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Hurricane Sandy

 

 CMS 1135 Waiver

 
​
SNFs that are impacted by Hurricane Sandy can apply for a CMS 1135 Waiver. Under the Waiver, the Health and Human Services (HHS) Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available.
 
The Waiver was designed to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods. In addition, the Waiver allows for providers who provide such services in good faith to be reimbursed and exempted from sanctions (absent any determination of fraud or abuse).
 
For more information on the Waiver and details on how to apply, visit the CMS guide on requesting a 1135 Waiver.
 
 
AHCA Clarifications
The CMS 1135 Waiver allows certain waivers to the Medicare and Medicaid Program during an emergency. The 1135 Waiver is enacted during an emergency and can only be granted for a specific amount of time. CMS has developed an extensive list of FAQ for each provider type – we recommend you review this document carefully. Please be advised AHCA asked questions based on a state receiving the 1135 waiver.

AHCA has been in contact with CMS to clarify some issues that are specific to SNFs. Below are answers to questions that we have asked.

1. Should each facility apply for a waiver individually?
That’s basically correct. We have some waivers that can be issued on a blanket basis (such as the MDS transmission flexibility) and the three-day prior hospitalization waiver.

2. Does each facility need to apply for a 3-day hospital stay waiver individually?
Correct but they will have to use the disaster modifier to code claims for patients admitted without the qualifying stay. More information will be provided on this, CMS anticipates today November 2, 2012.

3. If my state does not have a CMS 1135 Waiver signed, may I apply for a waiver anyway?
CMS can grant a waiver to facilities in those states that have the waiver authority. However, if there are facilities struggling to respond/recover in non-waiver states, CMS would like to be notified of that so they can consider if those flexibilities are needed.

4. Does each SNF need to apply for a waiver to qualify for the MDS transmission flexibility?
Because NY has applied for and been approved for the Section 1135 Waiver, the MDS flexibility is issued on a blanket basis for all NY facilities.

5. Does the 1135 waiver apply to all MDS/PPS requirements i.e. the 5 day admission assessment, EOT?
CMS will clarify this and get back to AHCA.

6. To apply for waiver does the facility contact their Department of Health or CMS directly?
The provider contacts CMS Directly, via email. Those in affected storm regions should contact the appropriate CMS office​. ​
 

 Resources

 
List of State Offices and Agencies of Emergency Management
Links disaster info, planning and applying for assistance
Click for more information
 
SBA
SBA provides low interest disaster loans to homeowners, renters, businesses of all sizes and private, nonprofit organizations to repair or replace real estate, personal property, machinery & equipment, inventory and business assets that have been damaged or destroyed in a declared disaster
More information
 
 
CMS information
More information 
 
 
CDC info for Health Care Providers
Includes info on all aspects of care in the facility
More information
 
Protective Equipment in Hurricane Flood Response
More information
 
 
Guide for Managing Worker Fatigue
More information
 
 
Emergency Prescription Assistance Program (EPAP)
Outlines the process for prescription drug claims for medications and durable medical equipment (DME) for designated eligible individuals in a Federally-identified disaster area
More information
 
 
Staying Safe in Cold Weather
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