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Waivers 'get Medicare regs out of your way'

Waivers 'get Medicare regs out of your way' Stakeholders: What about audits?

WASHINGTON - The Department of Health and Human Services will waive or modify requirements for Medicare, Medicaid and CHIP providers in New York and New Jersey due to Hurricane Sandy.

HHS Secretary Kathleen Sebelius has declared a public health emergency in the two states under section 1135 of the Social Security Act, clearing the way for providers to submit waiver requests to CMS for at least 60 days.

“The purpose of the waivers is to get Medicare regulations out of your way to increase your capacity, in terms of response,” said David Wright, a deputy regional administrator, during a special conference call CMS hosted Nov. 1.

Under section 1135, HHS may permit affected providers to adjust certain operating procedures temporarily while continuing to receive reimbursement under Medicare, Medicaid and CHIP.

An example of a waived requirement cited during the call: a provider getting reimbursed for servicing a Medicare Advantage beneficiary who has been displaced and is in a location outside of his or her network.

“It doesn't allow reimbursement for things that wouldn't otherwise be reimbursed,” Wright said. “We can't provide reimbursement for those who aren't Medicare beneficiaries or to providers not otherwise certified by Medicare to provider those services.”

CMS officials advised providers to submit waiver requests, including “sufficient information to justify the need,” to CMS's regional office.

“Our goal is to turn around waiver requests within 24 hours,” Wright said.

During the Q&A portion of the call, AAHomecare's Walt Gorski asked CMS officials if they would stop audits temporarily due to the strain on providers.

“(Providers) are working in overdrive to care for patients and since ours is primarily a delivery model business, they rely on payments, especially when they're working 24/7,” he said.

CMS's response: “We don't usually speculate (until a regulation is in place),” said Charlotte Newman, deputy director of the Office of Public Engagement. “We don't have an answer for you on that. We've duly noted your concern.”

Tom Kruse, president and CEO of Hoveround, noted that during Hurricane Katrina, power wheelchairs were a purchased item and there were waivers to get beneficiaries new chairs if necessary. But now power wheelchairs are rental items.

“How do we get a new chair to these folks?” he asked.

CMS officials referred Kruse to a CMS website with FAQs and other materials on waivers. One of those FAQs states: “Medicare will pay for the replacement of equipment which the beneficiary owns or is purchasing, is oxygen equipment, or is a capped rental item—when the equipment/item is lost, destroyed, irreparably damaged, or otherwise rendered unusable due to circumstances relating to an emergency.”


FAQs and other materials on waivers:

Email questions to [email protected]


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