Returning to Routine Operations at the End of the Public Health Emergency - Section 1135 Waiver Authority - Disaster Relief SPAs

Sep 11, 2026

Uploaded by Margaret

Document outlines key transition steps for states when ending COVID-19 Public Health Emergency (PHE) flexibilities in Medicaid and CHIP. It summarizes termination timing for section 1135 waivers and Medicaid/CHIP Disaster Relief SPAs, and provides guidance for reviewing, notifying beneficiaries, informing providers, updating systems and financial reporting, and assessing managed care and program integrity risks. It also details options for disaster relief SPA provisions (expire, temporarily extend, or continue indefinitely) and highlights tribal consultation requirements for certain SPA submissions.

LanguageEnglish

CategoryPresentations

FormatPDF

Pages9

Reading Time3 min

AccessFree to download

Section 1135 Waiver Authority

Review

Notify

Inform

Update

Disaster Relief SPA Authority

Let it Expire

Temporarily Extend

Continue Indefinitely

State Actions When Sunsetting Disaster Relief SPA Provisions

Provide Advance Notice

Update Systems and Processes

Inform Providers Timely

Ensure Financial Reporting

Assess Managed Care Implications

Tribal Consultation Requirements

State Actions in Preparation for the end of PHE: Summary

Returning to Routine Operations at theEnd of the Public Health Emergency SunsettingMedicaid and CHIPDisaster ReliefSPAsand Section 1135Waivers May 26, 2022 Temporary Authorities Adopted DuringCOVID-19 Public Health Emergency |
Authority |
Termination Date | | --- | --- | |
Medicaid & CHIP 1135 Waivers |
Expire at the end of the PHE 1 | |
Medicaid and CHIP DisasterRelief SPAs |
Expire at the end of PHE, or an earlierdate elected by the state | • States should review their Disaster Relief SPAs and section 1135 waiversapproved during the PHE in order to plan appropriately. • States must comply with relevant regulatoryand statutory requirements when transitioningback to routine operations. 1Per CMS guidance in the December 2020 SHO, there are several flexibilities where states will have a longer period of time to come into compliancewith regulatory timeframes. The contents ofthis document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract.This document is intended only to provide clarity to the public regarding existing requirements under the law. 2 # Section 1135 Waiver Authority Review: In advance of the end of the PHE, CMS recommends states review approvedsection 1135 waivers to determine actions needed for returning to routine operations atthe end of the PHE. Notify: States must provide 10-day advance notice to Medicaid beneficiaries whenrequired under 42 CFR part 431, subpart E before ending certain section 1135 waivers.1 Inform: States should inform providers of changes timely to minimize disruption.2 Update: States should evaluate necessary changes to systems and/or processes,financial reporting and managed care operations.2 In addition, states should consider theprogram integrity risks created by the PHE and its unwinding and mitigate them to theextent practicable.3 NOTE: Per the December 2020 SHO Letter \#20-004, states have additional time tocomplete certain actions after the PHE ends. Examples include initial HCBS level of caredeterminations, provider screening requirements, and temporary provider enrollment.4 1Per CMS guidance in the December 2020 SHO; APPENDIX B – Requirements for Ending Temporary Flexibilities 2Per CMS guidance in the December 2020 SHO; APPENDIX D – Operational Actions Needed to End Temporary Authorities 3Risk Assessment Tool for Evaluating COVID-19 Flexibilities and Waivers, Medicaid and CHIP Learning Collaborative July 15, 2021 4Per CMS guidance in the December 2020 SHO; APPENDIX C - Timeframes for Resolution of Section 1135 Waivers and Pending Eligibility and Enrollment ActionsThe contents ofthis document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract.This document is intended only to provide clarity to the public regarding existing requirements under the law. 3 # Disaster Relief SPA Authority As states are reviewing the flexibilities granted during the PHE, CMSrecommends that states review their approved Medicaid Disaster ReliefSPA provisions to determine, with respect to each provision, whetherthey want to: 1. Let it Expire – allow the provision to expire at the end of thePHE; 2. Temporarily Extend – extend the provision after the PHEexpires through a streamlined SPA approval process; or 3. Continue Indefinitely - continue the change through a non -disaster amendment to the state plan that does not include aspecific end date (where permissible) . The contents ofthis document do not have the force and effect of law and are not meant to bind the public in any way, unless specifically incorporated into a contract.This document is intended only to provide clarity to the public regarding existing requirements under the law. 4 # State Actions When SunsettingDisaster Relief SPA Provisions Provide atLeast a 10-day AdvanceNotice toBeneficia

FAQs

When do section 1135 waivers and Medicaid/CHIP Disaster Relief SPAs end after the PHE?

Medicaid and CHIP 1135 waivers expire at the end of the PHE. Medicaid and CHIP Disaster Relief SPAs expire at the end of the PHE or earlier based on an elected state date.

What actions should states take when transitioning back to routine operations?

States should review approved waivers/SPAs, plan for regulatory and statutory compliance, provide required advance notice to beneficiaries, inform providers, update systems and processes and financial reporting, and assess managed care implications.

What options do states have for Medicaid Disaster Relief SPA provisions during unwinding?

States may let provisions expire at the end of the PHE, temporarily extend them after the PHE through a streamlined SPA process, or continue changes indefinitely through a non-disaster state plan amendment where permitted.

Sep 11, 2026

Uploaded by Margaret