BREAKING NEWS

BREAKING NEWS

How Natural Disasters Affect Medicare, Benefits

Question: What happens to Medicare and other insurance benefits and rules when there is a natural disaster like Hurricane Harvey? I know it didn’t happen here, but I was curious.

Answer: Disasters like Hurricane Harvey and others we have had in the past, disrupt so much more than what we see on the news and social media. Things like paying bills, banking, medical treatments and appointments, taking or refilling your medications, grocery shopping, attending school and college classes, etc., are just some of the day to day activities that are completely disrupted. Once the crisis dies down we begin to realize how disruptive this situation can be for much longer than the storm or flood lasts.

Centers for Medicare & Medicaid Services have a protocol that they put in place for situations like this. It is available on their website and I have included the link for the Hurricane Harvey information; www.cms.gov/About-CMS/Agency-Information/Emergency/Hurricanes.html.

This link is specific for Hurricane Harvey, but each time there is a disaster of this type CMS follows a similar protocol. This protocol primarily issues waivers (exceptions) that allow individuals to receive treatment, care, medications, etc outside of their normal rules and regulations.

To quote the website: “The President declared a state of emergency for Texas and the HHS Secretary declared a Public Health Emergency for Texas which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act.”

When the President declares a state of emergency for an area of the country, it triggers these protocols be put in place to protect those individuals with Medicare and Medicaid. The area and scope of the disaster determines who and where these protocols are to be followed.

For instance: individuals that have to leave their home area, sometimes traveling into other counties and states to find a safe place to be, still need to take their medications, receive treatments and need emergency services. They have left their home, their doctors, their pharmacy and their network of providers. They will receive an emergency waiver of usual networks, and pre-authorizations and refill rules.

Imagine a 76-year-old, Sally, who was displaced due to flooding. She is now staying with her niece in San Diego. She left her home in crisis, does not have anything but the clothes on her back. She has no Insurance Cards, ID, Medications, checkbook, credit cards, NOTHING. Medicare allows her insurance company (requires her insurance company) to issue new cards, approve medication refills even if too soon, and approve and pay for medical care outside of her normal network of providers.

In this situation, her insurance provider would have many of those medical records, her medications she needs refilled, her medical history and other important information.

Sally would be in terrible shape for a long time without this added protection that is part of the Section 1135 of the Social Security Act.

This Section 1135 of the Social Security Act also allows Nurses and Doctors who hold licenses and certifications in other parts of the country to come to the Disaster Area and surrounding areas to help. This Act waives the rules that requires them to have a license or certificate from the state they are in providing care as long as they have an equivalent license or certificate from another state. This Act allows all necessary medically-trained help to get there and actually care for those in need.

Many of you have probably seen notifications on social media sites requesting Nurses, Doctors, EMT’s and others to come help. Some places may be offering high wages to come help with this natural disaster. This Section 1135 of the Social Security Act allows that to happen.

These waivers also allow individuals to be moved into a Skilled Nursing Facility (SNF) without a 3-day prior hospital stay. Many of these individuals are treated in emergency medical shelters and then need to be moved to a more stable situation, like a SNF. This waiver is a useful tool in getting the individuals moved into a facility where they can get the ongoing care they need.

Under this Section 1135 of the Social Security Act, waivers usually last for 60-days after the end of the emergency period. These waivers can be extended if necessary. I think we would all agree that with Hurricane Katrina, the disaster lasted a whole lot longer than 60-days. Providers must resume compliance with normal rules and regulations as soon as they are able to do so, and in any event, the waivers or modifications a provider was operating under are no longer available after the termination of the emergency period.

I know that you have heard me say many times that I LOVE Medicare! I am so proud of what CMS has done to protect those with Medicare. I am also thrilled to have an opportunity to tell you about it!

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or e-mail her at janells@lutheran-jamestown.org.

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