Karen M. Fuller

1. Karen M. Fuller Centers for Medicare & Medicaid Services WCDSC Manager-SF CLIA, State Operations and WCDSC Emergency Coordinator San Francisco Regional Office

2. Authority for 1135 Waivers

3. 1135 of the Social Security Act Waivers

4. Examples of Modifications under 1135 Waiver Authority

5. EMTALA Waiver

6. 1135 Waiver Review Process

7. Waiver Review Inputs CMS

8. Expectations of Waived Providers

9. Options without an 1135 Waiver (subject to State licensure)

10. EMTALA-No Waiver

11. Summary • 1135 Waivers dependent on situation and national Declarations. • Waivers reviewed on case-by-case basis using national guidelines and inputs (most common CAH bed increase/los waivers, temporary relocation of residents to other facilities with non-waived bed increases granted, short term relocation of emergency departments of hospitals). • Reimbursement questions can be coordinated with S&C but Medicare and Medicaid Divisions and contractors provide determinations and instructions. • Patient and individual safety is always our first consideration. • Action in response and recovery requires collaborative timely action – we have and will continue to do this together.

12. Selected References • http://www.cms.hhs.gov/SurveyCertEmergPrep/ • http://www/fema.gov/government/grant • http://www.oes.ca.gov • http://ww.cdc.gov/niosh/topics/flood/ • http://www.fda.gov/cdhr/emergency/

13. Thank you Karen Fuller 415 744-3741 Karen.Fuller@cms.hhs.gov