Waiver or Modification of Requirements Under Section 1135 of the Social Security Act

July 8, 2025

1. Pursuant to section 1135(b) of the Social Security Act (the Act) (42 U.S.C. § 1320b-5), I, Robert F. Kennedy, Jr., Secretary of Health and Human Services, hereby waive or modify the following requirements of titles XVIII, XIX, and XXI of the Act and regulations thereunder, and the following requirements of Title XI of the Act, and regulations thereunder, insofar as they relate to Titles XVIII, XIX, and XXI of the Act, but in each case, only to the extent necessary, as determined by the Centers for Medicare & Medicaid Services, to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid, and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the consequences of severe storms, straight-line winds, and flooding, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse:
1. Certain conditions of participation, certification requirements, program participation or similar requirements for individual health care providers or types of health care providers, including as applicable, a hospital or other provider of services, a physician or other health care practitioner or professional, a health care facility, or a supplier of health care items or services, and pre-approval requirements.
2. Requirements that physicians or other health care professionals hold licenses in the State in which they provide services, if they have an equivalent license from another State (and are not affirmatively barred from practice in that State or any State a part of which is included in the emergency area).
3. Sanctions under section 1867 of the Act (the Emergency Medical Treatment and Labor Act, or EMTALA) for the direction or relocation of an individual to another location to receive medical screening pursuant to an appropriate state emergency preparedness plan or for the transfer ofan individual who has not been stabilized ifthe transfer is necessitated by the circumstances ofthe declared federal public health emergency for severe storms, straight-line winds, and flooding.
4. Sanctions under section 1877(g) ofthe Act (relating to limitations on physician referral) under such conditions and in such circumstances as the Centers for Medicare & Medicaid Services determines appropriate.
   
5. Limitations on payments under section 1851(i) ofthe Act for health care items and services furnished to individuals enrolled in a Medicare Advantage plan by health care professionals or facilities not included in the plan's network.
2. Pursuant to section 1135(b)(7) ofthe Act, I hereby waive sanctions and penalties arising from noncompliance with the following provisions ofthe HIPAA privacy regulations: (a) the requirements to obtain a patient's agreement to speak with family members or friends or to honor a patient's request to opt out ofthe facility directory (as set forth in 45 C.F.R.
   § 164.510); (b) the requirement to distribute a notice ofprivacy practices (as set forth in 45 C.F.R. § 164.520); and (c) the patient's right to request privacy restrictions or confidential communications (as set forth in 45 C.F.R. § 164.522); but in each case, only with respect to hospitals in the designated geographic area that have hospital disaster protocols in operation during the time the waiver is in effect.
   
3. Pursuant to section 1135(b)(5) ofthe Act, I also hereby modify deadlines and timetables and for the performance ofrequired activities, but only to the extent necessary, as determined by the Centers for Medicare & Medicaid Services, to ensure that sufficient health care items and services are available to meet the needs ofindividuals enrolled in the Medicare, Medicaid, and CHIP programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more ofthese requirements as a result ofsevere storms, straight-line winds, and flooding, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination offraud or abuse.

These waivers and modifications will become effective on July 10, 2025, but will have retroactive effect to July 2, 2025, in the State ofTexas, and continue through the period described in section 1135(e) ofthe Act. Notwithstanding the foregoing, the waivers described in paragraphs 1(c) and 2 above are in effect for a period oftime not to exceed 72 hours from implementation ofa hospital disaster protocol but not beyond the period described in section 1135(e) ofthe Act, and such waivers are not effective with respect to any action taken thereunder that discriminates among individuals on the basis oftheir source ofpayment or their ability to pay.

The waivers and modifications described herein apply in the geographic area covered by the President's declaration, pursuant to the Robert T. Stafford Disaster Reliefand Emergency Assistance Act, ofa major disaster as a result ofsevere storms, straight-line winds, and flooding on July 6, 2025, in the State of Texas; and my July 8, 2025, determination, pursuant to section 319 of the Public Health Service Act, that a public health emergency exists and has existed as a result of the consequences of severe storms, straight-line winds, and flooding since July 2, 2025, in the State of Texas.