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Emergency Preparedness >> Memorandum
To: AHCA and NCAL Members
From: Janice Zalen, Sr. Director of Special Programs
Subject: Public Health Emergency Declared for Indiana and Iowa; CMS Waives Certain Medicare Program Requirements Including 3-Day Hospital Stay
Date: 6/17/2008
HHS has declared a public health emergency in the flood-stricken states of Iowa and Indiana thus allowing CMS to waive certain Medicare requirements to assure that emergency health needs are met. According to a CMS news release, "... many Medicare beneficiaries have been evacuated to neighboring communities, where receiving hospitals and nursing homes may have no health care records, information on current health status or even verification of the person's status as a Medicare beneficiary. CMS is assuring those facilities that in this circumstance, the normal burden of documentation will be waived and that they can act under a presumption of eligibility." CMS has 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).  

Under Section 1812(f), CMS waived 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 the May and June 2008 Iowa and Indiana flooding or its aftermath; 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.

The receiving provider 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 the May and June Iowa and Indiana flooding and its aftermath. 

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 the Iowa an Indiana flooding, regardless of where the “host” SNF providing post-disaster care is located.

Unlike 1812(f), policies authorized under the section 1135 waiver authority are limited to the geographic areas and timeframes specified by the public health emergency declaration. Policies under section 1135 authority include:

  • CMS expanded the definition of "home" to allow those Medicare beneficiaries who are receiving home health services to receive those services in alternative sites.
  • CMS will ensure that rules that prevent early refills under Part D are waived. To this end, CMS has released a memo on accessing Part D medications and Part C provider network during states of emergency. This memo may be found on AHCA’s Web site at
  • If a long term care hospital admits a patient solely to meet the demands of the crisis, the patient’s stay will not be counted in calculating the 25-day average length of stay. 

CMS issued questions and answers (Q&As) to help providers with specific questions. Information on billing is included, as is more general information. The Q& As may be accessed on AHCA’s Web site at  or  CMS’ Web site and scroll down to “questions and answers.”   

For additional information, contact me at 202-898-2831 or