The Centers for Medicare & Medicaid Services (CMS) announced efforts underway to support Puerto Rico in response to recent earthquakes. Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in Puerto Rico that is retroactive to December 28, 2019. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the disastrous earthquakes. CMS will be waiving certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare quickly; and taking steps to ensure dialysis patients obtain critical life-saving services.
“During this trying time for the island, CMS is coordinating with our federal, state, and local partners in doing everything possible to facilitate our beneficiaries’ access to care – care that very well may be life-saving,” said CMS Administrator Seema Verma.
Key administrative actions CMS will be taking in response to the PHE declared in Puerto Rico include:
· CMS will temporarily waive or modify certain Medicare, Medicaid, and CHIP requirements. CMS will also issue a number of blanket waivers listed on the website below, and the CMS Regional Office will grant other provider-specific requests for specific types of hospitals and other facilities in Puerto Rico. These waivers work to provide continued access to care for beneficiaries.
· CMS will make available special enrollment periods for certain Medicare beneficiaries. This gives people impacted by the earthquakes the opportunity to change their Medicare health and prescription drug plans if eligible for the special enrollment period.
· CMS developed an inventory of Medicaid and CHIP flexibilities and authorities available to states in the event of a disaster.
· CMS is helping patients obtain access to critical life-saving services. The Kidney Community Emergency Response (KCER) program has been working with the End Stage Renal Disease (ESRD) Network of Puerto Rico, ESRD NW3, to assess the status of dialysis facilities in the potentially impacted areas related to generators, alternate water supplies, education and materials for patients. They are also assisting patients whose dialysis centers are temporarily closed to receive dialysis services at open locations.
· Patients have been educated to have an emergency supply kit on hand including important personal, medical, and insurance information; contact information for their facility, the ESRD NW hotline number, and contact information of those with whom they may stay or for out-of-state contacts in a water proof bag. They have also been instructed to have on hand supplies to follow a three-day emergency diet.
· CMS will temporarily suspend certain requirements necessary for Medicare beneficiaries who have lost or realized damage to their durable medical equipment, prosthetics, orthotics, and supplies as a result of the earthquakes. This will help to make sure that beneficiaries can continue to access the needed medical equipment and supplies they rely on each day.
· CMS will temporarily suspend current survey and enforcement activities for healthcare facilities in Puerto Rico, but will continue to investigate allegations of immediate threat to patient health and safety.
· During a public health emergency, Medicare Advantage Organizations and Part D Plan sponsors must take steps to maintain access to covered benefits for beneficiaries in affected areas. These steps include allowing Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities and waiving, in full, requirements for gatekeeper referrals where applicable.
· CMS Central Office and the Regional Offices hosted two webinars in 2018 regarding Emergency Preparedness (EP) requirements and provider expectations. One was an all provider training on 6/19/2018 (over 3,000 providers participated) and the other an all-surveyor training on 8/14/2018. Both presentations covered the EP Final Rule, which included emergency power supply; 1135 waiver process, Best Practices & Lessons Learned from past disasters, and Helpful Resources and more.
· CMS also compiled a list of Frequently Asked Questions (FAQs) and useful national emergency preparedness resources to assist State Survey Agencies (SAs), their State, Tribal, Regional, local emergency management partners, and health care providers to develop effective and robust emergency plans and tool kits to assure compliance with the EP rules.