Celtic Consulting

Wondering about the CMS 1135 Waiver?

Posted Monday, March 30, 2020

Wondering about the CMS 1135 Waiver?

Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, DNS-MT, RAC-MTA


CMS 1135 Waiver Review

There are 3 parts to the SNF 1135 waiver relevant to traditional Medicare Part A covered beneficiaries.

Waiver of the 3-night rule to access Medicare Part A benefits in a SNF.

This allows facilities to admit anyone for Medicare A coverage without the 3-night qualifying stay, if the admission is related to the pandemic. Not the diagnosis of coronavirus (COVID) specifically. So, an example would be a resident in the hospital who is being sent to the SNF in order to keep hospital beds and PPE equipment open for others. Or a resident who is diverted to a SNF from the ER or the community, so a bed can be used for the pandemic.


Waiver of the Spell of Illness/Benefit Period/100-days

This allows facilities to access up to an additional 100-day Medicare Part A benefit period, for those residents who are prevented from ending their Medicare stay and who are in a 60-day wellness window (custodial level of care). This does NOT mean to extend the benefit to long term residents who are not prevented from ending their skilled services. So a G-Tube fed resident, who had previously exhausted benefits and remains at a skilled level of care since then, would not qualify because they are NOT in a wellness, or custodial care window. A resident, who is completes Medicare A coverage, unable to discharge due to being exposed in the SNF to COVID, or can’t discharge because COVID was detected in the discharge setting, would qualify.


Extension of MDS completion and Submission Process

This portion of the waiver addresses late completion or late submission of the MDS. This does NOT include setting assessment reference dates (ARDs) late. The facility should continue to set ARDs timely, as that is the basis of payment for the Medicare Part A program. The extension of the completion and submission process addresses the regulatory issue of survey compliance. Late completed and late submitted assessments (MDSs) do not have an impact on Medicare Part A payments, as long as the ARD is set timely. The impact is to survey compliance.


Please do not hesitate to reach out if you have further questions or need additional assistance. The Celtic Consulting team provides education and training on Medicare and Medicaid regulations, MDS process, and provides MDS completion services should you find yourself in need of an MDS Coordinator to maintain compliance. Maureen McCarthy and her associates can be reached at 860-321-7413