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Last Modified: 10/14/2024 Location: FL, PR, USVI Business: Part A, Part B

Medicare Fee-for-Service (FFS) response to the disaster in Florida from the effects of Hurricane Milton

On October 8, HHS Secretary Xavier Becerra determined that a public health emergency exists in Florida and has existed since October 5. CMS is working closely with the state and federal partners to put these flexibilities in place to ensure those affected by this natural disaster have access to the care they need – when they need it most.
CMS stands ready to assist with resources and waivers external link to ensure hospitals and other facilities can continue to operate and provide access to care to those impacted by the consequences of the hurricane. Additional guidance regarding MAC response to natural disasters can be found in the CMS IOM Pub. 100-09 Medicare Contractor Beneficiary and Provider Communication Manual, Chapter 6, section 30.4.12. external pdf file.

Flexibilities and reminders for impacted areas

Use of the “CR” modifier and the “DR” condition code are mandatory on claims for items and services for which Medicare payment is conditioned on the presence of a “formal waiver” including, but not necessarily limited to, waivers granted under either §1135 or §1812(f) of the Social Security Act.
Temporary emergency coverage of Skilled Nursing Facilities (SNF) services that are not post-hospital SNF services is provided for beneficiaries who are evacuated, transferred, or otherwise dislocated as a result of the effects in the impacted areas, regardless of where the “host” SNF providing post-disaster care is located:
Coverage will also be provided for extended care services, with no requirement for a new spell of illness to renew provision of services by a SNF.
These temporary emergency policies will apply to the timeframes specified in the waiver issued under §1135 of the SSA.
First Coast will apply good cause for appeals in accordance with regulations and guidance as outlined in the Medicare Claims Processing Manual, Chapter 29, Section 240.4, Good Cause – Administrative Relief Following a Disaster external pdf file.
First Coast is also implementing the following flexibilities related to medical review (MR) activities for providers in the impacted counties:
First Coast will release any claims pending MR and not send MR additional documentations requests (ADRs) to any provider in affected counties for a period of 30 days
For the subsequent 60 days, First Coast will de-prioritize MR in affected counties
First Coast will allow medical review education sessions to be rescheduled upon request of the provider where a major disaster prevents availability

Resources

Visit the CMS Emergency Preparedness and Response Operations page to learn more about Medicare’s response to Hurricane Milton on its current emergencies external link section, including:
Information on blanket waivers external pdf file for the impacted Florida counties
How to request an individual §1135 waiver, if there is no blanket waiver, by following the instructions available at: https://cmsqualitysupport.servicenowservices.com/cms_1135 external link
You can also read Q&As applicable to the items and services furnished to Medicare beneficiaries within the impacted areas. These Q&As are available on the CMS website in two files:

We’re here to help

On behalf of First Coast, our thoughts are with those affected by this natural disaster. Asalways, we’re here to serve you. If you have any questions, please contact our Provider Contact Center. Or you can use our internet portal SPOT and interactive voice response system (IVR) to obtain information.
Please continue to check eNews for further updates and notifications related to Hurricane Milton as they become available. If you are not enrolled in eNews, click here to join.

Related links

Emergency Preparedness and Response Operations external link page on CMS.gov for up-to-date information
First Coast’s Disaster Information page
Quick-start guide to learn how to submit an 1135 waiver (PDF) external pdf file or a PHE inquiry (PDF) external pdf file
CMS YouTube training videos:
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.