CMS News Center

CMS Helping Texas & Louisiana With Hurricane Harvey Recovery 

Numerous efforts by the Centers for Medicare & Medicaid Services (CMS) are underway to support communities in Texas and Louisiana in response to Hurricane Harvey. Actions include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program requirements to provide immediate relief to those affected by the hurricane and resulting floods.

“In light of the natural disaster still unfolding in Texas and Louisiana, CMS is committed to acting as quickly and effectively as possible so the states can continue to ensure the vital healthcare needs of our most vulnerable beneficiaries are not interrupted,” said Seema Verma, CMS administrator. “CMS is in constant communication with officials in Texas and Louisiana to be sure we are doing all we can to support those in the path of this historic and devastating storm.”

CMS and the U.S. Department of Health & Human Services (HHS) are working in close coordination with the Kidney Community Emergency Response network and the states of Texas and Louisiana to ensure that beneficiaries have access to facilities to provide their treatments. As the CMS response continues, other efforts include supporting Texas and Louisiana in arranging special-purpose renal dialysis facilities, transporting patients to facilities, and arranging for new facilities to open in order to serve beneficiaries without interruption. In Texas, CMS is coordinating with the workforce on the ground that cares for renal patients to ensure there are enough facilities to serve beneficiaries in need of dialysis. The agency is accepting requests from end-stage renal disease suppliers to become a temporary renal dialysis facility.

Since the public health emergencies were declared, CMS has offered immediate administrative relief actions to Texas and Louisiana, including issuing several general waivers of certain requirements for specific types of providers in impacted counties and geographical areas. These waivers work to prevent gaps in access to care for beneficiaries, according to CMS officials.

With the public health emergency in effect, CMS can also waive or modify certain Medicare provisions for providers, including certain deadlines, conditions of participation, and certification requirements, officials said. Providers can now submit waiver requests to the state survey agency or the CMS regional office, and they will be evaluated to ensure they meet the requirements set out under the law. To help clarify billing instructions, CMS has issued technical direction to Medicare Administrative Contractors regarding the waivers and has reminded area Medicare Advantage plans regarding their responsibilities to relax certain requirements during a disaster or emergency.

The agency continues to update its emergency webpage (www.cms.gov/emergency) with important information for state and local officials, providers, healthcare facilities, and the public. To view previous updates regarding HHS activities related to Hurricane Harvey, visit www.hhs.gov/about/news. To learn more about HHS resources related to Hurricane Harvey, visit www.hhs.gov/hurricane-harvey. n

 CMS Launches Jimmo Settlement Agreement Webpage 

The Centers for Medicare & Medicaid Services (CMS) is reminding the Medicare community of the Jimmo v Sebelius settlement agreement from January 2013 that clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility (SNF), home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function, or to prevent or slow decline or deterioration (provided that all other coverage criteria are met). Specifically, the agreement requires manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under the following benefits:

• Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient’s current condition or prevent or slow further deterioration, so long as the beneficiary requires skilled care for the services to be safely and effectively provided.
• Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered, so long as the beneficiary requires skilled care for the safe and effective performance of the program.

The agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in SNFs, home health services, outpatient therapy (physical, occupational, and speech), and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide. 

For more information, visit CMS’ Jimmo Settlement webpage at www.cms.gov/Center/Special-Topic/Jimmo-Center.html.