Patient Repatriation and Reimbursement

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Patient Repatriation and Reimbursement Briefing
for NDMS Patient Movement After Action
Review December 13, 2005
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Mission

• HHS was mission assigned to orchestrate the
  return of all evacuees from Texas, Louisiana and
  Mississippi (both Hurricanes Katrina and Rita)
  that currently required medical transportation.
• This transportation mechanism is for any evacuee
  (NDMS or otherwise) with medical transportation
  requirements that exceed the capability of
  commercial transportation.

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Assumptions

• The requirement may be between 3,000 6,000
  patients
• Neither home states nor host states were
  providing transportation assets to support the
  return of evacuees
• No Federal transportation or patient evacuation
  assets or Federal patient reception assets were
  available to support this plan.
• Plan would require a capability that can
  reproduce the key functions of NDMS patient
  movement but in reverse and much slower pace
• FEMA Facilitated Relocation Program and/or
  funding allocated to all host states would fund
  and execute the transportation of all evacuees
  (NDMS or otherwise) that could travel via
  commercial means
• Many of the originating facilities and/or homes
  of record may be uninhabitable in the most
  affected areas
• Many NDMS hospital patients will have since been
  discharged to nursing homes, special needs
  shelters, Red Cross shelters and hotels
• Lack of transportation-related data and
  subsequent movement of the target population
  would hinder our ability to reach out to evacuees
  as individuals and track all NDMS patients
  return home.

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HHS Medical Travel Center

• HHS competed and awarded a contract to a
  Texas-based transportation company, CareFlite, in
  less than one week.
• CareFlite provides transportation for evacuees
  from where they were evacuated to (e.g. host
  state hospitals, nursing homes, long term care
  facilities, special needs shelters), to
  destination facilities or homes with approval
  from the receiving facility or the home state
  health department.
• CareFlite utilizes the most economic and
  efficient means to repatriate patients or groups
  of patients via fixed-wing, commercial
  fixed-wing, buses, ground transports, and medical
  escorts.
• Requires close coordination with
• FEMA Recovery Division and FEMA Facilitated
  Relocation Program
• Host state healthcare facility discharge planners
• Home state health departments

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The Plan and the Players

• FEMA Recovery Division and FEMA Facilitated
  Relocation Program
• All evacuees must register with FEMA as a
  disaster victim before accessing either the HHS
  Medical Travel Center of the FEMA program
• Family members and medical attendants traveled
  via the FEMA program in coordination with the
  transportation of the related patient via the HHS
  program
• The HHS Medical Travel Fact sheet required FEMA
  approval
• Alignment of travel policies
• Patients unable to return to their home state are
  able to select an alternative final-destination

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The Plan and the Players

• Host State Healthcare Facilities
• Licensed health care facilities (including
  hospitals and long-term care facilities) are
  responsible for coordinating discharge planning
  and for arranging a receiving facility
• Patients returning to facilities are transported
  via inter-facility arrangements, without State
  intervention.
• Patients/Family Members/Attendants
• Responsible for working with their home state
  health department if returning to a private
  residence
• Home State Health Departments
• Must vouch for the stability of the evacuees
  home of record AND surrounding public health and
  medical infrastructure
• Texas 211 system coordinates patients returning
  to private residences
• Louisiana is working towards the implementation
  of this system in the remaining affected areas

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Patient Transports by Start and Destination
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Transports as of 8 DEC
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Stumbling Blocks

• Duplicative repatriation systems
• Coordination between the local, State and Federal
  partners
• Scoopers
• Coordination of multiple call in numbers
• Pressure to get evacuees home for the holidays
• Where is everyone?

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NDMS Definitive Care

• DHS/FEMA and HHS/CMS have entered into an IAA
  under which 70 million has been transferred from
  FEMA to CMS to fulfill two important activities
  of the NDMS
• CMS will set up a mechanism to reimburse NDMS
  hospitals in 14 metropolitan areas that provided
  short-term inpatient hospital care to patients
  evacuated by NDMS in response to Hurricanes
  Katrina and Rita.
• CMS will provide funding to states that have set
  up uncompensated care funding pools. The states
  will use these funds to pay for medically
  necessary services and supplies provided to
  Katrina evacuees who do not have other coverage
  through insurance, including Medicaid and other
  relief options.
• CMS will give priority to honoring claims under
  the NDMS hospital reimbursement program.
  However, as this program is narrowly targeted to
  certain hospitals and patients, the majority of
  the funding perhaps 40 million or more will
  fund the state-administered uncompensated care
  pools.

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Hospital Reimbursement

• The NDMS agrees to reimburse hospitals for
  inpatient care furnished to NDMS-authorized
  evacuees who have no other insurance coverage.
  NDMS will also reimburse hospitals if an NDMS
  evacuee has only Medicaid or coverage through
  some other federal payer of last resort
• For patients with other federal coverage
  primarily, Medicare or military the hospitals
  bill those programs in accordance with their
  established program rules.
• The hospitals must bill available private
  insurance coverage before billing the NDMS for
  additional payment.
• Medical practitioners furnishing care to
  NDMS-authorized patients during their inpatient
  hospital stays may bill the NDMS in accordance
  with the above, and may be paid in accordance
  with the fee schedule used to pay physicians
  claims under Medicare.
• CMS is establishing a process to review and
  reimburse claims related to these NDMS hospital
  admissions and will provide funding to cover both
  administrative and health claims costs.
• CMS is in the process of hiring an experienced
  claims reimbursement contractor to administer
  these NDMS claims.

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Time Frames

• The NDMS hospital claims reimbursement contract
  should be awarded sometime during the week of
  December 19.
• The contractor will start to set up its NDMS
  claims operation in early January.
• Also in early January, the contractor will
  directly contact the hospitals that accepted NDMS
  patients to address billing issues.
• Both CMS and the contractor will also coordinate
  with the FCCs, as necessary, to develop processes
  for addressing various kinds of issues that may
  arise.
• If everything proceeds well, the contractor could
  begin processing NDMS hospital claims in
  mid-to-late January.

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NDMS Uncompensated Care

• NDMS program funds can be used, once NDMS
  hospitals have been reimbursed, to address
  broader uncompensated medical care needs arising
  from Hurricane Katrina.
• NDMS funds may be used to pay for uninsured
  evacuee medical needs as well as uninsured
  evacuee medical needs that cannot be deferred
  until the time when the normally-available health
  care system returns to operation.
• As of 6 DEC, CMS has approved 17 emergency
  demonstration projects under section 1115 of the
  Social Security Act. Under some of these
  waivers, the states have been allowed to
  establish uncompensated care pools to pay for
  medical care provided to Katrina evacuees who do
  not have health coverage or any other relief
  option.
• The list of states that have received CMS
  approval to establish uncompensated care funds
  may be found at http//www.cms.hhs.gov/katrina/11
  15wvr.asp.
• CMS will be working with these states to
  establish a process for allocating and
  transferring the available NDMS funds to these
  pools.
• Care received by NDMS-evacuated Katrina victims
  in non-hospital settings, as well as care
  received by Katrina victims who were not
  evacuated by the NDMS, may be reimbursable
  through the pools if there is no other relief
  option.

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• Thank you.
• Questions?