Medicare Compliance & Reimbursement

A Blanket 1135 Waiver allows for more flexibility in troubled times.

As the flood waters from Hurricane Harvey recede and the nation gets ready for Irma to strike, Medicare providers are on the front line assisting patients. HHS offers guidance and aide as providers treat patients and submit claims after the chaos.

The storm: Hurricane and then Tropical Storm Harvey left Texas reeling from over 52 inches of rain and heavy winds. It then moved on to wreak havoc on the Louisiana Gulf Coast. The aftermath has culminated in massive flooding, destroying homes, businesses, and infrastructure while displacing thousands of Texas and Louisiana residents in the process. About 30,000 people have sought refuge in temporary shelters, government officials estimated.

“As Louisiana and Texas contend with the historic flooding caused by Hurricane Harvey, HHS is committed to doing all that we can to ensure that those affected by this storm receive the vital assistance and support they need,” said HHS Secretary Tom Price in a release. “The people of Louisiana who rely on Medicare, Medicaid, and CHIP for their healthcare needs can be confident that this declaration will allow their care to continue despite the toll this disaster has taken in their communities.”

Understand These PHE Rules

The government announced areas of Texas were under a state of Public Health Emergency (PHE) on Aug. 26th and Louisiana followed on Aug. 28th, according to the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website. Once the president declares an emergency or disaster under the Stafford Act or the National Emergencies Act and the HHS Secretary declares a PHE under the Public Health Service Act, providers can then use those determinations to utilize the 1135 Waiver form.

Blanket waiver: CMS is able to waive certain documentation requirements to help ensure healthcare providers can deliver care to patients who have no health records, or even no proof of their Medicare status, the HHS release noted. “In addition to increasing the flexibility in providing assistance for CMS beneficiaries, HHS has deployed personnel to affected areas to help state and local authorities respond to communities’ medical needs, and additional staff is on standby to assist.”

Changes to the original MLN Matters releases SE17020 on Texas and SE17021 on Louisiana have expanded “Blanket Waivers” to various facilities and areas of healthcare that fall under Medicare.

CMS is currently working with the affected states to determine Medicaid but has outlined the following specific “flexibilities” available to Medicare providers as they offer treatment, submit claims, and run their practices during the aftermath of these PHEs, according to the CMS release on updated efforts:

• Delay or suspend onsite annual re-certification and revisit surveys for certified providers.
• Delay or suspend certain enforcement actions.
• Allow additional time for providers to submit Plans of Corrections.
• Allow healthcare providers to exceed their certified bed capacity by 10 percent (additional increases over the 10 percent will be processed on a case by case basis to assure safety).
• Allow clinical labs to set up Temporary Testing Sites and perform waived testing following the manufacturer’s instructions at the temporary site.

Read the CMS release at: www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-09-02.html.

Resources: For a closer look at MLN Matters SE17020 and SE17021, visit:

• www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17020.pdf.
• www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE17021.pdf.