Article
What was declared
President Trump approved an emergency declaration for wildfires in Washington on Aug. 4. On Aug. 7, HHS Secretary Robert F. Kennedy Jr. declared a public health emergency for the state and signed a Section 1135 waiver. The waiver took effect Aug. 10 and is retroactive to Aug. 1. ASPR has sent regional staff to support state officials, and the Washington State Hospital Association has posted wildfire response resources.
What the waiver allows
Section 1135 waivers are available only when both a presidential declaration and a public health emergency are in place. The Washington waiver covers the declared area and includes:
- Conditions of participation. Certain certification, participation and pre-approval requirements can be waived for hospitals, practitioners and other providers.
- Licensure. Practitioners licensed in another state may practice in Washington unless they are barred from practice in any state in the emergency area.
- EMTALA. Sanctions are waived for redirecting patients for screening under a state emergency plan and for transferring unstabilized patients when the emergency requires it.
- Physician referral rules. Sanctions under the Stark law may be waived under conditions CMS sets.
- Medicare Advantage. Payment limits are modified for enrollees who receive care from out-of-network providers.
- Privacy. Some HIPAA sanctions are waived for hospitals operating under disaster protocols, such as speaking with family without patient agreement.
The limits
The waivers apply only as needed to keep care available and to let providers acting in good faith be paid and avoid penalties, absent fraud or abuse. The EMTALA and HIPAA relief lasts only 72 hours from when a hospital activates its disaster protocol. None of the waivers allow decisions that discriminate based on payment source or ability to pay.
Lessons for every hospital
Wildfire smoke can affect hospitals well beyond the fire line. Even outside Washington, leaders can use this declaration to test their own readiness.
- Know the trigger. Make sure command staff understand that waivers depend on federal declarations and on activating the hospital’s own disaster protocol.
- Track the clock. Build the 72-hour limit on EMTALA and privacy relief into incident checklists.
- Document decisions. Record why each waived requirement was needed, since relief depends on good faith.
- Prepare for outside clinicians. Have a fast process to verify out-of-state licenses and grant disaster privileges.
- Plan for air quality. Review filtration, supply stocks and surge plans for respiratory patients during smoke events.
Archive entry for Aug 13, 2026, added Nov. 11, 2026.