Irene creates paperwork tangle for hospitals
Hospitals need reimbursement for the care they gave during Tropical Storm Irene.
By BARBARA BENSON
Aug 30, 2011 2:52 pm
On Monday, many of the patients who had been evacuated from hospitals and nursing
homes in advance of Hurricane Irene were transferred back—leaving financial chaos in
the hurricane's wake.
Sorting out the billing for the evacuations and patient transfers could take days. Patient
care, staffing, transportation, ambulances, food—all of it must be reimbursed. Patients
were transported in ambulances, ambulettes, buses and, in some cases, by private car.
Medical staff visited their patients at their temporary quarters. Costs were incurred by
both the evacuated and receiving institutions.
“The question is, who pays for what? Who bills for the services and costs incurred?”
said Richard Herrick, CEO of the New York State Health Facilities Association, a longterm care facility trade group.
Evacuation of a nursing home is a rare event, he added, but in this case, roughly 15
homes in the state were evacuated. “The scale of this event was unprecedented,” he
said.
Many questions have arisen. What is the Medicare and Medicaid reimbursement policy
with respect to the transfer of patients between institutions? If a federal disaster area is
declared, do the feds pick up the tab? How will private insurers pay for the costs
incurred?
On Tuesday, New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie
requested an expedited major disaster declaration from the federal government to help
deal with the storm's aftermath.
Last Friday, Greater New York Hospital Association raised the issue with its members.
The trade group got assurances from the state Department of Health that Medicaid will
provide appropriate compensation to both the receiving and transferring facilities. The
hospital association also informed members that the health department asked Medicaid
managed care plans and commercial insurers to relax utilization controls and network
requirements so that patients could receive services if they relocated.
The health department is looking at several possible reimbursement models, and will
check with the federal Centers for Medicare & Medicaid Services to make sure they
meet federal guidelines. The state health department also will address reimbursement
issues on its website.
A Centers for Medicare & Medicaid Services spokesman said that if a hospital needed
to transfer a Medicare patient because of an emergency evacuation, the normal transfer
payment policies would apply. “The payment would not be dependent on the formal
declaration of an emergency,” he said.
Mr. Herrick said that he hoped reimbursement decisions would be made within 10 days
so that nursing homes won't have to wait for payment. But, he cautioned, “my
assumption is some costs will never be reimbursed.
“It is a very fragile time financially for nursing homes, and I have to think they showed a
tremendous amount of good faith that it will all turn out positive,” he said.
By Monday afternoon, nursing home patients were still being transferred back to their
home institutions, said Neil Heyman, president of the Southern New York Association,
which represents nursing homes in the New York area.
He estimated that about 5,000 nursing home residents were involved in evacuations in
New York City's Zones A and B. Some nursing homes chose to shelter-in-place
because there were not enough beds at other facilities.
“There were a few things that didn't happen according to script, but overall, the
evacuations worked,” he said. He describes the crisis as a “fantastic learning
experience. We got everyone to safety in a remarkably short period of time, which
shows how wonderfully cooperative people can be.”