CMS waives provider screening, DME requirements for TX and LA hurricane victims

The Centers for Medicare & Medicaid Services (CMS) today approved suspending certain Medicare enrollment screening requirements for healthcare providers and suppliers that are assisting with Hurricane Harvey recovery efforts in areas impacted in Texas and Louisiana. 

CMS also has issued new guidance to support people who are impacted by the loss of their durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) due to Hurricane Harvey. The ongoing response from CMS is focused on helping Medicare and Medicaid beneficiaries, providers, facilities and the general public with their immediate needs and ensuring access to healthcare services and resources are not interrupted throughout the recovery.

Today, the agency finalized new guidance for Fee for Service Medicare beneficiaries who have lost or realized damage to their DMEPOS as a result of Hurricane Harvey. Health and Human Services Secretary Tom Price, MD, established a waiver under section 1135 of the Social Security Act that allows CMS to temporarily suspend the face-to-face requirement, a new physician’s order, and new medical necessity documentation for replacement due to loss or damage from the hurricane. This action will help to make sure that beneficiaries can continue to access the needed medical equipment and supplies they rely on each day.

Suppliers are still required to include a narrative description on the claim explaining why the equipment must be replaced. In addition, suppliers should keep documentation that indicates whether the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable as a result of the hurricane.

CMS Administrator Seema Verma said the agency has established a hotline for healthcare providers in the two impacted states to enroll in the federal health programs and receive temporary Medicare billing privileges. “This is an unprecedented opportunity to work with health care providers to put our patients and people with Medicare benefits first,” Verma said. “While we have heard from providers in these states that are willing and able to help, we know that by temporarily relaxing these and other Medicare provider and supplier enrollment requirements, we can make the services of skilled professionals more readily available to those in need. We are working to ensure that doctors, facilities, suppliers and their teams are in place to help those impacted by damage from Hurricane Harvey.”

The new toll free Hotline Telephone Number: 1-855-247-8428
Hours of Operation: 8:00 AM – 6:00 PM ET

Under its waiver authorities CMS established a toll-free hotline servicing Medicare’s Part B providers and suppliers in Texas and Louisiana.  The hotline is intended for non-certified Part B providers and other practitioners to initiate provisional temporary Medicare billing privileges. Novitas Solutions, a Medicare Administrative Contractor (MAC), will work to assist providers in both states to temporarily enroll health care providers. To assist in this effort CMS is waiving the following enrollment requirements:  

1. Payment of the application fee (42 C.F.R 424.514)
2. Finger print based criminal background checks (FCBC- 42 C.F.R Section 424.518)
3. Site visits – (42 C.F.R Section 424.510)
4. In-state licensure requirements (42 C.F.R Section 424.510)

Verma said that beginning Monday, Sept. 11, 2017, providers will be able to initiate temporary Medicare billing privileges over-the-phone and on the same day. Anyone calling today (Thursday, Sept. 7, 2017) through Friday, Sept. 8, 2017, will receive a return call Monday, Sept. 11, 2017, to be enrolled over the phone.

In addition, CMS is:

• Exercising waiver authority to allow providers who are not currently enrolled to initiate temporary billing privileges by providing limited information, including, but not limited to, National Provider Identifier (NPI), Social Security Number (SSN) or a business Employer Identification Number taxpayer identification numbers (SSN/EIN/TIN), and valid in-state or out-of-state licensure.

• Temporarily ceasing revalidation efforts for Medicare providers located in Texas, Louisiana and areas otherwise directly impacted by Hurricane Harvey.

• Lifting the temporary enrollment moratorium in Texas on Part B non-emergency ambulance suppliers. The agency has authority to lift an enrollment moratorium at any time if the President declares an area a disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act.  CMS has carefully reviewed the potential impact of continued moratorium in Texas and the decision to lift the temporary enrollment moratoria on Part B non-emergency ambulance suppliers in Texas was made to expedite aid in the disaster response.  CMS is working to publish a notice in the Federal Register to announce the lifting of the moratoria.

• Waiving the practice location reporting requirements and not taking administrative actions with respect to providers who fail to notify them of their temporary practice location via the CMS-855.  This temporary process will remain in effect from the declared disaster effective dates (August 25, 2017 for Texas and August 28, 2017 for Louisiana) until the disaster designation is lifted, after which the provider shall resume all reporting requirements.  If the temporary location is still being utilized until the previous location is re-established, it must be reported to the MAC via the appropriate CMS-855.

CMS will continue to work with Texas and Louisiana in their recovery. The agency continues to update its emergency page (www.cms.gov/emergency) with important information for state and local officials, providers, healthcare facilities and the public.