CMS Blanket Waivers and NC Medicaid Temporary Flexibilities Due to Hurricane Helene UPDATE

North Carolina Governor Roy Cooper issued Executive Order 315 on September 25, 2024, which declared a state of emergency for North Carolina in anticipation of potential severe weather caused by the approach of Hurricane Helene.  

The bulletin describes flexibilities effective September 26, 2024, for the NC Medicaid program, including NC Medicaid Direct and NC Medicaid Managed Care. Of interest to nursing facilities are Expediting Nursing Home Admissions for Individuals Displaced due to Hurricane Helene and Temporary PASRR Procedures Due to Hurricane Helene.  

An updated bulletin, extends the above flexibilities (and others listed in the bulletin) to October 15, 2024. One new item added addresses the ability to admit displaced ACH residents into nursing facilities.  It states, “For individuals displaced from an adult care home (ACH), on line 15 of the FL2, requested level of care should be “Nursing Facility” and on line 16 notate “Temporary Placement due to Hurricane Helene.”  

An accelerated payments update for Medicare Part A was posted October 8, 2024. Providers looking for this support should contact their assigned Medicare Administrative Contractor (MAC).

For the above listed waivers, the emergency area is the entire State of North Carolina.  

In addition to the waivers listed above, the Centers for Medicare & Medicaid Services has granted blanket waivers for certain counties in North Carolina. The waivers include: 

1. Reporting Minimum Data Set (MDS). CMS is modifying the requirements at 42 CFR §483.20(b)(2) to provide relief to SNFs on the timeframes in which they must conduct a comprehensive assessment and collect MDS data. CMS is not waiving the requirements for facilities to conduct the assessment and collect MDS data at 42 CFR 483.20(b)(1).  
2. Waive Pre-Admission Screening and Annual Resident Review (PASARR). CMS is waiving 42 CFR § 483.20(k), allowing nursing homes to admit new residents who have not received Level 1 or Level 2 Preadmission Screening. Level 1 assessments may be performed postadmission on or before the 30th day after admission. 
3. Three-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS may cover SNF stays without a three-day prior inpatient hospitalization. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes a one-time renewal of SNF coverage without first having to start a new benefit period (this portion of the waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances). 
4. Physician Visits in Skilled Nursing Facilities/Nursing Facilities. CMS is waiving the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.  
5. Physical Environment. CMS is waiving requirements under 42 CFR 483.90 to temporarily allow for rooms in a long-term care facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this purpose include activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long as residents can be kept safe, comfortable, and other applicable requirements for participation are met.  

The above blanket waivers do not apply statewide, but only to certain counties included in the President’s disaster declaration. These counties are Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Clay, Cleveland, Gaston, Haywood, Henderson, Jackson, Lincoln, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania, Watauga, Wilkes, and Yancey Counties and the Eastern Band of Cherokee Indians.  

Click here for a summary of the waivers with additional details.