Health and Human Services Secretary Mike Leavitt has given Medicare beneficiaries and their healthcare providers greater flexibility in meeting emergency health needs in flood-stricken Iowa and Indiana.
"The flooding in Iowa and Indiana is devastating to each individual and to their communities," Leavitt announced on Monday. "This designation will allow HHS to immediately assist our beneficiaries and providers in the areas where hospitals and other health care delivery systems have been disrupted. It will help ensure that medical assistance is provided promptly and effectively."
HHS reports that because of flood damage to local healthcare facilities, beneficiaries have been evacuated to neighboring communities, where hospitals and nursing homes may have no healthcare records, information on current health status or even verification of the person's status as a Medicare beneficiary.
The Centers for Medicare & Medicaid Services has assured those facilities that in this circumstance, the normal burden of documentation will be waived and they can act under a presumption of eligibility.
"In emergencies such as this, CMS has the flexibility to ensure that vital healthcare services can be maintained and utilized," said CMS Acting Administrator Kerry Weems. "Many of the agency's normal operating procedures will be relaxed to speed provision of healthcare services to the elderly and persons with disabilities who depend upon these services."
CMS officials said they will waive certain program requirements for the following institutional providers:
- Critical Access Hospitals - CMS will allow these hospitals to take more than the mandated limit of 25 patients and not count the expected longer lengths of stay for evacuated patients against the 96-hour average;
- Skilled Nursing Facilities - CMS will waive the three-day prior hospitalization requirement for admission for evacuated patients and relax limits on the benefit period for those evacuated patients;
- Long-Term Care Hospitals - CMS won't count the evacuated patients in calculating the 25-day average length of stay;
- Inpatient Rehabilitation Facilities - CMS won't count the evacuated patients in determining compliance with the 60 percent rule requirement. The 60 percent rule says at least 60 percent of the population in a facility must be deemed eligible for that facility.
In addition, CMS will expand the definition of "home" to allow Medicare beneficiaries who are receiving home health services to receive those services in alternative sites.
As pertaining to Medicare Part D prescription benefits, CMS will ensure that rules that prevent early refills are waived. This will assist beneficiaries who have left prescriptions in evacuated homes or lost their prescription during the evacuation.
In addition, certain sanctions under the Emergency Medical Treatment and Labor Act (EMTALA) will not be imposed for 72 hours after a hospital implements a hospital disaster protocol so long as actions by the hospital do not discriminate among individuals on the basis of their source of payment, ability to pay or on the basis of race, color or national origin.
Beneficiaries in health plans will be able to go out of network during this emergency. CMS officials are working with the health insurance industry to ensure there are no barriers to service for those in plans.
Also, the End Stage Renal Disease (ESRD) network has been activated, and CMS may grant further waivers if needed.
CMS will be working with the Federal Emergency Management Agency to manage lost, stolen or left-behind DME equipment.
Has your organization been affected by flooding? Send your comments to Associate Editor Chelsey Ledue at chelsey.ledue@medtechpublishing.com.