The Centers for Medicare & Medicaid Services (CMS) has announced Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) flexibilities in response to ongoing wildfires in Southern California that started last week.
In a Jan. 10 news alert, CMS said state of California waivers are available for affected providers. Medicare beneficiaries who have lost their durable medical equipment (DME) or whose DME has been damaged due to the wildfires can receive replacements of items and services. Impacted beneficiaries should call the (800) MEDICARE number for help.
For Medicare beneficiaries who are displaced from their homes and therefore unable to obtain part D medications at network pharmacies, “plans will be required to assure that their enrollees have adequate access to drugs dispensed at out-of-network (OON) pharmacies,” the announcement said. “Plans are required to reimburse beneficiaries up to their usual plan allowance for any payments enrollees make to OON pharmacies. Similarly, if the nature of the disaster requires voluntary or mandatory evacuation, plans will similarly be required to reimburse beneficiaries for OON payments for refills of Part D medications to any beneficiary located in an ‘emergency area,’ defined as the area in which there has been a Stafford Act or national emergencies act declaration and a PHE [public health emergency] declaration.”
Another example of a flexibility, the CMS announcement said, would be for pharmacies to remove the “refill too soon” restriction for Medicare beneficiaries who have lost all their medications due to the emergency.
President Joe Biden declared on Jan. 8 that an emergency existed in California starting on Jan. 7. On Jan. 10, Department of Health & Human Services Secretary Xavier Becerra declared that a California public health emergency began on Jan. 7. Waivers and modifications are effective Jan. 12, but have retroactive effect to Jan. 7.
Becerra said in the Jan. 10 waiver/modification of requirements announcement that he was ordering the changes “to ensure that sufficient health-care items and services are available to meet the needs of individuals enrolled in the Medicare, Medicaid, and CHIP programs and to ensure that health-care providers that furnish such items and services in good faith, but are unable to comply with one or more of these requirements as a result of the consequences of wildfires and straight-line winds, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse.”
