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Emergency Preparedness >> Memorandum
To: AHCA and NCAL Members
From: Janice Zalen, Sr. Director of Special Programs
Subject: HHS Responds to Hurricane Ike and Declares a Public Health Emergency for TX and LA
Date: 9/16/2008

In response to Hurricane Ike, on September 11, 2008, HHS declared a public health emergency in TX, which was quickly followed by a second public health emergency declaration for LA. These declarations enabled CMS to waive certain Medicare requirements to assure that emergency health needs are met. The declarations may be accessed on the HHS Web site at and

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 update its detailed information on Hurricane Gustav as it relates to Medicare to include Hurricane Ike. 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

On September 12, CMS’ Survey and Certification Group issued a memo to state survey agency directors stating, “We will take these emergency circumstances 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 updated its “S&C Public Health Emergency - All Hazards Frequently Asked Questions (FAQs),” which can be found at These FAQs provide 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. 

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