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

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

2. 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.

3. 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 patient’s return home.

4. 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

5. 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

6. 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 evacuee’s 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

8. Patient Transports by Start and Destination

9. Transports as of 8 DEC

10. 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?

11. 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.

12. 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.

13. 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.

14. 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/1115wvr.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.

15. Thank you. • Questions?