Emergency Waivers Help Providers Care for Hurricane-Affected Patients

September 14, 2017 Phil C. Solomon

Healthcare providers, if you serve Medicare, Medicaid and Children’s Health Insurance Program (CHIP) patients in the counties and geographical areas impacted by Hurricane Irma and Hurricane Harvey, or see patients who have been displaced from their homes in these areas who are in need of care, you need to know how government payers are responding to the crises, as well as the compliance implications of their actions for your facilities.

“Hurricane Irma has proven to be highly destructive and poses a significant threat to the health and safety of all Americans in its path,” said Health and Human Services (HHS) Secretary Tom Price, MD.  “HHS has pre-positioned assets and personnel who can rapidly deploy to assist local responses in Florida to Hurricane Irma, and this declaration will help ensure that access to care is maintained for those with Medicare and Medicaid.”  Secretary Price also authorized emergency efforts in Texas in the aftermath of Hurricane Harvey.

Beyond deployment of emergency resources, Secretary Price has declared a public health emergency in Florida, Georgia, South Carolina, Puerto Rico and the U.S. Virgin Islands in response to Hurricane Irma and in Texas and Louisiana in response to Hurricane Harvey.

The public health emergencies have enabled the Centers for Medicare and Medicaid Services (CMS) to issue several blanket programmatic waivers of certain requirements for providers who care for Medicare, Medicaid and CHIP beneficiaries, based on Section 1135 of the Social Security Act.  The blanket waivers are designed to offer beneficiaries—including those who are evacuated, transferred or dislocated as a result of the hurricanes—access to medical care during the emergency.  The waivers give hospitals, skilled nursing facilities (SNFs), other healthcare facilities and clinicians more flexibility to deliver emergency and other healthcare services in the wake of the disasters.

The flexible temporary policies regarding specified requirements are designed to bolster the effectiveness of the emergency response by, for example, allowing hospitals to share medical records without the usual restrictions and permitting doctors accredited by other states’ Medicaid programs to provide emergency treatment.  Individual facilities in the impacted areas or those treating patients evacuated from the impacted areas need not apply for these blanket waivers.

Following is a summary of the blanket waivers for both Hurricane Irma and Hurricane Harvey, under Sections 1135 or 1812(f) of the Social Security Act (for the impacted areas in the U.S. Virgin Islands, Puerto Rico, Florida, Georgia, South Carolina, Texas and Louisiana).

  • 1812(f):  Waives the requirement for a three-day prior hospitalization to obtain coverage of a stay in a SNF providing temporary emergency coverage of SNF services without a qualifying hospital stay for individuals evacuated, transferred or otherwise dislocated in 2017.  For certain beneficiaries who have exhausted their SNF benefits, the waiver authorizes renewed SNF coverage without first having to start a new benefit period.
  • 483.20:  Provides relief to all impacted SNFs on the timeframe requirements for Minimum Data Set (MDS) assessments and transmission.
  • 484.20(c)(1):  Provides relief to all impacted home health agencies on the timeframes related to OASIS transmission.
  • Waives the requirement for Critical Access Hospitals to limit the number of beds to 25 and limit the length of stay to 96 hours.  This is a blanket waiver for all impacted hospitals.
  • Waives the requirement for Inpatient Prospective Payment System (IPPS) hospitals to house acute care patients in distinct units, where the distinct part unit’s beds are appropriate for acute care inpatients.  The IPPS hospital should bill for the care and indicate in the patient’s medical record that the patient is an acute care inpatient being housed in the excluded unit due to capacity issues related to the hurricane.  This is a blanket waiver for all IPPS hospitals located in the affected areas that need to use distinct part beds for acute care patients as a result of the hurricane.
  • Waives the requirement for a face-to-face visit with a physician, a new physician’s order and new medical necessity documentation for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) when DMEPOS are lost, destroyed, irreparably damaged or rendered unusable.  Under this waiver, suppliers must continue to provide a narrative description on the claim explaining the reason why the equipment must be replaced.  They are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable as a result of the hurricane.
  • Allows coverage for replacement prescription fills for a quantity up to the amount originally dispensed of covered Part B drugs in instances in which the dispensed medication was lost or rendered unusable by damage due to the hurricane.

For providers in the states of Texas and Louisiana, CMS has extended the September 1, 2017 deadlines to October 2, 2017 for the following:

  • Applications for sole community hospital (SCH) status
  • Written requests for low-volume hospital status in order to receive the low-volume hospital payment adjustment for discharges in fiscal year (FY) 2018
  • Applications for reclassification to the Medicare Geographic Classification Review Board (MGCRB)
  • Extensions for IPPS Wage Index revisions

Please note that, according to CMS, these temporary emergency policies apply to timeframes specified in the waiver(s) issued under Section 1135 of the Social Security Act.  More information is available on the CMS website here.

For instances in which there is no blanket waiver, providers can request an individual Section 1135 waiver by following the instructions available here.  According to CMS, “specific waivers granted as a result of the emergency or disaster may be retroactive to the beginning of the emergency or disaster if warranted.  CMS also has the authority to exercise certain flexibilities, which are agency policies or procedures that can be adjusted under current authority—and generally speaking, can be adjusted without reprogramming CMS’s systems.”

The effects of these natural disasters on care delivery, as well as billing and reimbursement, will not only be felt for the short term, but are likely to ripple through your organizations for at least several months and possibly more than a year.  We encourage you to check the Hurricane page on the CMS website frequently for updates.  Questions regarding claims can be directed to your Medicare Administrative Contractor on its toll-free number, which can be found here.  ICD-10 coding advice from the Centers for Disease Control and Prevention in the aftermath of the disasters is available here.

Read more updates: MiraMed eAlerts

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Phil C. Solomon is the publisher of Revenue Cycle News, a healthcare business information blog and serves as the Vice President of Marketing Strategy for MiraMed, a healthcare revenue cycle outsourcing company.  As an executive leader, he is responsible for creating and executing sales and marketing strategies which drive new business development and client engagement. Phil has over 25 years’ experience consulting on a broad range of healthcare initiatives for clinical and revenue cycle performance improvement.  He has worked with industry’s largest health systems developing executable strategies for revenue enhancement, expense reduction, and clinical transformation. He can be reached at philcsolomon@gmail.com

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