Do You Know the Answers to These Medicare Disaster Relief Questions?

Medicare waiver for hurricane impact

Because of Hurricane Florence, CMS issued several waivers in North Carolina, South Carolina, and Virginia to help with access to healthcare. Even if you’re not in an affected area, this should be a reminder that disaster prep isn’t just about working in theory. You need to understand it well enough to apply it. Below you’ll find some questions based on the Medicare resources available. You can see if you need to study to ensure you know the rules when an emergency strikes.

1. How Do You Bill for Psychiatric Patient Moved to Acute Care Bed?

Many of the waivers related to Hurricane Florence are under Section 1135 or 1812(f) of the Social Security Act. One blanket waiver for IPPS and other acute care hospitals (with excluded distinct part inpatient psychiatric units) relates to inpatients relocated from the excluded distinct part psychiatric unit to an acute care bed and unit.

Question: Suppose that because of capacity issues related to Florence, an acute care hospital relocates a patient from the excluded distinct part inpatient psychiatric unit to an acute care bed. Should the hospital bill for this patient (who is in an acute care bed) under the inpatient psychiatric facility prospective payment system?

Answer: Yes, the hospital still should bill for this patient under the inpatient psychiatric facility prospective payment system.

Important: Medicare indicates you should include in the medical record that the psychiatric inpatient is in the acute care bed and note the reason. In our example, the reason to note is capacity issues due to Hurricane Florence.

You’ll find this information in MLN Matters SE18014, which also indicates that the acute care bed needs to be appropriate for a psychiatric patient, such as ensuring safety of the patient and others.

2. You Have to Share Space. Change of Address Required?

Certain emergency-related policies and procedures may be implemented without Section 1135 waivers. CMS has an FAQ for these, and that’s the source for this next question.

Question: Your office sustained damage from a hurricane, and your doctor is working temporarily out of another doctor’s office in the same state. Do you need to file a change of address with Medicare?

Answer: The response in the FAQ is yes. It’s possible a physician or non-physician practitioner could reassign benefits to the group using the CMS-855R. The provider may need to submit a CMS-855I if he hasn’t updated the enrollment record in more than five years. Your contractor is a good source for more specifics.

3. Do You Have to Hold to HIPAA?

Medicare also has a Q&A for policies and procedures implemented only with a Section 1135 waiver. That’s where you’ll find the answer to our next question.

Question: During a public health emergency, is the HIPAA Privacy Rule suspended?

Answer: Nope! The Privacy Rule still applies. But the Social Security Act does allow the HHS secretary to waive some sanctions and penalties for covered hospitals.

In particular, if a covered hospital fails to comply with these provisions, the secretary may waive sanctions and penalties:

  • the requirements to:
    • obtain a patient’s agreement to speak with family members or friends involved in the patient’s care
    • honor a request to opt out of the facility directory
    • distribute a notice of privacy practices
  • the patient’s right to:
    • request privacy restrictions
    • request confidential communications.

For more information, you can see the HHS Office for Civil Rights site on Health Information Privacy.

What About You?

How did you do? Were you aware of these resources? Have you printed out the information you’ll need in case your internet connection is down during an emergency? (And as a bonus tip, don’t forget that in August 2017 the CDC released ICD-10-CM advice for coding encounters for individuals affected by a hurricane. That advice has now been incorporated into the 2019 Official Guidelines.)



Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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