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Get Ready: 1135 Waivers, Licensing Extensions Ending Soon

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1135-based licensure waivers

HHS recently extended the Public Health Emergency (PHE) into January 2021, keeping the 1135 waivers — including licensing requirements — in place, for now.

While there is no definitive expiration date for the waivers, one thing is certain — these waivers will end, and if you’re not prepared you could lose your license.

1135 Waivers

By granting a PHE, HHS can temporarily waive or modify certain Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and HIPAA requirements in an emergency area during the emergency period.

The 1135 waivers have benefited you many ways, enabling you to be more easily reimbursed for services and exempted from sanctions. These waivers include:

  • Conditions of participation or other certification requirements and program participation and similar requirements
  • Preapproval requirements
  • Requirements that you are licensed in the State in which you are providing services, so long as you have equivalent licensing in another State (this waiver is for purposes of Medicare, Medicaid, and CHIP reimbursement only – state law governs whether a non-Federal provider is authorized to provide services in the state without state licensure)
  • Emergency Medical Treatment and Labor Act (EMTALA)
  • Stark self-referral sanctions
  • Performance deadlines and timetables may be adjusted (but not waived)
  • Limitations on payment for items and services you provide to Medicare Advantage enrollees when you are out-of-network

The national emergency and PHE together keep the waivers in place, along with each individual state mandate. The big issue is that there isn’t a one-size-fits-all approach to ending the waivers. Any of these scenarios could signal the waivers’ expiration:

  • An end to the national emergency
  • An end to the PHE
  • Any end or change to the 1135 waivers

It’s unclear when any of the items including the pandemic and the PHE are ending. There is nothing definitive, except that the termination depends on each state.

States Mandate Overall Licensing Requirements

Don’t take the extended PHE as an invitation to hold off fulfilling your state licensing requirements! A PHE declaration doesn’t waive or preempt state licensing requirements. Your state has the final say in whether you are authorized to provide services without a license.

The Federation of State Medical Boards (FSMB) has released a rundown of how each state and territory is handling licensing and continuing medical education waivers and requirements. You should pay close attention to what your state is doing and the projected deadlines that affect you in your home state and other states you practice in:

  • Licensing waivers: Many states extended temporary emergency licenses to physicians who held licenses in other states, to come and assist during the pandemic. Some states, including Colorado, also allowed physicians with an expired license to operate within a certain time frame without being fined. For more information on individual states, see this list of states declaring emergency declarations and details on licensing waivers.
  • Retired/inactive physicians: With the healthcare system overwhelmed at the start of the pandemic, many states were calling retired and inactive physicians back into service, expediting licenses. Louisiana called on medical students to serve as volunteers. For more information on individual states, see this list of states expediting licenses for retired/inactive physicians.
  • Telehealth providers: Many states expanded their telehealth services, allowed an expansion of professions to provide telehealth, and granted temporary licenses to if you provided telehealth visits to patients in a different state where you did not have a license. Connecticut, for example, expanded the type of healthcare professionals that can provide telehealth services to dentists, genetic counselors, and occupational or physical therapist assistants, among others. They also allowed audio-only telemedicine modalities, and prohibiting insurers from reducing reimbursement for telemedicine services. For more information on individual state requirements for telehealth, see this list of states waiving in-state licensure requirements for telehealth.
  • Continuing medical education (CME). With a nation on lockdown, acquiring CME credits during the pandemic was difficult to say the least. Many states extended the credit requirements for license renewals, while other states like Massachusetts suspended CME for physicians whose license expired between April 2, 2020 and Dec 31, 2020. For more information on individual state requirements for CME, see the list of states modifying CME requirements.

Get Ready for Licensing Waiver Expirations

If you aren’t ready to move forward with your licensing updates you need to be. Neglecting to go through the process now will cost you reimbursements for services you already provided. If you’re unsure how to go about updating your license or getting your CME credits, Kevin Cripe can help.

Sign up for his upcoming training, “Licensing Waivers Expire Jan. 1: Comply or Risk Losing Your License,” for step-by-step practical advice on keeping up with licensing requirements so you can keep your license and your patients!

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