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[Music] hi my name is Jillian Martin Im a senior health care consultant at CLA in an MDS master teacher through the American Association of nursing assessment coordinators today were going to be discussing the CMS 1135 waiver and how that impacts Medicare access and reimbursement in a skilled nursing facility when the president declares a disaster or emergency under the national emergencies act the Secretary of Health and Human Services is authorized to waive or modify certain requirements for Medicare Medicaid in the Childrens Health Insurance Program today we will be talking about the waiver as it applies to Medicare only back in March the 1135 blanket waiver was enacted it impacts all seventeen provider types a little differently and even for skilled nursing facilities it covers a lot of material that we will not be discussing today just keep in mind that today we are discussing Medicare Part A only so not Medicare Advantage and not Medicaid those some of the requirements will o