- In the wake of Hurricane Irma, HHS re-opened the National Disaster Medical System (NDMS) Definitive Care Reimbursement Program, a special Medicare reimbursement program that ensures hospitals and other medical facilities receive payment for the healthcare costs of patients medically evacuated after natural disasters.
“Hurricane Irma significantly affected access to medical care in the areas hardest hit by the storm, and patients who need care in these impacted areas must rely on facilities in areas spared by the storm,” stated Robert Kadlec, MD, HHS Assistant Secretary for Preparedness and Response. “We are activating NDMS’ Definitive Care Reimbursement Program to ensure that the medical facilities and hospitals accepting these patients will be reimbursed for the vital care they are providing.”
HHS designed the NDMS Definitive Care Reimbursement Program to cover the healthcare costs of care furnished to individuals who are injured or have become sick because of natural disasters. These individuals do not have healthcare options in their regions because of the disaster.
Individuals seeking healthcare are directed to NDMS-designated facilities through Federal Coordinating Centers.
The special Medicare reimbursement model covers services for primary care, home health care, rehabilitation, and physical therapy as well as medically necessary hospital care, which can last longer than the usual 30-day stay.
Qualifying healthcare facilities will earn up to 110 percent of the Medicare reimbursement rate or a comparable rate if an appropriate Medicare reimbursement rate is available in that region.
Although, the participating facilities must make up to 25 beds available for NDMS patients.
HHS projected that about 85 percent of patients will be covered by the NDMS Definitive Care Program in eligible healthcare organizations in Puerto Rico. The patients who hailed from the US Virgin Islands were medically evacuated using resources from the US Department of Defense and Federal Emergency Management Agency’s national ambulance contract.
The federal department added that the program will also provide medical professionals who can support state and local healthcare providers in affected regions. The NDMS currently includes 5,000 medical, public health, and emergency management professionals who belong to over 70 response teams.
HHS has not activated the special Medicare reimbursement program since an earthquake devastated Haiti in 2010.
Additionally, CMS announced its efforts to help hospitals and healthcare organizations recover from Hurricane Irma. The federal agency recently stated that it has granted 14 Medicare reimbursement and requirement waivers to providers affected by the hurricane.
The waivers granted to hospitals and other medical facilities included:
• Treatment of medical/surgical patients in non-Inpatient Prospective Payment System (IPPS) hospitals: participation requirements waived for acute care patients placed and billed in a non-IPPS hospital, meaning Florida providers can treat patients in non-IPPS hospitals, including rehabilitation and long-term care hospitals
• Waiver of three-day prior hospitalization requirements for skilled nursing facilities: Medicare will cover skilled nursing facility care of hospital transfers without a qualifying three-day inpatient hospital stay for individuals who were evacuated or transferred because of Hurricane Irma
• Temporary suspension of critical access hospital bed requirement: waives the mandate that critical access hospitals limit the number of beds to 25 and the length of stay to 96 hours
• Quality reporting and value-based purchasing program flexibilities: automatic exceptions for quality reporting granted to hospitals, prospective payment system-except cancer hospitals, inpatient psychiatric facilities, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, long-term care hospitals, ambulatory surgical centers, and renal dialysis facilities in counties identified as major disaster counties by the Federal Emergency Management Agency (FEMA)
• Rehabilitation hospital CMS-13 requirements: Florida rehabilitation hospitals can treat patients without abiding by a CMS rule that requires 60 percent of the patients treated at the facility to be paid under the rehabilitation prospective payment system for one of 13 specified conditions
• Prior authorizations for Medicare Advantage plans: Medicare Advantage organizations in certain areas will not enforce prior authorization and other gatekeeper requirements
• Emergency Medical Treatment and Labor Act waiver: sanctions granted under section 1867 of the act for the relocation of individuals to receive medical screening at another location because of Hurricane Irma
• Minimum Data Set (MDS) and Outcome Assessment Information Set (OASIS) waiver: deadlines modified for OASIS and MDS assessments and transmissions for affected facilities
• Suspension of enforcement activities: temporary revocation of current survey and enforcement activities for hospitals, although CMS will continue to investigate accusations of immediate patient health and safety threats
Building on the nine waivers granted to hospitals and medical facilities, providers will also face four waivers. CMS granted waivers for conditions of participation and certification in Florida, limitations on out-of-state physicians practicing, physician self-referral laws (on a case-by-case basis), and Medicare contractor requirements.
CMS granted similar waivers and special exceptions to providers affected by Hurricane Harvey.
“CMS has been working closely with officials in Florida and granted several waivers to help provide immediate medical relief to those affected by Hurricane Irma,” stated Seema Verma, CMS Administrator. “We hope these waiver provisions will provide healthcare providers, facilities and suppliers the flexibility they need so they can focus on the health and safety of those impacted by the Hurricane.”