Normal procedures relaxed for benefits of evacuees
CMS grants temporary eligibility
Many of the normal operating procedures for Medicare, Medicaid, and the State Children's Health Insurance Programs (SCHIP) were relaxed to accommodate the emergency health care needs of beneficiaries and medical providers in states devastated by Hurricane Katrina.
Special evacuee status was granted by the Centers for Medicare & Medicaid Services (CMS) to all those who fled states because of the hurricane, allowing them to apply for a full range of federal benefits without having to produce the normal forms of documentation to verify eligibility.
A new Medicaid and SCHIP application template was developed, through which states were granted the ability — through emergency Section 1115 demonstrations — to provide temporary eligibility for all groups served by those programs. Using the new program, CMS said, evacuees displaced because of the storm are able to quickly enroll in Medicaid or SCHIP in the state to which they have been evacuated by completing a simplified form giving their income and assets, if any.
States were given the flexibility to enroll those evacuees without requiring documents such as tax returns or proof of residency, CMS said, with applications accepted retroactively through Aug. 24. The program will last through Jan. 31, 2006.
Under the waiver, necessary medical services will be delivered to children up to age 19 and their parents, pregnant women, individuals with disabilities, low-income Medicare beneficiaries, and those who need long-term care and meet certain income requirements.
Evacuees receiving services through Texas Medicaid or SCHIP are not charged any out-of-pocket costs, and receive the standard Medicaid benefit package plus certain additional benefits, such as additional mental health coverage. Developed to reimburse Texas health care providers for care provided to Hurricane Katrina evacuees, the program will apply to other states as well, CMS said.
The program also includes an uncompensated care pool to pay for services for those not eligible for Medicaid or lacking health insurance.
Among other Medicaid and SCHIP changes available through the special 1115 demonstration initiative are:
- During the period of presumptive eligibility, the host state is required to verify circumstances of eligibility to the extent possible.
- Host states, at a minimum, will provide their own Medicaid and SCHIP benefit packages to the evacuees.
- Host states must extend the expedited application process to evacuees who may be newly eligible because of new economic circumstances created by the hurricane — that is, loss of job and income that may have made them ineligible before the storm.
- Host states will submit their estimated expenditures to CMS as a component of their usual cost reporting for determining federal payments.
The latest information on the program is available at www.cms.hhs.gov.
New codes aid billing efforts
In response to a request from CMS, the National Uniform Billing Committee (NUBC) approved a series of new codes to facilitate medical billing for services rendered to victims of Hurricane Katrina.
The new condition code "DR" (disaster related) is intended to help CMS and other health plans identify claims for which the admission is related to a disaster. In addition, CMS has said that long-term care hospitals caring for Katrina evacuees will be excluded from the calculated statistics intended to ensure the average long-term care stay is 25 or more days.
Additional uses for the new claim identifier may be developed as CMS reviews and finalizes future disaster policies.
Other new codes approved by NUBC, acting only as placeholders until implementation, include a new occurrence code, "DR," and occurrence span code, "MR." The occurrence code could, for example, capture the date of a declared disaster, like Katrina, while the occurrence span code could capture a date range, when a disaster was declared and when the disaster officially ended.
The codes also could reflect the date that the Federal Emergency Management Association (FEMA) declared an area to be a disaster area.
In addition to these codes, a new value code, "DR," is intended to record a specific numeric or monetary amount pertaining to the disaster.
Hospital billing personnel dealing with evacuees are urged to check the NUBC web site (www.nubc.org) periodically for additional changes and updates.
Answers to frequently asked questions about general Medicare billing and payment policy may be found at www.cms.hhs.gov/katrina/MedicareFFS.pdf.
ICD-9-CM coding advice for health care encounters in the hurricane aftermath is available at www.ahacentraloffice.com/ahacentraloffice/images/Katrina.
Many of the normal operating procedures for Medicare, Medicaid, and the State Children's Health Insurance Programs (SCHIP) were relaxed to accommodate the emergency health care needs of beneficiaries and medical providers in states devastated by Hurricane Katrina.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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