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CMS ACTIONS TO HELP
BENEFICIARIES, PROVIDERS IN KATRINA STRICKEN AREAS
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 persons' 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/hki.
Frequently asked questions and their answers on the site will be
updated daily by 2 pm.
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