Department of Health & Human Services
Centers for Medicare & Medicaid Services
Consortium for Quality Improvement and Survey & Certification Operations
61 Forsyth St SW, Suite 4T20
Atlanta, Georgia 30303-8831
September 17, 2018
Christian L. Soura
Vice President/Policy and Financ
South Carolina Hospital Association
1000 Center Point Road
Columbia, SC 29210-5802
www.SCHA.org
Re: Hurricane Florence Waiver Requests
Dear Christian Soura:
We have reviewed your request for the waivers outlined below.
The President declared a state of emergency for South Carolina and the HHS Secretary declared a Public Health Emergency which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act.
CMS is granting these waivers and they include the following:
- Treatment of Medical/Surgical patients in non-PPS hospitals and/or units: We respectfully request a blanket waiver be issued allowing hospitals the ability to treat medical/surgical patients in non-PPS hospitals and/or units (e.g., Rehabilitation, LTCH).
CMS Response: This waiver is hereby granted. Hospitals utilizing this flexibility should use the "DR" (Disaster Related) condition code for Medicare claims filed for Medicare beneficiaries receiving care in these hospitals/units. When an acute-care patient is placed and billed for in a freestanding non-IPPS hospital, CMS will waive any participation requirements that would prevent this, or that would affect the non-IPPS freestanding hospital’s status as a non-IPPS hospital (e.g., 60% rule for a freestanding IRF).
Hospitals are further advised to ensure they restrict the patients admitted to these units to the acuity level the hospital/unit may safely manage. Specific billing questions may be directed to the Medicare Administrative Contractor.
Please reference Blanket Waivers for Hurricane Florence. - Waiver of Three-Day Prior hospitalization for Skilled Nursing Facility Coverage: We respectfully request a blanket waiver be issued allowing skilled nursing facility coverage of hospital transfers absent a qualifying three day inpatient admission and for people who are evacuated, transferred, or otherwise dislocated due to Hurricane Florence.
CMS Response: This waiver is hereby granted. Skilled Nursing Facilities utilizing this flexibility should use the "DR" (Disaster Related) condition code for Medicare claims filed for Medicare beneficiaries receiving care under this waiver. Specific billing questions may be directed to the Medicare Administrative Contractor.
Please reference Blanket Waivers for Hurricane Florence. - Out of State Physician Practice:
We respectfully request a blanket waiver be issued allowing requirements that physicians or other health care professionals hold licenses in the State in which they provide services, if they have an equivalent license from another State (and are not affirmatively barred from practice in that State or any State a part of which is included in the emergency area).
CMS Response: CMS hereby grants this waiver to allow out of state physicians to receive Medicare reimbursement (contingent on any concurrent and necessary State Medical Board or other licensure requirements). - CAH Hospitals Exceeding 25-beds:
We respectfully request a blanket waiver be issued for requirements that Critical Access Hospitals (CAH) limit the number of beds to 25, and that the length of stay be limited to 96 hours. This waiver request is limited to identified impacted counties and geographical areas. The State or impacted provider (i.e. CAH) should still forward provider information and waiver requests to the CMS Atlanta RO for tracking purposes.
CMS Response: This waiver is hereby granted.
Please reference Blanket Waivers for Hurricane Florence. - MDS and OASIS:
We respectfully request a blanket waiver be issued for timeframe requirements for OASIS and Minimum Data Set (MDS) assessments and transmission. The State or impacted provider (i.e. home health agencies and skilled nursing facilities, respectively) should still forward provider information and waiver requests to the CMS Atlanta RO for tracking purposes.
CMS Response: CMS hereby modifies the deadlines for OASIS and MDS assessments and transmission per the guidance contained in the Emergency Q&As.
Please reference Blanket Waivers for Hurricane Florence. - Medicare Contractor Requirements:
We respectfully request a blanket waiver be issued for providing for the temporary suspension of Medicare contractor requirements regarding medical review and some benefit integrity responsibilities. This includes the following:- Assurances that future retrospective denials based on inappropriate place of service will take into account the period of time and circumstances when the disaster occurred;
- Assurances that future medical review audits and denials will take into account the period of time and circumstances when the disaster occurred;
- Assurances that Medicare’s two day payment policy used in determining whether an inpatient admission is reasonable and payable under Medicare Part A will take into account the period of time and circumstances when the disaster occurred;
- A delay in requests by Medicare contractors (e.g. MACs, RACs, ZPICs, CERTs) for additional documentation requests/medical records from hospitals;
- A delay in the amount of time a hospital has to appeal audit findings;
- A delay in any hearings to challenge RAC determinations; and
- A delay in the 30 day period before the RAC sends the results of their audit to the MAC for recoupment.
CMS Response: MACs, RACs and UPICs will temporarily deprioritize Medical Review and audit work in the impacted areas. - Suspension of Enforcement Activities:
We respectfully request a blanket waiver be issued for the temporary suspension of survey agency requirements of plans of correction and/or other survey enforcement timelines that were in process for hospitals. We are not requesting a lapse of enforcement for actions of ill intentions.
CMS Response: CMS has implemented suspension of current survey and enforcement activities but will continue to investigate allegations of immediate threat to patient health and safety. - Quality Reporting and Value Based Purchasing Programs:
We respectfully request a blanket waiver be issued for the exceptions under certain Medicare quality reporting and value-based purchasing programs to acute care hospitals, PPS-exempt cancer hospitals, inpatient psychiatric facilities, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, Renal Dialysis Facilities, long-term care hospitals, and ambulatory surgical centers located in areas affected by Hurricane Florence due to the devastating impact of the storm.
We ask that this waiver apply to all counties based on the declaration of a Public Health Emergency by the Secretary of Health and Human Services applicable to the entire State of South Carolina.
CMS Response: 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. The scope and duration of the exception under each Medicare quality reporting program will be provided in a memorandum in the next several days. - CMS-13 Requirements:
We respectfully request a blanket waiver be issued allowing rehab hospitals the ability to treat medical/surgical patients and receive an exemption from the requirements of CMS13 which requires that 60 percent of the patients treated at a facility paid under the rehab prospective payment system be treated for one of 13 specified conditions
CMS Response: This waiver is hereby granted. The 1135 waiver discussed under Item #1 allow any IPPS patient to be placed in an IRF bed. For purposes of applying the 60 percent rule, these patients are not counted in determining compliance when a PHE/1135 waiver is in effect. This is explained in the FAQs (Section 1135 Disaster FAQs/Q1).
Providers must resume compliance with normal Medicare fee-for-service rules and regulations as soon as they are able to do so and, in any event, the waivers or modifications a provider was operating under are no longer available after the termination of the emergency period.
We acknowledge the devastation providers are currently experiencing, however we hope these waiver provisions will provide the relief requested so provider personnel can focus on the health and safety of those impacted by the Hurricane.
If you have questions or concerns regarding this correspondence, please send inquiries to our corporate mailbox, ROATLHSQ@cms.hhs.gov, or contact Linda D. Smith, Associate Regional Administrator at (404) 562-7469 or by e-mail at linda.smith@cms.hhs.gov.
Sincerely,
Renard L. Murray, D.M.
Consortium Administrator
Centers for Medicare & Medicaid Services
Cc: Sandra M. Pace, Associate Consortium Administrator
Consortium for Quality Improvement and Survey & Certification Operations
Joshua D. Baker, Director
South Carolina Department of Health and Human Services
MaryJo Roué, Bureau Chief, Bureau of Certification
South Carolina Department of Health & Environmental Control