The document discusses key steps and requirements for disaster declarations and waivers. A governor first declares a state of emergency. The President then declares an emergency under the Stafford Act. Next, the HHS Secretary declares a public health emergency under Section 319. Once these steps occur, the HHS Secretary can issue an 1135 waiver to modify certain Medicare, Medicaid, and HIPAA rules in emergency areas. The waiver allows for reimbursement and compliance flexibility to assist healthcare during disasters.

1. Spotlight on CMS & HHS Updates to Combat
Disasters
Presented By Kristin J. Webb-Hollering

2. Today’s Webinar Agenda
• The who, what, when, where, and why of a Public Health Emergency
• An overview of the Stafford Act and federal declarations
• The reimbursement guidelines of the 1135 Waiver
• CMS restrictions, exceptions, and more during and after a disaster
• The lowdown on timetables, extensions, geography, and state information
• Coding and billing resources for submitting claims after a catastrophic event
• The HIPAA rules under an 1135 Waiver and Public Health crisis
• Health IT basics on securing health records and systems
• How the National Disaster Medical System Definitive Care Reimbursement Program works
• Provider information on compliance and reimbursement relief efforts in the wake of Hurricanes’
Harvey, Irma, and Maria

3. Emergency Declarations
Before, during, or after a natural disaster like Hurricane Irma, the governor of a U.S. state or
territory declares a State of Emergency.
Here is the timeline of how an “emergency” is declared.
• First, a governor issues a State of Emergency due to a disaster that devastates an area in a state or
territory. During this time, some municipal and/or state executive, judicial, and legislative services
may be suspended.
• The State of Emergency tells the federal government that the state needs additional resources to
handle the incident.
• Next, the President of the United States acknowledges that an emergency exists under the
Stafford Act or the National Emergencies Act.
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4. What is the Stafford Act?
StaffordActThe Stafford Act, which is
short for the Robert
T. Stafford Disaster Relief
and Emergency
Assistance Act, allows federal
organizations to assist state
and local governments after
the President of the United
States declares a natural
disaster an emergency.
Definitions
Definitions of emergency and
major disaster fall under Title
I, Section 102 of the Act. It is
interesting to note that
“emergency” relates to any
occasion when state or local
governments need federal
help. A “major disaster”
refers specifically to natural
catastrophes such as
hurricanes, floods,
earthquakes, fires, and the
like.

5. Public Health Emergency Overview
WHO
• Usually, after the President establishes an emergency under
the Stafford Act, then the Secretary of the Department of
Health and Human Services (HHS) declares a Public Health
Emergency (PHE).
WHAT
• The HHS Secretary determines there’s a PHE under Section
319 of the Public Health Service Act (PHSA).

6. Public Health Emergency Overview
WHEN
• A Section 319 PHE is good for a duration of 90 days, but it
may be shortened by the the HHS Secretary if it’s
determined an emergency no longer exists.
WHERE
• The PHE covers the state and/or local areas referenced in
the HHS Secretary’s declaration under Section 319 of the
PHS Act only.

7. Public Health Emergency Overview
Why
• The Secretary determines that there’s a high risk of disease and
disorder due to the emergency or disaster. The hazards are
significant enough to declare the PHE. Under Section 319 of the
PHSA, the Secretary can now offer grants, do investigations,
support state and local healthcare efforts, and waive certain
federal requirements that may be compromised due to the
disaster.

8. From Emergency to the 1135 Waiver
A disaster or emergency
occurs.
A state of emergency is
called by a governor.
The President declares an
emergency or disaster
under the Stafford Act or
the National Emergencies
Act for the impacted areas
or state.
The HHS Secretary
declares a Public Health
Emergency under the
Public Health Service
Act, Section 319.
Once the PHE is determined,
Section 1135 of the Social
Security Act authorizes the
HHS Secretary to waive or
modify certain Medicare,
Medicaid, CHIP, and HIPAA
requirements.

9. Public Health Emergency Fun Fact
The Secretary of the Department of Health and Human
Services can determine a Public Health Emergency under Section 319
of the Public Health Service Act without the Presidential declaration
of an emergency under the Stafford or National Emergencies Acts.
However, for certain federal health programs’ regulations that
fall under the Social Security Act (i.e. Medicare, Medicaid, CHIP) to be
waived with an 1135 Waiver, the President must declare an
emergency under the Stafford or National Emergencies Act and the
HHS Secretary must declare a Public Health Emergency under Section
319 of the Public Health Service Act.

10. Review the requirements that must be met
to make the 1135 Waiver possible . . .
Presidential
declaration
under Stafford
or National
Emergencies
Act
HHS Secretary
determination
of a Public
Health
Emergency
Requirements
can now be
waived or
modified under
section 1135 of
the Social
Security Act.