CMS: Medicare/Medicaid Actions To Help Beneficiaries, Providers

[NRSKarenRN, BSN, RN]

from cms listserve email

the centers for medicare & medicaid services has acted to

assure that the medicare, medicaid and state children's health

insurance programs will flex to accommodate the emergency

health care needs of beneficiaries and medical providers in

the hurricane katrina devastated states.

many of the programs' normal operating procedures will be

relaxed to speed provision of health care services to the

elderly, children and persons with disabilities who depend upon them.

because of hurricane damage to local health care facilities,

many beneficiaries have been evacuated to neighboring states

where receiving hospitals and nursing homes have no health

care records, information on current health status or even

verification of the person's status as a medicare or medicaid

beneficiary. cms is assuring those facilities that in this

circumstance the normal burden of documentation will be waived

and that the presumption of eligibility should be made.

federal medicaid officials are also working closely with state

medicaid agencies to coordinate resolution of interstate

payment agreements for recipients who are served outside their

home states.

the agency will also offer the following relief immediately:

* health care providers that furnish medical services in

good faith, but who cannot comply with normal program

requirements because of hurricane katrina, will be paid for

services provided and will be exempt from sanctions for

noncompliance, unless it is discovered that fraud or abuse occurred.

* crisis services provided to medicare and medicaid

patients who have been transferred to facilities not certified

to participate in the programs will be paid.

* programs will reimburse facilities for providing

dialysis to patients with kidney failure in alternative settings.

* medicare contractors may pay the costs of ambulance

transfers of patients being evacuated from one health care

facility to another.

* normal prior authorization and out-of-network

requirements will also be waived for enrollees of medicare,

medicaid or schip managed care plans.

* normal licensing requirements for doctors, nurses and

other health care professionals who cross state lines to

provide emergency care in stricken areas will be waived as

long as the provider is licensed in their home state.

* certain hipaa privacy requirements will be waived so

that health care providers can talk to family members about a

patient's condition even if that patient is unable to grant

that permission to the provider.

* hospitals and other facilities can be flexible in

billing for beds that have been dedicated to other uses, for

example, if a psychiatric unit bed is used for an acute care

patient admitted during the crisis.

* hospital emergency rooms will not be held liable under

the emergency medical treatment and labor act (emtala) for

transferring patients to other facilities for assessment, if

the original facility is in the area where a public health

emergency has been declared.

more information about cms emergency relief activities,

including a detailed explanation of billing and payment policy

revisions, and phone numbers for the state medical assistance

offices can be found can be found at www.cms.hhs.gov/katrina.

frequently asked questions and their answers on the site will

be updated daily by 2pm.

[sirI, MSN, APRN, NP]

Certain HIPAA privacy requirements will be waived so

that health care providers can talk to family members about a

patient's condition even if that patient is unable to grant

that permission to the provider

The one thing I am glad to see they are being lax about is HIPAA. I was wondering how this could be enforced during disaster times......

[Straydandelion]

Thanks for the information!