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Pursuant to Section 1135(b) of the Social Security Act (the Act) (42 U.S.C. § 1320b-5), I
hereby waive or modify the following requirements of titles XVIII, XIX, or XXI of the
Act or regulations thereunder, and the following requirements of Title XI of the Act, and
regulations thereunder, insofar as they relate to Titles XVIII, XIX, or XXI of the Act, but
in each case, only to the extent necessary, as determined by the Centers for Medicare &
Medicaid Services, to ensure that sufficient health care items and services are available to
meet the needs of individuals enrolled in the Medicare, Medicaid and SCHIP programs
and to ensure that health care providers that furnish such items and services in good faith,
but are unable to comply with one or more of these requirements as a result of the severe
storms and flooding in Indiana, may be reimbursed for such items and services and
exempted from sanctions for such noncompliance, absent any determination of fraud or
abuse:
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Certain conditions of participation, certification requirements, program
participation or similar requirements, or pre-approval requirements for individual
health care providers or types of health care providers, including as applicable, a
hospital or other provider of services, a physician or other health care practitioner
or professional, a health care facility, or a supplier of health care items or
services.
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Requirements that physicians or other health care professionals hold licenses in
the State in which they provide services, if they have a license from another State
(and are not affirmatively barred from practice in that State or any State in the
emergency area).
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Sanctions under section 1867 of the Act (the Emergency Medical Treatment and
Labor Act, or EMTALA) for the redirection of an individual to another location to
receive a medical screening examination pursuant to a state emergency
preparedness plan or transfer of an individual who has not been stabilized if the
transfer arises out of the circumstances of the severe storms or flooding.
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Sanctions under section 1877(g) (relating to limitations on physician referral)
under such conditions and in such circumstances as the Centers for Medicare &
Medicaid Services determines appropriate.
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Limitations on payments under section 1851(i) of the Act for health care items
and services furnished to individuals enrolled in a Medicare Advantage plan by
health care professionals or facilities not included in the plan's network.
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Pursuant to Section 1135(b)(7) of the Act, I hereby waive sanctions and penalties arising
from noncompliance with the following provisions of the HIPAA privacy regulations:
(a) the requirements to obtain a patient's agreement to speak with family members or
friends or to honor a patient's request to opt out of the facility directory (as set forth in 45
C.F.R. § 164.510); (b) the requirement to distribute a notice of privacy practices (as set
forth in 45 C.F.R. § 164.520); and (c) the patient's right to request privacy restrictions or
confidential communications (as set forth in 45 C.F.R. § 164.522); but in each case, only
to the extent necessary, as determined by the Office for Civil Rights, to ensure that
sufficient health care items and services are available to meet the needs of individuals
enrolled in the Medicare, Medicaid and SCHIP programs and to ensure that health care
providers that furnish such items and services in good faith, but are unable to comply
with one or more of these requirements as a result of the severe storms and flooding, may
be reimbursed for such items and services and exempted from sanctions for such
noncompliance, absent any determination of fraud or abuse.
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Pursuant to Section 1135(b)(5), I also hereby modify deadlines and timetables and for the
performance of required activities, but only to the extent necessary, as determined by the
Centers for Medicare & Medicaid Services, to ensure that sufficient health care items and
services are available to meet the needs of individuals enrolled in the Medicare, Medicaid
and SCHIP programs and to ensure that health care providers that furnish such items and
services in good faith, but are unable to comply with one or more of these requirements
as a result of the severe storms and flooding in Indiana, may be reimbursed for such items
and services and exempted from sanctions for such noncompliance, absent any
determination of fraud or abuse.
These waivers and modifications will become effective at 12:00 PM Eastern Standard Time on
June 16, 2008, but will have retroactive effect to June 6, 2008, in the State of Indiana, and
continue through the period described in Section 1135(e). Notwithstanding the foregoing, the
waivers described in paragraphs l(c) and 2 above are in effect for a period of time not to exceed
72 hours from implementation of a hospital disaster protocol, and such waivers are not effective
with respect to any action taken thereunder that discriminates among individuals on the basis of
their source of payment or their ability to pay.
The waivers and modifications described herein apply in the geographic area covered by the
President's declarations, pursuant to the Robert T. Stafford Disaster Relief and Emergency
Assistance Act, on June 8, 2008, of a major disaster in the State of Indiana as a result of severe
storms and flooding; and my June 14,2008, determination, pursuant to section 319 of the Public
Health Service Act, that a public health emergency exists and has existed since June 6, 2008, in
the State of Indiana as a result of severe storms and flooding.
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