Alaska’s post-earthquake blanket waivers

As Alaska recovers from the magnitude 7.0 earthquake that struck on November 30, the Centers for Medicaid & Medicare services (CMS) announced several blanket waivers to help providers in the state continue to care for patients.

On the day of the quake, President Donald Trump issued an emergency declaration for the state, specifically authorizing FEMA to “identify, mobilize, and provide, at its discretion, equipment and resources necessary to alleviate the emergency’s impacts” and to provide direct Federal assistance in Anchorage Municipality, Kenai Peninsula Borough, and Matanuska-Susitna Borough.

A few days later, U.S. Secretary of Health and Human Services Alex Azar declared a public health emergency in Alaska that was retroactive to the day of the quake, which in turn triggered legal authorities given to the CMS.

“HHS is working closely with state health authorities and monitoring the needs of healthcare facilities,” Secretary Azar said in a press release. “This declaration will help ensure that Americans who were affected by the earthquake and rely on Medicare, Medicaid, and the Children’s Health Insurance Program have continuous access to the care as the area recovers.”

CMS announced several supports it’s offering that are available “with and without waivers.” For example, CMS made special enrollment periods available for some people who want a health plan through the Federal Health Insurance Exchange and “all Medicare beneficiaries affected by the Alaska earthquake.” Some waivers authorized by CMS are being implemented on a “blanket” basis, while some require providers to submit requests.

Blanket waivers, according to CMS, can be enacted “when a determination has been made that all similarly situated providers in the emergency area needed such a waiver or modification.” The nine temporary blanket waivers (or in some cases, blanket-waiver categories) CMS announced in response to the Alaska earthquake are:

Skilled Nursing Facilities 1812(f): Waives “the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility stay,” for people who had to evacuate, transfer, or were “otherwise dislocated” because of the earthquake; also authorizes renewed Skilled Nursing Facilities coverage without having to start a new benefits period for some people who recently exhausted their benefits. Another waiver loosens timeframe requirements for a required assessment in Medicare or Medicaid certified nursing homes.

Home Health Agencies 484.20(c)(1): “Provides relief to Home Health Agencies on the timeframes” related to a required assessment.

Critical Access Hospitals: Waives the requirements that certain hospitals limit the number of beds to 25 and the length of stays to 96 hours.  

Housing Acute Care Patients In Excluded Distinct Part Units: Allows for housing acute care patients in “excluded distinct part units,” where the beds are appropriate for that sort of care, because of disaster-related issues.

Durable Medical Equipment: Eases the process for suppliers of medical equipment, prosthetics, orthotics, and supplies to replace such equipment that’s been lost or damaged. Also temporarily extends the deadline for notification of subcontracting arrangements.

Replacement Prescription Fills: Medicare can cover certain replacement prescription fills when medication that’s been lost or “rendered unusable” by the earthquake.

Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a HospitalIPPS and other acute care hospitals to relocate patients from an “excluded distinct part psychiatric unit to an acute care bed and unit” if needed, when the beds are appropriate and “the staff and environment are conducive to safe care.”

Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital:Similarly, allows IPPS and other acute care hospitals to relocate patients from an “excluded distinct part rehabilitation unit to an acute care bed and unit” when needed and appropriate because of capacity issues or other circumstances caused by the emergency.

Ensuring Correct Processing of Home Health Disaster Related Claims: Allows Medicare Administrative Contractors to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs).

A statement from the Alaska Department of Health and Social Services explains other waivers that are in effect, which include permission for Secretary Azar to waive sanctions and penalties resulting from specific instances of HIPAA noncompliance at covered hospitals. More information about specific waivers is available on the CMS website.

The DHSS website also offers several resources for Alaskans coping with the aftermath of the earthquake, including guides for dealing with mental-health impacts. Among the list of resources, DHSS mentions that Aetna Behavioral Health is offering free telephone support to help individuals — both customers and non-customers — affected by the earthquake to cope with emotional impacts.

According to the Alaska Earthquake Center out of the University of Alaska Fairbanks (last updated December 2), no casualties were reported as a result of the quake, but hospitals did report several injuries, two of which were life-threatening.