Hurricane-Related CMS Information Releases: Hurricane Michael and Medicare Disaster Related Florida and Georgia Claims Extraordinary Circumstances Extension / Exception (ECE) due to Hurricane Florence

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

CMS has just issued a revised special edition MLN Matters (SE18021) on Hurricane Michael and Medicare Disaster Related Florida and Georgia Claims. President Trump has declared a state of emergency for the states of Florida and Georgia, and the HHS Secretary declared a Public Health Emergency, which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act.

The 6-page article provides information about blanket waivers that CMS has issued for impacted geographical areas. “These waivers will prevent gaps in access to care for beneficiaries impacted by the emergency. This article was revised to add information regarding the emergency declared for the state of Georgia.”

Individual facilities do not need to apply for the approved blanket waivers which include:

  • Skilled Nursing Facilities
  • Home Health Agencies
  • Critical Access Hospitals
  • Housing Acute Care Patients in Excluded Distinct Part Units
  • Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital
  • Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital
  • Emergency Durable Medical Equipment, Prosthetics, Orthotics, and Supplies for Medicare Beneficiaries Impacted by an Emergency or Disaster
  • Medicare Advantage Plan or other Medicare Health Plan Beneficiaries

Also, Medicare payment may be permitted for replacement prescription fills (for a quantity up to the amount originally dispensed) of covered Part B drugs in circumstances where dispensed medication has been lost or otherwise rendered unusable by damage due to the disaster or emergency.

The MLN Matters article also contains links to additional resources.

The Centers for Medicare & Medicaid Services (CMS) is issuing a blanket exemption for data submission for the Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP), for Medicare providers adversely affected by the devastating impact of Hurricane Florence.

LTCH providers located within the Federal Emergency Management Agency (FEMA)-designated “major disaster” counties in North Carolina, and South Carolina will not be required to submit quality measure data to meet submission requirements for the reporting quarters specified by CMS. For a list of the designated counties and other information, see the related Email notification, issued October 11, 2018

Exemptions are being issued for several quality reporting data submission requirements because of possible damage to facilities and/or systems resulting in their inability to gather or submit data, as well as the need to prioritize immediate resources for direct patient care.

LTCH QRP exemptions

CMS has granted a blanket exemption for all LTCHs in the designated counties for the following LTCH QRP data submission requirements, including required quality data submitted via the LTCH CARE Data Set, as well as Healthcare-Associated Infection (HAI) data submitted via the Center for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN):

  • Second Quarter 2018 (April 1, 2018 – June 30, 2018) for November 15, 2018, submission deadline
  • Third Quarter 2018 (July 1, 2018 – September 30, 2018) for February 15, 2019, submission deadline

While you can continue to submit quality data to CMS, any data submissions for the above-listed exempt CY 2018 quarters will not be considered when determining compliance related to the FY 2019 reporting requirements for your LTCH. That is, you will not be held accountable for data collected and submitted during the 2018 quarters identified above. We would like to also note that this exemption from quality reporting requirements for the LTCH QRP may impact the minimum case threshold counts for calculation of quality metrics, in which case CMS would suppress the applicable data on the LTCH Compare site, when quality measure target periods that include Q2 and/or Q3 2018 data are calculated and posted. LTCH providers may submit questions about this blanket exemption to LTCHQRPReconsiderations@cms.hhs.gov.

For LTCHs outside the FEMA-designated counties affected by Hurricane Florence, please follow the directions related to requesting an exemption or extension, as listed on the LTCH Quality Reporting Reconsideration and Exception & Extension website.