The Centers for Medicare & Medicaid Services (CMS) recently modified and waived certain Medicare enrollment and billing requirements to ensure the availability of adequate medical care for Medicare beneficiaries in states affected by Hurricanes Harvey and Irma.

Reflecting on the destruction left by Hurricane Harvey, President Trump on Aug. 26, 2017, declared that a major disaster exists in the state of Texas. Later that day, Secretary Thomas Price of the U.S. Department of Health and Human Services declared that a public health emergency exists in Texas, retroactive to Aug. 25, 2017.

Pursuant to section 1135 of the Social Security Act, Secretary Price authorized and implemented two specific waivers and modifications related to the geographical areas impacted by Hurricane Harvey: the suspension of the temporary moratorium on non-emergency ground ambulance supplier enrollment in Texas, and the temporary suspension of certain Medicare enrollment screening and billing requirements for providers aiding in recovery efforts in Texas and Louisiana.

  1. Suspension of the Temporary Non-Emergency Ambulance Moratorium in Texas

Due to increased fraud and abuse concerns, on July 30, 2013, CMS implemented a temporary moratorium that prevented the enrollment of new Part B non-emergency ground ambulance suppliers in Texas. Thereafter, CMS extended the moratorium at six-month intervals and recently extended the moratorium on July 29, 2017, for another six-month period. But CMS has authority to lift an enrollment moratorium if the president declares an area a disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act.

Therefore, to aid in Hurricane Harvey’s disaster response, CMS, pursuant to its authority under 42 CFR § 424.570(d), lifted the temporary enrollment moratorium on new Part B non-emergency ambulance suppliers in Texas. This lifting period became effective Sept. 1, and applies to Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). Non-emergency ground ambulance suppliers can now enroll in Medicare, Medicaid and CHIP until the lifting period ends. Providers and suppliers, however, will be subjected to CMS’ high-screening level, which could involve the following:

  1. An unannounced site visit
  2. The submission of fingerprints for a national background check from every individual who maintains a 5 percent or greater ownership interest
  3. The submission of a criminal history record check of the FBI’s Integrated Automated Fingerprint Identification System on every individual who maintains a 5 percent or greater ownership interest

CMS will publish a notice in the Federal Register to announce its lifting of the moratorium.

  1. Waiver of Screening Requirements in Texas and Louisiana

Additionally, on Sept. 8, CMS suspended certain Medicare Part B enrollment screening requirements for healthcare providers and suppliers that are supporting the Hurricane Harvey recovery efforts in Texas and Louisiana. CMS intends to allow providers who do not currently participate in Medicare, and those practicing in other states, to help care for hurricane victims by waiving some Medicare enrollment requirements:

  1. Site visits
  2. Payment of the application fee
  3. Fingerprint-based criminal background checks
  4. In-state licensure requirements

Enrollment will also allow non-certified providers and suppliers to receive temporary Medicare billing privileges starting Sept. 11, 2017. To receive these privileges, providers must call a toll-free hotline telephone number and provide limited information including National Provider Identifier, Social Security Number or business Employer Identification Number taxpayer identification numbers, and valid in-state or out-of-state licensure. According to CMS representatives, if a provider delivered care to a hurricane victim prior to Sept. 11, 2017, but during the official disaster period in either Texas or Louisiana, CMS has the ability to backdate the claim and the waiver could apply retroactively.

The relaxed screening requirements and temporary billing privileges will conclude once the president lifts the disaster declaration in the applicable location. At that time, each provider and supplier must submit a complete enrollment application pursuant to CMS guidelines.

  1. Waivers for Healthcare Providers in South Carolina, Georgia and Florida

On Sept. 11, 2017, CMS issued various blanket waivers for providers delivering care in the areas of South Carolina and Georgia that were impacted by Hurricane Irma. CMS also granted 14 general waivers to support Florida in response to Secretary Price’s declaration of a public health emergency in Florida.

Specifically, CMS’ waivers will provide Medicare reimbursement to out-of-state licensed physicians and will suspend certain conditions of participation and certification requirements for healthcare providers who deliver care to hurricane victims. Though CMS has not clearly specified which requirements it will waive, CMS stated that it will continue to work with providers, facilities and suppliers in Florida to best address the immediate needs of its beneficiaries.

By temporarily relaxing Medicare enrollment and billing requirements, CMS seeks to ensure that beneficiaries left in the wake of Hurricanes Harvey and Irma have sufficient access to readily available skilled professionals. As Secretary Price continues to declare public health emergencies in various geographic areas in the paths of these storms, CMS will likely continue to issue waivers and modifications. For more information, please contact either of the authors of this alert.