September 18, 2017

Anesthesia care providers, if you serve Medicare, Medicaid and Children’s Health Insurance Program (CHIP) patients in the counties and geographical areas impacted by Hurricane Irma and Hurricane Harvey, or have patients coming into your facilities who have been displaced from their homes and are in need of care, you need to know how government payers are responding to the crises and the compliance implications of these actions for your facilities and groups.

Regardless of location, all anesthesia care providers could be called upon to care for patients in similar circumstances.  Hurricanes Harvey and Irma impacted specific geographic areas, but public health emergencies caused by natural disasters such as these can happen anywhere.  Who can forget Sandy and Katrina? 

This eAlert reminds us of that reality and offers an opportunity for all anesthesia practitioners to familiarize or re-familiarize themselves with the federal government’s mechanism for responding to large-scale natural disasters and other emergencies.  This mechanism includes waivers and modifications of certain federal healthcare program requirements to enable affected people to receive emergency and other care, and for clinicians and facilities to be paid for their services. 

The Department of Health and Human Services (HHS) has deployed assets and personnel to assist local responses to the hurricanes in affected areas.  In addition, HHS Secretary Tom Price, MD, has declared public health emergencies in Florida, Georgia, South Carolina, Puerto Rico and the U.S. Virgin Islands for Hurricane Irma and in Texas and Louisiana for Hurricane Harvey.  These actions have enabled the Centers for Medicare and Medicaid Services (CMS) to issue several programmatic waivers and modifications based on Section 1135 of the Social Security Act.

These include waivers and modifications regarding:

• Requirements for physicians and other healthcare professionals to hold licenses in the state in which they provide services if they have an equivalent license from another state.  In other words, out-of-state providers wishing to provide services should provide services, as should providers who are not enrolled in Medicare or Medicaid.  Maintain as much documentation as possible, including recipient information; services rendered with dates and locations; and information on the nature of the emergency necessitating provision of services (if applicable). 
• Sanctions under the Emergency Medical Treatment and Labor Act (EMTALA) for relocating an individual for treatment.
• Sanctions related to limitations on physician referrals as deemed appropriate by CMS.
• Limitations on payments for healthcare services furnished to individuals enrolled in a Medicare Advantage plan by clinicians or facilities not included in the plan’s network.
• For hospitals in designated geographic areas that have hospital disaster protocols in place during the time of the waiver, sanctions and penalties for noncompliance with the following HIPAA privacy regulations: requirements to obtain a patient’s agreement to speak with family members or friends or honor a patient’s request to opt out of the facility directory; the requirement to distribute a notice of privacy practices; and the patient’s right to request privacy restrictions or confidential communications.
• Deadlines and timetables for required activities (only to the extent necessary) to ensure that healthcare services are available for Medicare, Medicaid and CHIP beneficiaries.

More detailed information on these waivers and modifications can be found here.

Blanket Hospital Waivers

CMS has issued several blanket waivers to give beneficiaries access to medical care and other healthcare services during the emergencies, and to give hospitals, other healthcare facilities and clinicians flexibility to deliver emergency and other services in the wake of the disasters.  More information is available on the CMS website here.

For instances in which there is no blanket waiver, providers can request an individual Section 1135 waiver by following the instructions available here.  According to CMS, “specific waivers granted as a result of the emergency or disaster may be retroactive to the beginning of the emergency or disaster if warranted.  CMS also has the authority to exercise certain flexibilities, which are agency policies or procedures that can be adjusted under current authority—and generally speaking, can be adjusted without reprogramming CMS’s systems.”

For anesthesiologists and nurse anesthetists in the affected areas and surrounding communities, the effects of these natural disasters on anesthesia care delivery, as well as billing and reimbursement, will not only be felt for the short term, but are likely to ripple through your groups and facilities for at least several months.

These are exceptional circumstances involving the concentrated delivery of services to larger numbers of people in less carefully controlled conditions.  As a result, you can anticipate delays in receiving payment—all the more reason to do everything you can on your end to comply with the terms of the waivers and modifications and to document services delivered as thoroughly and carefully as possible.

We encourage you to check the Hurricane page on the CMS website frequently for updates.  Questions regarding claims can be directed to your Medicare Administrative Contractor (MAC) on its toll-free number, which can be found here.  ICD-10 coding advice from the Centers for Disease Control and Prevention in the aftermath of the disasters is available here.

With best wishes,

Tony Mira
President and CEO