Introduction
Xavier Becerra, Secretary of Health and Human Services, has declared a public health emergency (PHE) in the states of Florida, Georgia, North Carolina, Tennessee, and South Carolina in response to Hurricane Helene[1]. As a result, Centers for Medicare & Medicaid Services (CMS) has implemented financial and operational relief measures[2] for healthcare providers and suppliers in these states, with additional relief in Federal Emergency Management Agency (FEMA)-designated disaster areas.
Expanded CMS Resources in Florida, Georgia, North Carolina, Tennessee, and South Carolina
CMS has extended the following additional resources and regulatory flexibilities:
- 1812f Waivers and Blanket 1135 Waivers. An explanation of these waivers (which include waiver of the qualifying inpatient stay requirement for a skilled nursing facility admission) is available here.
- Special Enrollment Periods for Impacted Individuals – provides individuals an additional 60 days from the end of the PHE to secure health insurance coverage if they missed the initial enrollment deadlines as a result of Hurricane Helene.
- Medicaid and CHIP Agencies Disaster-Response Toolkit (Toolkit) – the Toolkit lists all regulatory exceptions and flexibilities in place under the PHE specific to Medicaid and CHIP.
- Dialysis Care Support – the PHE activates the Kidney Community Emergency Response (KCER) program and End-Stage Renal Disease (ESRD) networks. These networks are responsible for assessing the status of dialysis facilities in impacted areas and assisting evacuated individuals with accessing dialysis care.
- Replacement of Durable Medical Equipment and Supplies – Medicare beneficiaries who lost or damaged their medical equipment due to Hurricane Helene are eligible for replacements. Beneficiaries should contact 1-800-MEDICARE (1-800-633-4227) for assistance.
- Suspension of certain Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provisions – For hospitals that have implemented a disaster protocol, the United States Department of Health and Human Services (HHS) may waive specific HIPAA Privacy Rule provisions including:
- Obtain a patient’s agreement to speak with family members or friends.
- Honor a request to opt out of the facility directory.
- Distribute a notice.
- The patient’s right to request privacy restrictions.
- The patient’s right to request confidential communications.
- Use existing permissions and flexibilities in the HIPAA Rules that apply in emergencies and other circumstances.
Key CMS Assistance for Providers in Federal Emergency Management Agency (FEMA) disaster zones
- Accelerated and Advance Payments – CMS is offering Medicare Part A providers and Part B suppliers accelerated or advance payments based on their previous 90 days of claims billed to Medicare. These payments are subject to automatic recoupment through future Medicare payments over a 90-day period.
- Debt Repayment Flexibility – Providers with existing debt under an Extended Repayment Schedule (ERS) established at the maximum 60-month term or at less than a 60-month term may restructure two consecutive months of payments or request an additional two months be added to their existing ERS, respectively, without the need for additional financial documentation.
- Disrupted Communication on Debt Collection – CMS is providing measures for healthcare providers affected by postal disruptions to delay or reschedule debt communications. Providers who did not receive overpayment demand letters due to mail service interruptions could request the letters be rescinded and reissued once services are resumed.
Conclusion
CMS is working to assist providers in maintaining operational continuity and stabilize healthcare delivery systems during a time of significant disruption. Providers can reach out to the Medical Administrative Contractors (MAC) for their jurisdiction to obtain more information. If you have questions or if PYA can help in any way, please email one of our Executive Contacts below or call 800.270.9629.
[1] https://www.cms.gov/about-cms/what-we-do/emergency-response/current-emergencies
[2] https://www.cms.gov/newsroom/news-alert/cms-provide-hurricane-helene-public-health-emergency-accelerated-and-advance-payments-medicare-fee
