Agency grants Florida 14 waivers to provide immediate relief to those impacted
The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma issued a letter granting 14 waivers to support Florida in response to Hurricane Irma. In the wake of the historic and unprecedented hurricane, Health and Human Services Secretary Tom Price, M.D., declared a public health emergency in Florida. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to those affected by the hurricane. The actions include temporarily waiving or modifying certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements.
“CMS has been working closely with officials in Florida and granted several waivers to help provide immediate medical relief to those affected by Hurricane Irma,” said Administrator Verma. “We hope these waiver provisions will provide healthcare providers, facilities and suppliers the flexibility they need so they can focus on the health and safety of those impacted by the Hurricane.”
CMS offered immediate administrative relief actions including issuing 14 general waivers of certain requirements for specific types of providers in Florida. These waivers work to provide continued access to care for beneficiaries. CMS granted the following waivers to support Florida:
Waivers for Hospitals and Medical Facilities
- Treatment of Medical/Surgical patients in non-Inpatient Prospective Payment System (IPPS) hospitals:
CMS will waive participation requirements for acute-care patients placed and billed in a non-IPPS hospital. This waiver allows hospitals in Florida to treat patients in non-IPPS hospitals as well, such as Rehabilitation and Long Term Care hospitals.
- Waiver of Three-Day Prior hospitalization for Skilled Nursing Facility Coverage:
CMS granted this waiver to allow skilled nursing facility coverage of hospital transfers absent a qualifying three day inpatient admission for people who are evacuated or transferred due to Hurricane Irma.
- Critical Access Hospitals Exceeding 25-beds:
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.
- Quality Reporting and Value Based Purchasing Programs:
CMS will grant exceptions for quality reporting for Hospitals, PPS- Exempt Cancer Hospitals, Inpatient Psychiatric Facilities, Skilled Nursing Facilities, Home Health Agencies, Hospices, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, Ambulatory Surgical Centers, and Renal Dialysis Facilities quality reporting and value base payment programs, without having to submit an extraordinary circumstances exception request, for counties that have been designated by the Federal Emergency Management Agency (FEMA) as a major disaster county.
- Rehabilitation Hospital CMS-13 Requirements:
CMS granted Florida this waiver to allow rehabilitation hospitals the ability to treat patients and receive an exemption from certain requirements of the CMS-13 rule. The CMS-13 rule requires that 60 percent of the patients treated at a facility paid under the rehab prospective payment system be treated for 1 of 13 specified conditions. CMS will ensure that patients admitted due to the emergency will not adversely impact CMS’s determination of these hospitals’ compliance with the rule.
- Medicare Advantage Plans:
When a public health emergency is in effect, Medicare Advantage Organizations in affected areas are required to waive prior authorization and other gatekeeper requirements and to allow care to be provided by non-contracted providers and facilities. The requirements were recently addressed in a memo following Hurricane Harvey, available here: https://www.cms.gov/About-CMS/Agency- Information/Emergency/Downloads/Reminder-Pharmacy-Provider-Federal-Disaster.pdf
- EMTALA Waiver:
CMS granted Florida’s request to waive sanctions under section 1867 of the Act (the Emergency Medical Treatment and Labor Act, or EMTALA) for the relocation of individuals to receive medical screening at another location due to a declared Federal public health emergency for Hurricane Irma. Since the EMTALA waiver is limited to the 72-hour period following activation of the hospital’s disaster protocol, CMS should be notified when hospitals activate their disaster protocols.
- Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) Waiver:
This waiver modifies the deadlines for OASIS and MDS assessments and transmission. For more information and guidance, visit: https://www.cms.gov/About-CMS/Agency-Information/Emergency/downloads/MedicareFFSEmergencyQsAs1135Waiver.pdf
- Suspension of Enforcement Activities:
CMS granted the temporary suspension of current survey and enforcement activities for hospitals, but will continue to investigate allegations of immediate threat to patient health and safety.
Waivers for Healthcare Providers
- Waiver of Conditions of Participation and Certification:
This action will waive certain conditions of participation and certification requirements for healthcare providers. CMS will work with healthcare providers, facilities and suppliers in Florida as specific needs are identified under this section and will immediately consider how best to address those within our authority to permit regulatory flexibilities.
- Out of State Physician Practice:
This waiver will allow out of state licensed physicians to receive Medicare reimbursements who provided healthcare services in Florida.
- Physician Self-Referral:
CMS will work with Florida to address these waiver requests on a case-by-case basis. For more information, visit: https://www.cms.gov/About-CMS/Agency-Information/Emergency/downloads/MedicareFFS-EmergencyQsAs1135Waiver.pdf
- Medicare Contractor Requirements:
This action will temporarily de-prioritize Medicare contractor medical review and audit work requirements in the areas impacted in Florida by Hurricane Irma.
To read the letter, please visit: https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/QAs-FL-Irma-1135-Waivers.PDF.
CMS has also granted similar waivers for other states and geographical areas as a result of hurricanes Irma and Harvey.
CMS will continue to work with all states and geographic areas in the path of hurricanes Irma and Harvey. The agency continues to update its emergency page (www.cms.gov/emergency) with important information for state and local officials, providers, healthcare facilities, suppliers and the public.
To read previous updates regarding HHS activities related to Hurricane Irma and Hurricane Harvey, please visit https://www.hhs.gov/about/news/hurricane-response/index.html.
To learn more about HHS resources related to Hurricane Irma, please visit www.phe.gov/irma