CMS Waives Medicare Regulations for California
The Centers for Medicare & Medicaid Services (CMS) issued several blanket waivers, Nov. 13, for those who are evacuated, transferred, or otherwise displaced as a result of the California wildfires. These waivers are retroactive to Nov. 8, and allow healthcare providers to continue caring for Medicare patients affected by the emergency without having to apply for individual waivers.
California Declared a Disaster Area
President Trump declared Nov. 9 that a major disaster exists in California as a result of the wildfires that have been raging across the state these past weeks.
According to a CBS News report, Nov. 15, two major wildfires continue to burn in Northern and Southern California: Camp Fire and Woolsey Fire.
Camp Fire is located in Butte County, near Sacramento. Approximately 140,000 acres are reported burned, with 56 fatalities confirmed. Woolsey Fire is located in Los Angeles and Ventura Counties. Approximately 98,362 acres are reported burned, with three fatalities.
Waivers in Effect for California
Change Request 6451, issued July 31, 2009, applies to items and services furnished to Medicare patients within California from Nov. 8, 2018, for the duration of the emergency. There several blanket waivers in effect, which apply only to entities affected by the 2018 wildfires in California.
Skilled Nursing Facilities (SNFs)
- Section 1812(f) – CMS waives the requirement for a three-day prior hospitalization for coverage of a SNF stay for people who are evacuated, transferred, or otherwise displaced as a result of the effect of the wildfires. It also authorizes renewed SNF coverage for certain patients who recently exhausted their SNF benefits before the start of a new benefit period.
- 42 CFR 483.20 – CMS waives the time frame requirements for minimum data set assessments and transmissions for all facilities.
Home Health Agencies (HHAs)
- 42 CFR 484.20(c)(1) – CMS waives the time frames related to OASIS transmission on all HHAs.
- MACs are authorized to extend the auto-cancellation date of Requests for Anticipated Payments (RAPs).
Critical Access Hospitals (CAHs)
CMS waives the requirements that CAHs limit the number of beds to 25 and the length of stay to 96 hours.
Acute Care Hospitals
Hospitals billing under the Inpatient Prospective Patient System (IPPS) may house acute care inpatients in excluded distinct part units, as appropriate. The IPPS hospital should bill for the care and annotate the patient’s medical record to indicate the situation.
Acute care hospitals with excluded distinct part inpatient psychiatric units may relocate inpatients to an acute care bed and unit, as deemed appropriate. Continue to bill for inpatient psychiatric services under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) and annotate the patient’s medical record with an explanation of the situation (e.g., The patient is a psychiatric inpatient being cared for in an acute care bed because of circumstances related to the wildfires). An assessment of the acute care bed and unit location should be made to ensure the safety of patients, staff, and others.
Acute care hospitals with excluded distinct part inpatient rehabilitation units may relocate inpatients to an acute care bed and unit, as deemed appropriate. Continue to bill for inpatient rehabilitative services under the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and annotate the patient’s medical record with an explanation of the situation (e.g., The patient is a psychiatric inpatient being cared for in an acute care bed because of circumstances related to the wildfires). The acute care beds should be appropriate for providing care to patients, and patients should continue to receive intensive rehabilitative services.
A blanket waiver has been issued to suppliers for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) lost, destroyed, irreparably damaged, or otherwise rendered unusable as a result of wildfires. The face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement. Suppliers must still include a narrative description on the claim explaining the reason why the item(s) must be replaced. CMS advises suppliers to maintain documentation indicating what had to be replaced and why.
Note: Patients with coverage other than original Medicare should contact their plan directly.
Covered Part B medications that were lost or destroyed as a result of the wildfire may be refilled (for a quantity up to the amount originally dispensed) and qualify for Medicare payment.
Medicare Billing Requirements
Use condition code DR and modifier CR on claims for items and services for which Medicare payment is conditioned on the presence of a formal waiver.
Check the CMS website for up-to-date information.
MLN Matters® SE18025, Nov. 15, 2018