CMS Provides Additional Protection Measures for California Beneficiaries Affected by Wildfires

CMS Provides Additional Protection Measures for California Beneficiaries Affected by Wildfires

With a growing number of Medicare beneficiaries affected by California wildfires and other natural and manmade disasters across the country, the Centers for Medicare and Medicaid Services has provided additional protection measures to ensure these beneficiaries have access to care, prescription drugs and durable medical equipment. These measures are in addition to the Special Enrollment Period (SEP) mentioned in our press release earlier this month. The SEP allows beneficiaries affected by the wildfires who are unable to make their healthcare choice/changes during Medicare’s annual election period that runs through Dec 7, to enroll into, switch or disenroll from a Medicare Advantage and/or Part D plan through March 31, 2019.

Some of the additional measures, as summarized in our partner’s, Justice in Aging, fact sheet, include:

  • Prescription Drug Coverage: Plans are expected to provide flexibility with respect to use of out-of-network pharmacies; to lift their refill-too-soon edits: and to allow affected enrollees to obtain the maximum extended day supply if requested and available. See CMS Q&A for consumers, instruction to plans, and additional guidance to plans.
  • Durable Medical Equipment Covered by Medicare: Under a blanket waiver, the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) where DMEPOS are lost, destroyed, irreparably damaged or otherwise rendered unusable. A CMS fact sheet explains that, in fee–for-service, beneficiaries still must use Medicare suppliers, including, where appropriate, competitive bidding suppliers. In Medicare Advantage, beneficiaries should contact their plan regarding supplier availability.
  • Waiver of Three-Day Hospital Stay Requirement for Skilled Nursing Facility Coverage: CMS has waived the 3-day prior hospitalization for coverage of a skilled nursing stay and the spell of illness requirement for evacuees and others who need skilled nursing facility care.
  • Using Out-of-Network Providers in Medicare Advantage: CMS has instructed plans that they must allow Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities. Plans must waive, in full, requirements for gatekeeper referrals where applicable. Plans must temporarily reduce plan-approved out-of-network cost sharing to in-network cost-sharing amounts.

See JiA’s fact sheet for more resources and information. Also, view and share these consumer handbooks with detailed information on housing, benefit programs, federal relief, insurance assistance, document recovery, fraud prevention and other issues regarding these natural disasters, created by Morrison and Foerster.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.