CMS issues waivers, disaster provisions for victims of California wildfires

CMS announced certain public health emergency policies have been enacted in California to assist those affected by the recent wildfires across the state.

On October 15, Eric D. Hargan, acting secretary of the Department of Health and Human Services, declared a public health emergency in California retroactive to October 8, a move which allows CMS to waive or modify certain Medicare requirements to provide uninterrupted access to healthcare for beneficiaries.

CMS applied waivers and modifications under Sections 1135 and 1812(f) of the Social Security Act. Provisions under these acts include the ability to temporarily waive the three-day prior hospitalization requirement for coverage of a skilled nursing facility (SNF) stay for people who are evacuated, transferred, or otherwise dislocated due to the wildfires. The waiver also renews SNF coverage for beneficiaries who recently exhausted their SNF coverage without having to first start a new benefit period.

CMS will also provide special enrollment periods to beneficiaries affected by the wildfire and will waive certain sanctions and penalties resulting from noncompliance with certain provisions of the HIPAA privacy regulations.

Healthcare professionals should use condition code -DR (disaster related) and modifier -CR (catastrophe/disaster related) on all claims for items and services where Medicare payment is conditional on the presence of a formal waiver. Further guidance on the disaster policies in place in California are available via MLN Matters SE17035 or via CMS’ wildfires page.