Policy For Care During a Disaster

The Secretary of Health and Human Services has the right to exercise his or her waiver authority under Section 1135 of the Social Security Act if, in addition to a Presidential declaration of a disaster or emergency under the Stafford Act or National Emergencies Act, the Secretary declares a public health emergency under Section 319 of the Public Health Service Act. If an 1135 waiver is issued, CMS will identify all plan requirements and responsibilities. Detailed guidance and requirements for Medicare Advantage plans will be posted on the Department of Health and Human Services website and on the CMS website. Capital Blue Cross will check these websites frequently during disasters and emergencies to determine when the public health emergency/disaster declaration has ended and normal operations may resume.

Under the Secretary’s Section 1135 waiver, CMS may authorize DME and A/B MAC’s to pay for Part C-covered services furnished to enrollees and seek reimbursement from CBC for those healthcare services, retrospectively.

In the event of a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, but absent, or prior to the issuance of, a Section 1135 waiver by the Secretary, we will:

• Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted, Medicare certified facilities
• Waive in full, requirements for gatekeeper referrals where applicable
• Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing
• Waive the 30-day notification requirements to enrollees as long as all the changes (such as the reduction of cost-sharing and waiving authorization) benefit the enrollee.

Additionally, Capital Blue Cross will make accommodations with members impacted by the disaster to help ensure access to needed prescription drugs.

Typically, the source that declared the disaster will clarify when the disaster or emergency is over. If, however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if CMS has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration. If Capital Blue Cross is not able to resume normal operations after 30 days, we will notify CMS.