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Hurricanes

At the request of the Governor of an affected State, the President may, under the authority of the Robert T. Stafford Disaster Relief and Emergency Act, declare a major disaster or emergency if an event is beyond the combined response capabilities of the State and affected local governments.  If a Presidential declaration occurs, the HHS Secretary may, under section 319 of the Public Health Service Act, declare that a Public Health Emergency (PHE) exists in the affected State.  Once a PHE is declared, section 1135 of the Social Security Act authorizes the Secretary, among other things, to temporarily modify or waive certain Medicare, Medicaid, CHIP, and HIPAA requirements as determined necessary by CMS.

CMS helps states and U.S. territories to maintain access to care for those with Medicare and Medicaid by supporting the ability of participating hospitals and other healthcare facilities to provide timely care to as many people impacted by an emergency or disaster as possible.  CMS will exercise allowable flexibilities and issue waivers as needed to accommodate the needs of those impacted by an emergency or disaster. 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. Information and documents about flexibilities and authorities that may be available in the case of an emergency or disaster are available in the Downloads section below.

Under Section 1135 or 1812(f) of the Social Security Act, CMS can issue several blanket waivers as a result of a disaster or emergency. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Providers do not need to apply for an individual waiver if a blanket waiver has been issued.  Providers can request an individual Section 1135 waiver, if there is no blanket waiver, by following the instructions available at https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Requesting-an-1135-Waiver-Updated-11-16-2016.pdf.

2017 Hurricane Maria:

U.S. Virgin Islands:  A Public Health Emergency Declaration was issued on September 19, 2017, with a finding that a public health emergency existed beginning on September 16, 2017.   Authority to grant waivers under Social Security Act, Section 1135  was issued on September 19, 2017, and was effective retroactive to September 16, 2017.  The PHE and Section 1135 waiver authority was extended to March 14, 2018 and was extended again on March 15, 2018 to June 12, 2018.

Puerto Rico:  A Public Health Emergency Declaration was issued on September 19, 2017, with a finding that a public health emergency existed beginning on September 17, 2017.   Authority to grant waivers under Social Security Act, Section 1135  was issued on September 19, 2017, and was effective retroactive to September 17, 2017.  The PHE and Section 1135 waiver authority was extended to March 15, 2018 and was extended again on March 16, 2018 to June 13, 2018.

The Public Health Emergency Declaration documents and the Social Security Act waiver documents for Puerto Rico and the U.S. Virgin Islands may be found in the Downloads section below.

Blanket Waivers for the United States Virgin Islands and Puerto Rico

Under Sections 1135 or 1812(f) of the Social Security Act, CMS has issued several blanket waivers in the impacted counties and geographical areas in United States Virgin Islands and Commonwealth of Puerto Rico. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Individual facilities do not need to apply for the following approved blanket waivers:

  • Skilled Nursing Facilities
    • 1812(f): This waiver of the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility stay provides temporary emergency coverage of Skilled Nursing Facility (SNF) services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of Hurricane Maria in United States Virgin Islands and Commonwealth of Puerto Rico in 2017.  In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period. (Blanket waiver for all impacted facilities)
    • 483.20: This waiver provides relief to Skilled Nursing Facilities on the timeframe requirements for Minimum Data Set assessments and transmission. (Blanket waiver for all impacted facilities)
  • Home Health Agencies
    • 484.20(c)(1): This waiver provides relief to Home Health Agencies on the timeframes related to OASIS Transmission. (Blanket waiver for all impacted agencies)
  • Critical Access Hospitals
    • This action waives the requirements that Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours. (Blanket waiver for all impacted hospitals)
  • Housing Acute Care Patients In Excluded Distinct Part Units
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS hospitals that, as a result of Hurricane Maria, need to house acute care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute care inpatient.  The IPPS hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the hurricane.  (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.)
  • Durable Medical Equipment
    • As a result of Hurricane Maria, CMS has determined it is appropriate to issue a blanket waiver to suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) where DMEPOS is lost, destroyed, irreparably damaged, or otherwise rendered unusable.  Under this waiver, the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable as a result of these hurricanes.
    • As a result of Hurricane Maria, CMS is temporarily extending the 10 business day deadline to provide notification of any subcontracting arrangements. During the temporary extension period, affected contract suppliers will have 30 business days to provide notice to the Competitive Bidding Implementation Contractor of any subcontracting arrangements. CMS will notify DMEPOS Competitive Bidding contract suppliers via e-mail when this temporary extension expires. All other competitive bidding program requirements remain in force. Note: CMS will provide notice of any changes to reporting timeframes for future events.
  • Replacement Prescription Fills
    • Medicare payment may be permitted for replacement prescription fills (for a quantity up to the amount originally dispensed) of covered Part B drugs in circumstances where dispensed medication has been lost or otherwise rendered unusable by damage due to the emergency.
  • IPPS Hospitals
    • FY 2014 and FY 2015 S-10 Revisions CMS is currently granting a 31-day extension to the deadline to resubmit certain Worksheet S-10 data for IPPS hospitals located in the the Commonwealth of Puerto Rico.  As noted in the FY 2018 Inpatient Prospective Payment System (IPPS)/LTCH PPS Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38208, August 14, 2017), our initial deadline had been September 30, 2017. For revisions to be considered, we are modifying the deadline in accordance with Waivers or Modifications of Requirements under Section 1135(b)(5) of the Social Security, such that amended FY 2014 and FY 2015 cost reports due to revised or initial submissions of Worksheet S-10 must be received by Medicare Administrative Contractors on or before October 31, 2017. 
  • Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient psychiatric units that, as a result of Hurricane Maria, need to relocate inpatients from the excluded distinct part psychiatric unit to an acute care bed and unit.  The hospital should continue to bill for inpatient psychiatric services under the inpatient psychiatric facility prospective payment system for such patients and annotate the medical record to indicate the patient is a psychiatric inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the hurricane.  This waiver may be utilized where the hospital’s acute care beds are appropriate for psychiatric patients and the staff and environment are conducive to safe care. For psychiatric patients, this includes assessment of the acute care bed and unit location to ensure those patients at risk of harm to self and others are safely cared for. 
  • Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient Rehabilitation units that, as a result of Hurricane Maria, need to relocate inpatients from the excluded distinct part Rehabilitation unit to an acute care bed and unit.  The hospital should continue to bill for inpatient rehabilitation services under the inpatient rehabilitation facility prospective payment system for such patients and annotate the medical record to indicate the patient is a rehabilitation inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the hurricane.  This waiver may be utilized where the hospital’s acute care beds are appropriate for providing care to rehabilitation patients and such patients continue to receive intensive rehabilitation services.   

These temporary emergency policies would apply to the timeframes specified in the waiver(s) issued under section 1135 of the Act in connection with the effect of Hurricane Maria in the United States Virgin Island and Commonwealth of Puerto Rico. More information is available in the 1135 Waiver Letter, which is posted in the Downloads section below. 

2017 Hurricane Nate:

Alabama: A Public Health Emergency Declaration was issued on October 8 2017, with a finding that a public health emergency exists beginning on October 6, 2017. A Social Security Act waiver was issued on October 7, 2017. A Social Security Act waiver was issued on October 10, 2017. The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on January 3, 2018. 

Florida:  A Public Health Emergency Declaration was issued on October 8 2017, with a finding that a public health emergency exists beginning on October 7, 2017. A Social Security Act waiver was issued on October 10, 2017. The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on January 4, 2018.

Louisiana:  A Public Health Emergency Declaration was issued on October 5 2017, with a finding that a public health emergency exists beginning on October 8, 2017. A Social Security Act waiver was issued on October 7, 2017. A Social Security Act waiver was issued on October 10, 2017. The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on January 2, 2018.

Mississippi: A Public Health Emergency Declaration was issued on October 8 2017, with a finding that a public health emergency exists beginning on October 6, 2017. A Social Security Act waiver was issued on October 7, 2017. A Social Security Act waiver was issued on October 10, 2017. The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on January 3, 2018.

The Public Health Emergency Declaration documents and the Social Security Act waiver documents for Florida may be found in the Downloads section below.

Blanket Waivers Expired for Alabama, Florida, Louisiana and Mississippi

Under Sections 1135 or 1812(f) of the Social Security Act, CMS has issued several blanket waivers in the impacted counties and geographical areas in Alabama, Florida, Louisiana and Mississippi. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Individual facilities do not need to apply for the following approved blanket waivers:

  • Skilled Nursing Facilities
    • 1812(f): This waiver of the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility stay provides temporary emergency coverage of Skilled Nursing Facility (SNF) services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of Hurricane Nate in Alabama, Florida, Louisiana and Mississippi in 2017.  In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period. (Blanket waiver for all impacted facilities)
    • 483.20: This waiver provides relief to Skilled Nursing Facilities on the timeframe requirements for Minimum Data Set assessments and transmission. (Blanket waiver for all impacted facilities)
  • Home Health Agencies
    • 484.20(c)(1): This waiver provides relief to Home Health Agencies on the timeframes related to OASIS Transmission. (Blanket waiver for all impacted agencies)
  • Critical Access Hospitals
    • This action waives the requirements that Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours. (Blanket waiver for all impacted hospitals)
  • Housing Acute Care Patients In Excluded Distinct Part Units
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS hospitals that, as a result of Hurricane Nate, need to house acute care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute care inpatient.  The IPPS hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the hurricane.  (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.)
  • Durable Medical Equipment
    • As a result of Hurricane Nate, CMS has determined it is appropriate to issue a blanket waiver to suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) where DMEPOS is lost, destroyed, irreparably damaged, or otherwise rendered unusable.  Under this waiver, the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable as a result of these hurricanes.
    • As a result of Hurricane Nate, CMS is temporarily extending the 10 business day deadline to provide notification of any subcontracting arrangements. During the temporary extension period, affected contract suppliers will have 30 business days to provide notice to the Competitive Bidding Implementation Contractor of any subcontracting arrangements. CMS will notify DMEPOS Competitive Bidding contract suppliers via e-mail when this temporary extension expires. All other competitive bidding program requirements remain in force. Note: CMS will provide notice of any changes to reporting timeframes for future events.
  • Replacement Prescription Fills
    • Medicare payment may be permitted for replacement prescription fills (for a quantity up to the amount originally dispensed) of covered Part B drugs in circumstances where dispensed medication has been lost or otherwise rendered unusable by damage due to the emergency.
  • Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient psychiatric units that, as a result of Hurricane Nate, need to relocate inpatients from the excluded distinct part psychiatric unit to an acute care bed and unit.  The hospital should continue to bill for inpatient psychiatric services under the inpatient psychiatric facility prospective payment system for such patients and annotate the medical record to indicate the patient is a psychiatric inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the hurricane.  This waiver may be utilized where the hospital’s acute care beds are appropriate for psychiatric patients and the staff and environment are conducive to safe care. For psychiatric patients, this includes assessment of the acute care bed and unit location to ensure those patients at risk of harm to self and others are safely cared for.
  • Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient Rehabilitation units that, as a result of Hurricane Nate, need to relocate inpatients from the excluded distinct part Rehabilitation unit to an acute care bed and unit.  The hospital should continue to bill for inpatient rehabilitation services under the inpatient rehabilitation facility prospective payment system for such patients and annotate the medical record to indicate the patient is a rehabilitation inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the hurricane.  This waiver may be utilized where the hospital’s acute care beds are appropriate for providing care to rehabilitation patients and such patients continue to receive intensive rehabilitation services.   

These temporary emergency policies would apply to the timeframes specified in the waiver(s) issued under section 1135 of the Act in connection with the effect of Hurricane Nate in Alabama, Florida, Louisiana and Mississippi. More information is available in the 1135 Waiver Letter, which is posted in the Downloads section below.

2017 Hurricane Irma:

Puerto Rico and the U.S. Virgin Islands:  A Public Health Emergency Declaration was issued on September 6, 2017, with a finding that a public health emergency exists beginning on September 5, 2017.   A Social Security Act waiver was issued on September 6, 2017, and is effective retroactive to September 5, 2017.  The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on December 3, 2017.

Florida:  A Public Health Emergency Declaration was issued on September 7, 2017, with a finding that a public health emergency exists beginning on September 4, 2017.  A Social Security Act waiver was issued on September 7, 2017, and is effective retroactive to September 4, 2017.  The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on December 2, 2017.

Georgia:  A Public Health Emergency Declaration was issued on September 8, 2017, with a finding that a public health emergency exists beginning on September 7, 2017.  A Social Security Act waiver was issued on September 8, 2017, and is effective retroactive to September 7, 2017.  The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on December 5, 2017.

South Carolina:  A Public Health Emergency Declaration was issued on September 8, 2017, with a finding that a public health emergency exists beginning on September 6, 2017.   A Social Security Act waiver was issued on September 8, 2017, and is effective retroactive to September 6, 2017. The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on December 4, 2017.

The Public Health Emergency Declaration documents and the Social Security Act waiver documents for these States and Territories may be found in the Downloads section below.

Blanket Waivers Expired for the United States Virgin Islands, Commonwealth of Puerto Rico and States of Florida, Georgia and South Carolina.

Under Sections 1135 or 1812(f) of the Social Security Act, CMS has issued several blanket waivers in the impacted counties and geographical areas in United States Virgin Islands, Commonwealth of Puerto Rico and State of Florida. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Individual facilities do not need to apply for the following approved blanket waivers:   

  • Skilled Nursing Facilities
    • 1812(f): This  waiver of the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility stay provides temporary emergency coverage of Skilled Nursing Facility (SNF) services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of Hurricane Irma in United States Virgin Islands, Commonwealth of Puerto Rico and States of Florida, Georgia and South Carolina in 2017.  In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period. (Blanket waiver for all impacted facilities)
    • 483.20: This waiver provides relief to Skilled Nursing Facilities on the timeframe requirements for Minimum Data Set assessments and transmission. (Blanket waiver for all impacted facilities) 
  • Home Health Agencies
    • 484.20(c)(1): This waiver provides relief to Home Health Agencies on the timeframes related to OASIS Transmission. (Blanket waiver for all impacted agencies)
  • Critical Access Hospitals
    • This action waives the requirements that Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours. (Blanket waiver for all impacted hospitals)
  • Housing Acute Care Patients In Excluded Distinct Part Units
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS hospitals that, as a result of Hurricane Irma, need to house acute care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute care inpatient.  The IPPS hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the hurricane.  (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.)
  • Durable Medical Equipment
    • As a result of Hurricane Irma, CMS has determined it is appropriate to issue a blanket waiver to suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) where DMEPOS is lost, destroyed, irreparably damaged, or otherwise rendered unusable.  Under this waiver, the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable as a result of these hurricanes.
    • As a result of Hurricane Irma, CMS is temporarily extending the 10 business day deadline to provide notification of any subcontracting arrangements. During the temporary extension period, affected contract suppliers will have 30 business days to provide notice to the Competitive Bidding Implementation Contractor of any subcontracting arrangements. CMS will notify DMEPOS Competitive Bidding contract suppliers via e-mail when this temporary extension expires. All other competitive bidding program requirements remain in force. Note: CMS will provide notice of any changes to reporting timeframes for future events.
  • Replacement Prescription Fills
    • Medicare payment may be permitted for replacement prescription fills (for a quantity up to the amount originally dispensed) of covered Part B drugs in circumstances where dispensed medication has been lost or otherwise rendered unusable by damage due to the emergency.
  • IPPS Hospitals
    • FY 2014 and FY 2015 S-10 Revisions CMS is currently granting a 31-day extension to the deadline to resubmit certain Worksheet S-10 data for IPPS hospitals located in the States of Florida, Georgia, and South Carolina, and in the Commonwealth of Puerto Rico.  As noted in the FY 2018 Inpatient Prospective Payment System (IPPS)/LTCH PPS Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38208, August 14, 2017), our initial deadline had been September 30, 2017 . For revisions to be considered, we are modifying the deadline in accordance with Waivers or Modifications of Requirements under Section 1135(b)(5) of the Social Security, such that amended FY 2014 and FY 2015 cost reports due to revised or initial submissions of Worksheet S-10 must be received by Medicare Administrative Contractors on or before October 31, 2017.
  • Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient psychiatric units that, as a result of Hurricane Irma, need to relocate inpatients from the excluded distinct part psychiatric unit to an acute care bed and unit.  The hospital should continue to bill for inpatient psychiatric services under the inpatient psychiatric facility prospective payment system for such patients and annotate the medical record to indicate the patient is a psychiatric inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the hurricane.  This waiver may be utilized where the hospital’s acute care beds are appropriate for psychiatric patients and the staff and environment are conducive to safe care. For psychiatric patients, this includes assessment of the acute care bed and unit location to ensure those patients at risk of harm to self and others are safely cared for.
  • Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient Rehabilitation units that, as a result of Hurricane Irma, need to relocate inpatients from the excluded distinct part Rehabilitation unit to an acute care bed and unit.  The hospital should continue to bill for inpatient rehabilitation services under the inpatient rehabilitation facility prospective payment system for such patients and annotate the medical record to indicate the patient is a rehabilitation inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the hurricane.  This waiver may be utilized where the hospital’s acute care beds are appropriate for providing care to rehabilitation patients and such patients continue to receive intensive rehabilitation services. 
  • These temporary emergency policies would apply to the timeframes specified in the waiver(s) issued under section 1135 of the Act in connection with the effect of Hurricane Irma in the United States Virgin Islands, Commonwealth of Puerto Rico and States of Florida, Georgia and South Carolina. More information is available in the 1135 Waiver Letters, which are posted in the Downloads section below.

2017 Hurricane Harvey:

Texas:  A Public Health Emergency Declaration was issued on August 26, 2017, with a finding that a public health emergency exists beginning on August 25, 2017.  A Social Security Act waiver was issued on August 26, 2017, and is effective retroactive to August 25, 2017. The Public Health Emergency declaration and Social Security Act waivers including the Section 1135 waiver authority expired on November 22, 2017.

Louisiana: A Public Health Emergency Declaration was issued on August 28, 2017, with a finding that a public health emergency exists beginning on August 27, 2017.   A Social Security Act waiver was issued on August 28, 2017, and is effective retroactive to August 27, 2017. The Public Health Emergency declaration and Social Security Act Waivers and the Section 1135 waiver authority expired on November 24, 2017.

The Public Health Emergency Declaration documents and the Social Security Act waiver documents for Texas and Louisiana may be found in the Downloads section below.

Blanket Waivers Expired for Texas

Under Sections 1135 or 1812(f) of the Social Security Act, CMS has issued several blanket waivers in the impacted counties and geographical areas in Texas and Louisiana. These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. Individual facilities do not need to apply for the following approved blanket waivers:

  • Skilled Nursing Facilities
    • 1812(f): This  waiver of the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility stay provides temporary emergency coverage of Skilled Nursing Facility (SNF) services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of Hurricane Irma in United States Virgin Islands, Commonwealth of Puerto Rico and States of Florida, Georgia and South Carolina in 2017.  In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period. (Blanket waiver for all impacted facilities)
  • Home Health Agencies
    • 484.20(c)(1): This waiver provides relief to Home Health Agencies on the timeframes related to OASIS Transmission. (Blanket waiver for all impacted agencies)
  • Critical Access Hospitals
    • This action waives the requirements that Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours. (Blanket waiver for all impacted hospitals)
  • Housing Acute Care Patients In Excluded Distinct Part Units
    • CMS has determined it is appropriate to issue a blanket waiver to IPPS hospitals that, as a result of Hurricane Harvey, need to house acute care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute care inpatient.  The IPPS hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the hurricane/tropical storm Harvey.  (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.)
  • Durable Medical Equipment
    • As a result of Hurricane Harvey, CMS has determined it is appropriate to issue a blanket waiver to suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) where DMEPOS is lost, destroyed, irreparably damaged, or otherwise rendered unusable.  Under this waiver, the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable as a result of these hurricanes.
    • As a result of Hurricane Harvey, CMS is temporarily extending the 10 business day deadline to provide notification of any subcontracting arrangements. During the temporary extension period, affected contract suppliers will have 30 business days to provide notice to the Competitive Bidding Implementation Contractor of any subcontracting arrangements. CMS will notify DMEPOS Competitive Bidding contract suppliers via e-mail when this temporary extension expires. All other competitive bidding program requirements remain in force. Note: CMS will provide notice of any changes to reporting timeframes for future events.
  • Replacement Prescription Fills 
    • Medicare payment may be permitted for replacement prescription fills (for a quantity up to the amount originally dispensed) of covered Part B drugs in circumstances where dispensed medication has been lost or otherwise rendered unusable by damage due to the emergency.
  • IPPS Hospitals
    • FY 2014 and FY 2015 S-10 Revisions CMS is currently granting a 31-day extension to the deadline to resubmit certain Worksheet S-10 data for IPPS hospitals located in the States of Texas and Louisiana.  As noted in the FY 2018 Inpatient Prospective Payment System (IPPS)/LTCH PPS Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38208, August 14, 2017), our initial deadline had been September 30, 2017 . For revisions to be considered, we are modifying the deadline in accordance with Waivers or Modifications of Requirements under Section 1135(b)(5) of the Social Security, such that amended FY 2014 and FY 2015 cost reports due to revised or initial submissions of Worksheet S-10 must be received by Medicare Administrative Contractors on or before October 31, 2017.

These temporary emergency policies would apply to the timeframes specified in the waiver(s) issued under section 1135 of the Act in connection with the effect of Hurricane Harvey in the State of Texas. More information is available in the August 30, 2017 Texas 1135 Waiver Letter, which is posted in the Downloads section below.

Blanket Waivers Expired for Louisiana

Under the authority of section 1135 of the Social Security Act, CMS has waived the 3-day prior hospitalization for coverage of a skilled nursing facility stay. The 1812(f) waiver allows nursing facility admission without the 3-day hospital stay and also waives the spell of illness requirement for evacuees and others affected by the hurricane who need skilled nursing facility care. This waiver is limited to identified impacted counties and geographical areas in Louisiana.  Individual facilities do not need to apply for this approved blanket waiver.  More information is available in the August 31, 2017 Louisiana 1135 Waiver Letter, which is posted in the Downloads section below.  

  • Medicare-dependent small, rural hospitals (MDHs)
    • In accordance with Waivers or Modifications of Requirements under Section 1135 of the Social Security Act issued August 26, 2017 and August 28, 2017 by Secretary Price, CMS is modifying the September 1, 2017 deadline for Medicare-dependent small, rural hospitals (MDHs) to apply for sole community hospital (SCH) status in advance of the expiration of the MDH program with an effective date of an approval of SCH status that is the day following the expiration date of the MDH program (that is, September 30, 2017 under current law). CMS is currently granting a 31-day extension to the deadline at § 412.92(b)(2)(v) for the States of Texas and Louisiana.
      If a hospital located in these areas that is classified as an MDH applies for classification as an SCH under the provisions of § 412.92(b)(2)(v), and that hospital's SCH status is approved, the effective date of approval of SCH status will be the day following the expiration date of the MDH program if such hospital applies for classification as a SCH not later than October 2, 2017.
  • Low-Volume
    • In accordance with Waivers or Modifications of Requirements under Section 1135 of the Social Security Act issued August 26, 2017 and August 28, 2017 by Secretary Price, CMS is modifying the September 1, 2017 deadline for hospitals to make a written request for low-volume hospital status that is received by its Medicare Administrative Contractor (MAC) in order for the 25-percent low-volume hospital payment adjustment to be applied to payments for its discharges beginning on or after the start of the Federal fiscal year (FY) 2018.  CMS is currently granting a 31-day extension to the deadline established in the FY 2018 Inpatient Prospective Payment System (IPPS)/LTCH PPS Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule (82 FR 38186) for the States of Texas and Louisiana. Requests for low-volume hospital status for FY 2018 from a hospital located in these areas must be received by the MAC no later than October 2, 2017 in order for the low-volume hospital payment adjustment to be applied beginning with the start of the FY 2018 (that is, for discharges occurring on or after October 1, 2017).
  • Extension for Medicare Geographic Classification Review Board (MGCRB) Applications
    • In accordance with Waivers or Modifications of Requirements under Section 1135 of the Social Security Act issued August 26, 2017 and August 28, 2017 by Secretary Price, CMS is modifying the September 1, 2017 deadline for applications for FY 2019 reclassifications to be submitted to the MGCRB. CMS has granted a 31-day extension to the deadline at § 412.256(a)(2) for the States of Texas and Louisiana. Applications for FY 2019 reclassifications from hospitals  in these areas must be received by the MGCRB not later than October 2, 2017.
  • Extension for Inpatient Prospective Payment System (IPPS) Wage Index Revisions
    • Regarding the FY 2019 wage index, CMS is modifying the September 1, 2017 deadline specified in the FY 2019 Hospital Wage Index Development Time Table for these hospitals to request revisions to and provide documentation for their FY 2015 Worksheet S-3 wage data and CY 2016 occupational mix data as included in the May 18, 2017 and July 12, 2017 preliminary Public Use Files (PUFs), respectively.  CMS has granted an extension for hospitals in the States of Texas and Louisiana until October 2, 2017.  MACs must receive the revision requests and supporting documentation by this date.  If hospitals encounter difficulty meeting this extended deadline of October 2, 2017, hospitals should communicate their concerns to CMS via their MAC, and CMS may consider an additional extension if CMS determines it is warranted. 

Medicare

Frequently Asked Questions for emergency situations both requiring and not requiring an 1135 waiver are posted in the Downloads section below.  Additional guidance to providers will be issued on an ongoing basis.

CMS has issued a memorandum for Medicare Advantage Organizations (MAOs) and Part D sponsors to remind them of their obligations to maintain access to the Part A/ B, supplemental Part C, and Part D benefits (as applicable) for beneficiaries in affected areas of Texas and Louisiana. The memorandum is linked in the Downloads section below.

Emergency information for people with Medicare can be found at https://www.medicare.gov/what-medicare-covers/getting-care-and-drugs-in-disasters-or-emergencies.html.

Hurricane Harvey Questions and Answers for Medicare Part D beneficiaries and Part D Plan sponsors can be found in the Downloads section below.

Facilities

CMS is granting exceptions under certain Medicare quality reporting and value-based purchasing programs without having to submit an extraordinary circumstances exception request for Hurricane Harvey and Irma if they are located within the  Federal Emergency Management Agency (FEMA) - Opens in a new window  - External Link Policy - Opens in a new window designated areas. Further information can be found in the in the memos on applicability of reporting requirements to certain providers in the Downloads section below.

Facilities and providers may find useful information in Provider Survey and Certification Frequently Asked Questions, which may be found in the Downloads section below.

Archived Emergency Information

Information on previous Hurricane Public Health Emergency efforts are available on our  Emergency Event Archive page. - Opens in a new window

Downloads

Related Links

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