Skip Ribbon Commands
Skip to main content
Emergency Preparedness >> Memorandum
To: AHCA and NCAL Members
From: Janice Zalen, Sr. Director of Special Programs
Subject: Public Health Emergency Declared for LA, TX, MS and AL: Certain Medicare Rules Relaxed
Date: 9/3/2008
On Sunday, August 31, 2008, HHS declared a public health emergency in affected counties in the states of LA, TX, MS and AL, thus allowing CMS to waive certain Medicare requirements to assure that emergency health needs are met. The declaration may be accessed on the HHS Web site at


CMS then issued waivers under its section 1135 authority, which apply to all providers; and under section 1812(f), which is applicable only to skilled nursing facilities (SNFs).  In short, the 1812(f) waiver allows nursing facility admission without the 3-day hospital stay and also waives the spell of illness requirement for evacuees and others affected by Gustav who need skilled nursing facility care. 


CMS has prepared detailed information on Hurricane Gustav as it relates to Medicare. This information is available on CMS’ Web site under frequently asked questions and answers (FAQs). These FAQs, which include billing information and more details on the Section 1135 waiver, are updated as new questions arise and may be accessed at Specifics relating to the 1812(f) waiver will be added to the FAQs soon, according to CMS. 


On September 2, CMS’ Survey and Certification Group issued a memo to state survey agency directors stating that the extraordinary circumstances in the four states “will be taken into account as we apply the Medicare and Medicaid standards that are designed to assure quality of care for all beneficiaries.” Along with the memo, CMS released an updated version of the S&C Public Health Emergency - All Hazards Frequently Asked Questions (FAQs). Both the memo and the updated FAQs are posted on the S&C Emergency Preparedness Web site, under the resources page, located at: and scroll down to the first item under “Downloads,“  “Survey and Certification All Hazards Frequently Asked Questions – Updated 9/2/2008” for the FAQs and to “Survey and Certification Memo 08-33 Concerning Hurricane Gustav” for the memo. These FAQs provide a wealth of information on waiver requirements, survey issues, enforcement questions and billing issues.   


Section 1812(f) Waiver

Under Section 1812(f), CMS waives the 3-day prior hospitalization requirement for nursing facility admission for any Medicare beneficiary who:

  • was evacuated from a nursing home in the emergency area; 
  • was  discharged from a hospital (in the emergency or receiving locations) in order to enable the hospital to provide care to more seriously ill patients;
  • needs SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the flooding.

Also under Section 1812(f), no new spell of illness will be required for recently discharged Medicare beneficiaries who:

  • were evacuated from a non-institutional setting in an emergency area;
  • need SNF care as a direct result of Hurricane Gustav; or
  • were in the process of “breaking the spell of illness” for a prior SNF Part A stay, and would not normally be eligible for additional SNF Part A benefits.

Receiving providers must document in the medical record both the medical need for the SNF admission and how the admission was related to the crisis created by Hurricane Gustav. 


In a phone conversation with AHCA, CMS clarified that individuals who were in a facility after using up their 100 days and now are in need of skilled care due to Hurricane Gustav or its aftermath, could meet the requirements under 1812(f).  For more detailed information, please watch the FAQs noted above and found at An updated question on this specific issue should appear any day.


Because the policies described above are under section 1812(f) authority, the policies are not limited to states that are designated as emergency areas. The policies apply to all beneficiaries who were evacuated from an emergency area as a result of Hurricane Gustav regardless of where the “host” SNF providing post-disaster care is located.

If you have questions, please contact me at 202-898-2831 or