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CMS offers widespread support for Puerto Rico amid Earthquakes

CMS offers widespread support for Puerto Rico amid Earthquakes

The Centers for Medicare & Medicaid Services (CMS) today announced efforts underway to support Puerto Rico in response to recent earthquakes. On January 8, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in Puerto Rico that is retroactive to December 28, 2019. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the disastrous earthquakes. CMS will be waiving certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare quickly; and taking steps to ensure dialysis patients obtain critical life-saving services.

“The Trump Administration is gravely concerned about public health conditions in Puerto Rico, and we are doing everything within our authority to provide relief to those affected by these devastating earthquakes,” said CMS Administrator Seema Verma. “During this trying time for the island, CMS is coordinating with our federal, state, and local partners in doing everything possible to facilitate our beneficiaries’ access to care – care that very well may be life-saving.”

Below are key administrative actions CMS will be taking in response to the PHE declared in Puerto Rico:

Waivers and Flexibilities for Hospitals and other Healthcare Facilities:  CMS will be temporarily waiving or modifying certain Medicare, Medicaid, and CHIP requirements. CMS will also issue a number of blanket waivers listed on the website below, and the CMS Regional Office will grant other provider-specific requests for specific types of hospitals and other facilities in Puerto Rico. These waivers work to provide continued access to care for beneficiaries. For more information on the waivers CMS has granted, visit:

Special Enrollment Opportunities for Earthquake Victims:  CMS will make available special enrollment periods for certain Medicare beneficiaries. This gives people impacted by the earthquakes the opportunity to change their Medicare health and prescription drug plans if eligible for the special enrollment period. For more information, please visit:

Disaster Preparedness Toolkit for State Medicaid Agencies:  CMS developed an inventory of Medicaid and CHIP flexibilities and authorities available to states in the event of a disaster. For more information and to access the toolkit, visit:

Dialysis Care:  CMS is helping patients obtain access to critical life-saving services. The Kidney Community Emergency Response (KCER) program has been working with the End Stage Renal Disease (ESRD) Network of Puerto Rico, ESRD NW3, to assess the status of dialysis facilities in the potentially impacted areas related to generators, alternate water supplies, education and materials for patients. They are also assisting patients whose dialysis centers are temporarily closed to receive dialysis services at open locations. Patients have been educated to have an emergency supply kit on hand including important personal, medical, and insurance information; contact information for their facility, the ESRD NW hotline number, and contact information of those with whom they may stay or for out-of-state contacts in a water proof bag. They have also been instructed to have on hand supplies to follow a three-day emergency diet. The ESRD NW3 toll-free hotline is 888-877-8400 and the KCER hotline is 866-901-3773. Additional information is available on the KCER website

Medical equipment and supplies replacements:  CMS will be temporarily suspending certain requirements necessary for Medicare beneficiaries who have lost or realized damage to their durable medical equipment, prosthetics, orthotics, and supplies as a result of the earthquakes. This will help to make sure that beneficiaries can continue to access the needed medical equipment and supplies they rely on each day. Medicare beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) for assistance.

Suspension of Enforcement Activities:  CMS will temporarily suspend current survey and enforcement activities for healthcare facilities in Puerto Rico, but will continue to investigate allegations of immediate threat to patient health and safety.

Ensuring Access to Care in Medicare Advantage and Part D:  During a public health emergency, Medicare Advantage Organizations and Part D Plan sponsors must take steps to maintain access to covered benefits for beneficiaries in affected areas. These steps include allowing Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities and waiving, in full, requirements for gatekeeper referrals where applicable.

CMS Central Office and the Regional Offices hosted two Webinars in 2018 regarding Emergency Preparedness (EP) requirements and provider expectations. One was an all provider training on 6/19/2018 (over 3,000 providers participated) and the other an all-surveyor training on 8/14/2018. Both presentations covered the EP Final Rule, which included emergency power supply; 1135 waiver process, Best Practices & Lessons Learned from past disasters, and Helpful Resources and more. Both webinars are available at

CMS also compiled a list of Frequently Asked Questions (FAQs) and useful national emergency preparedness resources to assist State Survey Agencies (SAs), their State, Tribal, Regional, local emergency management partners, and health care providers to develop effective and robust emergency plans and tool kits to assure compliance with the EP rules. The tools can be located at:

Survey & Certification Group Emergency Preparedness Regulation dated November 2016, Revised 6-1-2017.

CMS Regional Offices have provided specific Emergency Preparedness information to Medicare providers and suppliers through meetings, dialogue and presentations. The regional offices also provide regular technical assistance in Emergency Preparedness to State Agencies and staff, who, since November 2017, have been regularly surveying providers and suppliers for compliance with emergency preparedness regulations.  

CMS will continue to work with all geographic areas impacted by recent earthquakes. We encourage beneficiaries and providers of healthcare services that have been impacted to seek help by visiting CMS’ emergency webpage (

To find additional earthquake preparedness and response resources for the health sector and the latest regarding HHS activities for the earthquakes, please visit:

For more information about the Department of Health and Human Services’ PHE, please visit:


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