Medicare Advantage Plan Requirements during a State-declared Emergency
MA organizations are required to:
During disaster or emergency (declared by the Governor of a state or Protectorate) the following are in effect until the end date identified in the State declaration or for 30 days, if no end date is identified in the declaration.
Cover Medicare Parts A and B services and supplemental Part C plan benefits furnished at non-contracted facilities subject to § 422.204(b)(3), which requires that facilities that furnish covered A/B benefits have participation agreements with Medicare.
- Waive, in full, requirements for gatekeeper referrals where applicable.
- Provide the same cost sharing for the enrollee at a non-contracted facility as if it were a contracted facility.
- Changes that benefit the enrollee can be effective immediately without the 30-day notification requirement (examples include reductions in cost sharing and waiving prior authorizations).
More information on topic found
CMS is Delaying Implementation of the October 1, 2020 MDS Update
The Centers for Medicare and Medicaid Services (CMS)
that they are delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.
This delayed release will eliminate the need for significant SNF MDS training during the upcoming months as well as avoid increased documentation nationwide.
CMS staff continues to be actively engaged in discussions with AHCA and various other stakeholders, regarding the various changes, the impacts of these changes, as well as, the timeline to educate and train facility staff and update software and IT systems. See Full Details of CMS Press Release