COVID-19 Regulatory and Programmatic Flexibilities

The Center for Medicare and Medicaid Services (CMS) along with state and local governments have responded to the COVID-19 public health emergency with a suite of resources and supports for the health care system. One of the core components of these resources and supports includes modifying or waiving certain regulatory or programmatic requirements for the delivery of certain services and items under the Medicaid and Medicare programs. With respect to the Medicaid programs, CMS has primarily worked with states on these modifications through the Section 1135 waiver process to modify broad requirements. In terms of changes to long-term services and supports (LTSS), CMS has worked with states via Appendix K submissions to specifically modify 1915(c) programs and through state plan amendments (SPAs) for broader LTSS changes.

The purpose of this document is to put forward the series of flexibilities that should be made permanent past the public health emergency period alongside the flexibilities that should be discontinued, based on the experiences of MLTSS plans.

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