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Waiver Toolkit

IRF ToolKit: Apply for a Waiver

Updated July 23, 2020

During a public health emergency (PHE), HHS and CMS may waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements. CMS has issued a number of blanket waivers for IRFs, which are explained here.

AMRPA created an easy-to-use tracking chart on the status of AMRPA-requested waivers and other waivers impacting IRFs. The chart includes both the blanket waivers granted by CMS and regulatory flexibilities granted through the March 31 and April 30 Interim Final Rulemakings. For most of CMS’ blanket waivers, AMRPA staff is seeking clarity about how this information is being transmitted to Medicare contractors to ensure claims are reviewed in a uniform and accurate way. 

Providers do not need to apply to use these blanket waivers, and they are available to all IRFs, effective immediately. The template below has been updated to reflect CMS’ recent waiver activity.

CMS may also issue additional waivers to providers on a case by case basis. Some examples of the types of rules HHS and CMS may waive include, but are not limited to:

  • Conditions of participation or other certification requirements
  • Program participation and similar requirements
  • Preapproval requirements
  • Stark self-referral sanctions
  • Performance deadlines and timetables may be adjusted (but not waived).
  • Limitations on payment for health care items and services furnished to Medicare Advantage enrollees by non-network providers

Hospitals can apply for individual waivers for their facilities for additional relief. CMS says that the information that needs to be provided when you apply for that waiver include a primary contact person, a brief summary of why the waiver is needed, and the type of relief you are seeking and/or regulatory reference that the hospital is seeking to be waived. CMS also states that there is no specific form or format that is required to submit the information.

The waiver request can be directed to the inboxes noted below, with a copy to the appropriate State health department to make sure the waiver request does not conflict with any State requirements. The 1135 waivers issued by CMS applies only Federal requirements and does not apply to State requirements for licensure or conditions of participation. Providers must resume compliance with normal rules and regulations as soon as they are able to do so, or upon termination of the emergency declaration.

AMRPA has created a template for hospitals to use to submit their waiver requests: 

Click here to download the template.

We also encourage hospitals to continue to inform AMRPA as new issues arise, and we will update the template waiver request as needed.

Email Addresses for CMS Regional Offices:

  • [email protected] (Atlanta RO): Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee
  • [email protected] (Dallas RO): Arkansas, Louisiana, New Mexico, Oklahoma, Texas
  • [email protected] (Northeast Consortium): Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia, New York, New Jersey, Puerto Rico, Virgin Islands, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
  • [email protected] (Midwest Consortium): Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin, Iowa, Kansas, Missouri, Nebraska
  • [email protected] (Western Consortium): Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming, Alaska, Idaho, Oregon, Washington, Arizona, California, Hawaii, Nevada, Pacific Territories.