Waivers for SNFs Affected by Hurricanes

Thoughtware Article Published: Sep 01, 2017
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As hurricanes continue affecting parts of our nation, skilled nursing facilities (SNF) should be aware of certain waivers that may help them sustain important skilled care for their residents. Waivers granted under section 1135 of the Social Security Act temporarily waive or modify certain Medicare and Medicaid requirements for providers. In addition to 1135 waivers, specific waivers have been granted affecting SNFs. 

Several blanket waivers have been issued for affected areas, meaning those providers don’t have to apply for individual waivers. The Centers for Medicare & Medicaid Services (CMS) is continuously monitoring the situation and updating the Hurricanes section of its website, noting which areas are approved for which waivers. Waiver information is currently available for areas of Texas, Louisiana, the U.S. Virgin Islands, Puerto Rico, Florida, Georgia and South Carolina.

Providers must resume compliance with normal rules and regulations as soon as they’re able. Waivers under section 1135 typically end no later than the termination of the emergency period, or 60 days from the date the waiver was first published.

SNF Waivers

  • Section 1812(f) Waivers
    • Waive the requirement for a three-day prior hospitalization for SNF care coverage under Medicare A
    • Renew skilled coverage for residents who continue to need skilled care after recently exhausting days
  • 42 Code of Federal Regulations (CFR) 484.20 Waivers
    • Waive time frame requirements for Minimum Data Set (MDS) assessments and transmission
    • Make some exceptions for when the Assessment Reference Date (ARD) is set on, which is the date the facility chooses the ARD. This differs from the set-for date, which is the date designated as the ARD. This must still be within the required ARD window, as stated in the Provider Survey and Certification Frequently Asked Questions (FAQ)

Please note not all areas have been granted Section 1812(f) or 42 CFR 484.20 waivers. Continue monitoring the CMS website for updates on your area.

Evacuation Billing & MDS Issues

According to the Provider Survey and Certification FAQ for emergencies, providers should note the following:

  • It should be determined by day 15 of the evacuation whether the resident will be able to return to the evacuating facility within 30 days of the evacuation date. This determination must be documented and notices provided to residents, responsible parties, receiving facilities, the state survey agency and Medicaid agency.
  • Residents transferred to a receiving facility with an anticipated return to the evacuating facility within 30 days of the evacuation date can continue to have claims billed to Medicare by the evacuating facility. Claims are billed to Medicare as if the resident wasn’t transferred, and the MDS assessment cycle continues as normal. A billing agreement should be in place, and the evacuating facility is responsible for paying the receiving facility.
  • If the resident is determined unable to return within the 30-day time frame, the evacuating facility should complete a discharge assessment. The receiving facility should subsequently admit the resident (if the resident chooses a continued stay there) and complete assessments accordingly.
  • If the resident returns to the evacuating facility after the 30-day time frame, the receiving facility would complete the discharge assessment and the evacuating facility would then complete assessments based on the new admission.


  • Some Texas counties have been granted exceptions for certain Medicare quality reporting and value-based purchasing programs, without those providers having to submit an extraordinary circumstances exception request. More information can be found on the CMS website.
  • Information on tax and administrative relief can be reviewed in BKD’s article, “Relief Measures Available After Hurricane Harvey.”

For information on this and other matters, contact your BKD trusted advisor.

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