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DHHS Secretary Sebelius Announces National 1135 Waiver for H1N1

Nov 04, 2009

On October 27, 2009, HHS Secretary Kathleen Sebelius issued a so-called "1135 Waiver" related to the H1N1 influenza virus. This 1135 Waiver follows President Obama's declaration on October 24, 2009 that the H1N1 virus constitutes a national emergency. The two actions are intended to provide the federal government with additional flexibility with which to respond to a possible surge of patients infected with the H1N1 influenza virus.

The 1135 Waiver provides the Centers for Medicare & Medicaid Services (CMS) with the authority to waive certain Medicare, Medicaid or SCHIP program requirements that might otherwise limit the ability of the nation's healthcare system to respond to an H1N1 pandemic. Healthcare providers can now petition CMS for relief from specific program requirements. It is anticipated that many hospitals will seek waivers that would permit them to set up alternative screening locations (as opposed to the hospital's ED) for patients suspected of being infected with the H1N1 virus. These alternative screening locations may be in another area of the hospital or in another building located on the hospital's campus. However, alternative screening areas may also be located off-site (e.g., a high school gymnasium, a tent located on a parking lot, etc.).

To the extent your local response plan calls for patients suspected of being infected with the H1N1 virus to be transported to alternate screening locations, you would need a waiver of Medicare's (and possibly Medicaid's) destination requirement in order to be paid for transports to otherwise non-covered destinations. To illustrate why a waiver would be needed, assume that your local response plan calls for these patients to be transported first to a triage area set up at a local high school gymnasium. Transporting patients to the gymnasium would not be covered by Medicare without a waiver, as Medicare's coverage rules generally require that a patient be transported to a healthcare facility. The waiver would permit Medicare to pay for these transports. Note: a similar waiver may be needed under your state Medicaid's rules.

Waivers of specific program requirements are handled by the CMS Regional Offices. Waiver requests can be submitted via email or by calling the appropriate CMS Regional Office. Email addresses for the specific CMS Regional Offices are listed below:

· – Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee

· – Arkansas, Louisiana, New Mexico, Oklahoma, Texas

· – Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, the District of Columbia, Puerto Rico and the American Virgin Islands

· – Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin

· – Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming and the Pacific Territories

The H1N1 situation is currently very fluid, and NAEMT will continue to update members as new information arises.

NOTE: The above issue relates only to the transportation of patients suspected of being infected with the H1N1 virus. A waiver is not required to bill Medicare for administration of the H1N1 vaccine. The applicable HCPCS codes are G9141 – Influenza A (H1N1) immunization administration or G9142 – Influenza A (H1N1) vaccine, any route of administration.