The Centers for Medicare & Medicaid Services has applied blanket waivers to several states affected by Hurricane Helene — Georgia, Florida, North Carolina, South Carolina and Tennessee — in response to the public health emergency declared as a result of Hurricane Helene. The waivers relieve certain Medicare providers from several existing regulatory requirements for the duration of the PHE.

In addition, CMS has made available accelerated payments to Medicare Part A providers and advance payments to Medicare Part B suppliers affected by Hurricane Helene.

CMS has organized the blanket waivers by provider type, and blanket waivers are retroactively effective to the date of the PHE for each state.  

• Florida: Effective retrospectively Sept. 24.
• Georgia: Effective retrospectively Sept. 24.
• North Carolina: Effective retrospectively Sept. 25.
• South Carolina: Effective retrospectively Sept. 26.
• Tennessee: Effective retrospectively Sept. 26.

While there is minor variation among states, CMS' blanket waivers generally include the following. However, if you're in an affected state, review the blanket waivers to confirm which flexibilities are available to you:

Hospitals:

• Physical Site Requirements. CMS is waiving certain physical environment requirements under the hospital, psychiatric hospital, and critical access hospital conditions of participation at 42 CFR 482.41 and 42 CFR 485.623 to allow increased flexibilities for surge capacity.
• CMS is waiving the provisions related to telemedicine at 42 CFR 482.12(a)(8)– (9) for hospitals and 485.616(c) for critical access hospitals, making it easier for telemedicine services to be furnished to the hospital’s patients through an agreement with an off-site hospital.
• Temporary Expansion Locations. CMS is waiving certain physical environment requirements under 42 CFR 482.41 and 485.623 and the provider-based department location requirements at 413.65(e)(3) to allow hospitals to establish and operate as part of the hospital any location meeting those conditions of participation for hospitals, including any existing provider-based departments of the hospital. This extends to any entity operating as a hospital so long as the relevant location meets the conditions of participation and other requirements not waived by CMS.

Inpatient Rehab Facilities:

• Flexibility for IRFs Regarding the "60 Percent Rule." CMS is allowing IRFs to exclude patients from the freestanding hospital’s or excluded distinct part unit’s inpatient population for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF (commonly referred to as the "60 percent rule") if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such.

Skilled Nursing Facilities:

• Preadmission Screening: Allowing SNFs to admit new residents without Level 1 or 2 preadmission screenings.
• Three-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS may cover SNF stays without a three-day prior inpatient hospitalization. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes a one-time renewal of SNF coverage without first having to start a new benefit period (this portion of the waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).
• Physical Environment: CMS is waiving requirements under 42 CFR 483.90 to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity.

Home Health Agencies:

• OASIS Reporting. CMS is providing relief to HHAs on the timeframes related to OASIS transmission by extending the five-day completion requirement for the comprehensive assessment to 30 days and modifying the 30-day OASIS submission requirement. Delayed submission is permitted during the PHE.
• Remote Initial Assessment. CMS is waiving the requirements at 42 CFR 484.55(a) to allow HHAs to perform Medicare-covered initial assessments and determine patients’ homebound status remotely or by record review.

Practitioner Locations:

Out-of-State Practitioners. CMS is temporarily waiving requirements that out-of-state practitioners be licensed in the state where they are providing services when they are licensed in another state. CMS will waive the physician or nonphysician practitioner licensing requirements when the provider meets all of the following four conditions: 1) is enrolled as such in the Medicare program; 2) possesses a valid license to practice in the state that relates to their Medicare enrollment; 3) is furnishing services, whether in person or via telehealth, in a state in which the emergency is occurring in order to contribute to relief efforts in their professional capacity; and, 4) is not affirmatively excluded from practice in the state or any other state that is part of the 1135 emergency area.

Provider Enrollment:

• CMS is waiving screening requirements, including certain fees, for provider enrollment.

Questions on the waivers? Contact advocacy@apta.org

Visit APTA's Emergency Preparedness webpage to access resources for managing emergencies such as natural disasters.