We contacted CMS...
Following our September 9th Blog, Storm Related Transport Billing, Enhanced reached out to communicate with one of our key contacts within CMS. Our question to this CMS representative was to determine if it was anticipated that any waiver would be initiated on origin/destination or PCS requirements related to evacuation transports following the recent Tropical Storm Lee flooding along the Susquehanna River Basin in Pennsylvania and Maryland.
Once we learned that President Obama had declared 19 Counties in Northeastern and Central Pennsylvania a Federal disaster area, it seemed that there may be hope that such special action may be forthcoming, much like the Hurrican Katrina disaster of several years ago.
Our contact relayed that in order for Medicare to drop requirements the Secretary of Health and Human Services would have to issue an 1135 Waiver under the Stafford Act or National Emergencies Act under Section 319 of the Public Health Service Act. Under Section 1135 of the Social Security Act, the Secretary may temporarily waive or modify certain Medicare, Medicaid and Children's Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods so that providers who provide such service in good faith can be reimbursed and exempted from sanctions.
An example of this that applies to EMS would be for the Secretary to allow waivers or modifications to the Emergency Medical Treatment and Labor Act (EMTALA) sanctions for direction or relocations of an individual(s) to receive medical screening examination in an alternative location pursuant to an appropriate state emergency preparedness plan or tranfer of an individual who has not been stabilized if the transfer is necessitated by the circustances of the declared emergency ("Requesting an 1135 Waiver" CMS, Revised November 4, 2009)
Unfortunately, there appears to be no move to invoke an 1135 Waiver for this "Lee Disaster."
File with FEMA
Our advice to clients at this point, given this latest information, is to be sure that each affected client files with FEMA as part of the disaster reporting process, irregardless of the application of an 1135 Waiver or not. Let FEMA know now that you were pressed into service at additional cost and expense to your department so there is record of the cost to your organization.
We were also reminded of this fact. "Even when a national disaster is declared (such as Hurrican Katrina), FEMA would be the first avenue of funding, so Medicare payment may never come into play, anyway." As you'll recall from our first Blog on this subject, we alluded to this very fact as one of our bullet point cautions. Of course as each emergency is uniquely different, it warranted our contacting CMS for clarification for this particular emergency declaration and response.
However, as we experienced in 2006, FEMA's bureaucracy tends to be very cumbersome and resources are limited. Unfortunately, with the massive amount of destruction both then and even more so now with the Lee Disaster, the alotted funds are directed to the most urgent needs and, quite frankly, payment for evacuation transports are the least of FEMA's worries in such crises.
Still, file the paperwork. You just never know.
We're here to help...
Enhanced is here to help! We'll assist you in any way we possibly can to help you state your case for payment.
If you're not an Enhanced client and your billing contractor has given you no direction, call us today. We'll be happy to add you to our satisfied list of clients and share vital information with you too!