TJC clarifies 1135 waivers, which suspend rules during a disaster

by Brian A. Ward (bward@hcpro.com)

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Joint Commission (TJC)–accredited hospitals and critical access hospitals must have a process in their policies for requesting an 1135 waiver from CMS, which is issued during a disaster or emergency when conditions necessitate modifying or temporarily lifting CMS requirements.

TJC’s recent clarification was to Emergency Management (EM) Standard EM.02.01.01, element of performance (EP) 14. The accreditor explained that surveyors don’t expect to review an actual 1135 waiver during survey; however, they will want to review your 1135 waiver request process and confirm that leadership is knowledgeable about the requirements.

What

With an 1135 waiver, a facility can modify:

  • Conditions of Participation (CoP) or other certification requirements
  • Program participation and similar requirements
  • Preapproval requirements
  • State licensing requirements for physicians and other healthcare professionals
  • Emergency Medical Treatment and Active Labor Act (EMTALA) sanctions
  • Stark self-referral sanctions
  • Performance deadlines and timetable adjustments (these may not be waived)
  • Limitations on payment to permit Medicare enrollees to use out-of-network providers in an emergency

While there’s no standardized application template for an 1135 waiver, there is specific information that hospitals need to include in their request:

  • Provider name and type
  • Full address: county, city, town, state
  • Medicare provider number
  • Name and contact information of the provider’s point of contact
  • Consideration, such as the type of relief requested or regulatory requirement/reference to be waived
  • Brief summary of why the 1135 waiver is needed

TJC provided an example summary as follows: “The critical access hospital is the sole community provider without reasonable transfer options at this point during the specified emergent event (such as flooding, tornado, fires, flu outbreak). The critical access hospital needs a waiver to exceed its bed limit by X number of beds for Y days/weeks (be specific).”

For the rest of the analysis of The Joint Commission's clarification on 1135 waivers, read this Inside Accreditation & Quality article -> https://www.accreditationqualitycenter.com/articles/clarification-1135-waivers-temporary-suspension-rules-during-disaster