Medicare Bends Rules for Health-Care Facilities in Harvey’s Wake

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By Mindy Yochelson

Medicare is making accommodations to help beneficiaries affected by Hurricane Harvey, temporarily shelving requirements for health-care providers ranging from hospitals and dialysis centers to managed care plans.

The aim is to ease delivery of services to an increased number of beneficiaries affected by the flooding and other destruction. As Texas and Louisiana slowly dry out, exceptions to Medicare’s large body of regulatory do’s and don’ts continue to be made.

The Centers for Medicare & Medicaid Services Sept. 5 lifted the ban on new nonemergency ambulance Medicare suppliers in Texas in order to aid the disaster response.

The change comes less than six weeks after the agency extended the ban in Texas and five other states for another six months because of concerns with Medicare fraud. Providers that weren’t able to enroll before because of the moratorium will receive a high level of screening if they want to participate, the CMS said.

The American Ambulance Association supports the moratorium, Brian Werfel, Medicare consultant for the group, told Bloomberg BNA Sept. 6. However, the association recognizes the need for flexibility in light of the hurricane, he said.

The moratorium was intended to address a rapid increase in the number of nonemergency ambulance suppliers, especially those that focus on repetitive dialysis transports, and prevent them from coming into the program without appropriate vetting, he said.

The group will likely be able to judge CMS’s action better when the notice about the lifting is published in the Federal Register, he said.

Allowing Waivers

The administration’s declaration of a public health emergency in Texas and Louisiana opened the door to invoking Section 1135 of the Social Security Act. The provision lets the Department of Health and Human Services waive or modify Medicare and other federal health programs. Similar measures were taken during other hurricanes, including Katrina and Ike.

And the season isn’t over.

Medicare is warning providers that Hurricane Irma is about to make landfall in Puerto Rico and the U.S. Virgin Islands. The agency is making data available to public health officials in Puerto Rico and Florida that show the number of Medicare beneficiaries in each potentially affected area who rely on life-maintaining equipment, such as oxygen concentrators.

Easing Up on Facilities

Dialysis centers and hospitals are a big focus of the waivers due to Harvey.

Centers not certified to provide services for beneficiaries with end-stage renal disease (ESRD), but licensed in the two states, may bill Medicare for the time being, the agency said Sept. 1.

Kelli Collins, a vice president for patient engagement at the National Kidney Foundation, told Bloomberg BNA Sept. 6 the group’s helpline is fielding a lot of calls from beneficiaries with ESRD whose centers have been closed because of flooding or who have been displaced from their regular facility. The vast majority of patients with ESRD receive Medicare.

A number of the uncertified centers, known as special purpose renal dialysis facilities, were activated for Hurricane Harvey, Collins said.

“We support patients receiving care at facilities with equipment and trained staff that can safely perform this life-sustaining care for patients regardless of certification during this extraordinary time,” she said.

More Leeway for Hospitals

Meanwhile, deadlines that could lead to more money for small and rural hospitals in Texas have been pushed back. Medicare is extending—from Sept. 1 to Oct. 2—the deadline for requesting the low-volume hospital payment adjustment for fiscal 2018.

Critical access hospitals aren’t limited to just 25 beds and stays aren’t capped at 96 hours, as part of the temporary exceptions.

In addition, the Texas Hospital Association said it has asked the state for permission to bring in out-of-state health-care providers and grant them emergency privileges.

“To date that we are aware, the state has yet to approve the request for out of state emergency privileging,” Lance Lunsford, the association’s chief marketing and business development officer, told Bloomberg BNA Sept. 6.

Accelerated Payments

Hospitals may also seek permission from their Medicare administrative contractor for accelerated payments under Part A or for advance payments under Part B, the association reminded members. “These payments are available to providers as a means of ensuring continued cash flow,” the association said.

The main impact on hospitals has been on providing and maintaining services, he said. The floodwaters affected operations in terms of supply chain, power maintenance through generators and intermittent outages, and access to the hospitals, Lunsford said. However, “in many cases, it was business as usual amid the destruction,” he said. “Labor and deliveries occurred, heart attacks were treated, and acute services had to run at normal capacity as patients continued experiencing health issues.”

Lessons learned from storms such as Hurricane Ike were followed and staff members and facilities were prepared, Lunsford said.

Other Medicare Providers

For skilled nursing facilities, Medicare waived the requirements that beneficiaries first have a three-day hospitalization for those who were evacuated, transferred, or otherwise dislocated.

The agency also warned Medicare Advantage plans not to adhere to their usual network restrictions. Instead, they should temporarily reduce cost sharing for beneficiaries who use medical professionals outside the plan’s network to the amounts for in-network providers.

Similarly, Medicare Advantage and Part D drug plans must ensure enrollees have adequate access to outpatient drugs dispensed at out-of-network pharmacies.

Drug plans are also expected to lift their “refill-too-soon” provisions in any way they want as long as access to Part D drugs is provided at the point of sale.

Medicare managed care plans in the affected areas are “relaxing out-of-network restrictions, temporarily suspending business rules for prior authorization, and ensuring availability of medical records to facilitate continuity of care,” Cathryn Donaldson, director of communications for America’s Health Insurance Plans, told Bloomberg BNA.

“In the past, CMS has extended the enrollment period for affected beneficiaries when storms of this magnitude impact open enrollment,” Donaldson said However, she said wasn’t aware of any impending announcement.

The open enrollment period for 2018 is from Oct. 7 to Dec. 15.

To contact the reporter on this story: Mindy Yochelson in Washington at MYochelson@bna.comTo contact the editor responsible for this story: Kendra Casey Plank at

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