Hurricane Sandy Resources on Health Benefits Access- Emergency Rules & Deadlines Extended

The Empire Justice Center has compiled links to Resources for Those Affected by Hurricane Sandy.   Please see that link for information on Immediate/Emergency assistance, legal assistance, Food Stamps, Consumer, Social Security, Medicare, Medicaid, Housing, Immigration, and general information on where to get help.  

• See also Mayor's Release 11/4/2012 listing resources in NYC

Listed below are some links regarding access to Medicare, Medicaid and other health benefits.  Please check the above Empire Justice Center link too which is being updated frequently.

New Nov. 7, 2012 - Medicare Enrollment Period for 2013 Extended Past Dec. 7, 2012 - and Other Medicare Relief

Nov. 7, 2012 - CMS  granted the Medicare Rights Center's request to allow persons affected by Sandy to enroll in Part D or C (Medicare Advantage) outside of the Annual Enrollment Period, which would otherwise end Dec. 7, 2012. (MRC is  following up separately with the Social Security Administration regarding Part A and B enrollments.) There's no time limit for people to enroll.  They just need to call 1-800 Medicare, and explain that they were adversely affected by the hurricane. Individuals don't need to prove that they live in an area affected by Sandy.  The extension also applies to individuals who don’t live in the affected area but rely on help making healthcare decisions from friends or family members who live in the affected areas.

Here is a link to the Medicare Rights Center’s press release about the extended enrollment period for those affected by the hurricane.  Link to CMS Memorandum.

Also on Nov. 7th, CMS reiterated the responsibilities of Part C and D plans during a federal disaster, as outlined in current guidance (Managed Care and Part D Manuals, Benefits and Beneficiary Protections Chapters (section 160 Part C and 50.12 Part D).) As with all disaster declaration, Medicare Advantage plans and Part D sponsors are expected to do the following:

For Part C (Medicare Advantage)

•    Allow Part A/B and supplemental Part C plan benefits to provided at Medicare-certified non-contracted facilities;
•    Waive in full, requirements for gatekeeper referrals where applicable;
•    Temporarily reduce plan-approved out-of-network cost sharing to in-network cost-sharing amounts;  
•    Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost sharing and waiving authorization) benefit the enrollee.

For Part D:

• Ensure enrollees have adequate access to covered Part D drugs filled at out-of network pharmacies when those enrollees cannot reasonably be expected to obtain covered Part D drugs at a network pharmacy, and when such access is not routine.
• Lift their “refill-too-soon” restrictions .
• Allow an affected enrollee to obtain the maximum extended day supply, if requested and available at the time of refill.

Link to CMS Memorandum of Nov. 7th.

For more links re Medicare   see the Empire Justice Center link.

FAIR HEARINGS SCHEDULED in NYC during 2 weeks of Oct. 29th and Nov. 5th  -- will be automatically rescheduled 

• see updates at http://www.otda.ny.gov/oah 
• "If you have a hearing scheduled at Boerum Place in Brooklyn during the week of November 5th through November 9th and you are unable to attend, your hearing will be re-scheduled automatically."
• "If you have aid continue pending the outcome of the hearing, it will continue unaffected."

DEADLINE TO REQUEST FAIR HEARINGS Or FILE ARTICLE 78's SUSPENDED 

Governor Cuomo, on Oct. 31, 2012, has suspended the deadlines for fair hearing requests and legal filings indefinitely under State disaster emergency authority.  http://www.governor.ny.gov/executiveorder/52  

MEDICAID -- 

• TEMPORARY RELOCATION/CLOSING OF NYC MEDICAID OFFICES BECAUSE OF HURRICANE SANDY -

  • As of Thursday,  November 8, 2012 all Medicaid Community Offices with the exception of Bellevue are open.

  • As of March 5, 2013, HRA's Division of Accounts Receivable and Billing office located at 180 Water Street has been re-opened.  Payments for Medicaid spend down may be submitted in person or mailed to the address below:

• 12MA028 - Hurricane Sandy - Fee-for-Service Medicaid Processes During the State of Emergency (10/29/12)

Allows home care and personal care to be provided in disaster emergency shelters, where would otherwise be covered by Medicaid or commercial insurance.  Gives contact info to State personnel.

• 12MA029 - Hurricane Sandy - Authorization and Eligibility Verification Processes During the State of Emergency (10/29/12) 

  • State Dept. of Health relaxing prior authorization requirements for fee for service urgent care services until the State of Emergency has ended (that date to be decided jointly by local county/NYC and the State)

  • Providers will not be required to request computer (eMedNY) authorization to treat enrolled beneficiaries for the provision of urgent services and will be reimbursed accordingly.  

  • In the event that telecommunication failures prevent access to the Medicaid Eligibility Verification System, the Medicaid ID card will suffice as eligibility verification. If access to the eMedNY system prevents real time claim adjudication, pharmacies should dispense emergency supplies as necessary.

• NYC HRA MICSA Medicaid Alert Dated Nov. 2 - Medicaid Coverage Hurricane Sandy (Nov. 2, 2012)

If you are aware of individual case situations caused by Hurricane Sandy that are not covered by these easements we encourage you to bring them to our attention. We will do our best to assist and such cases may help us identify the need for further easements. If you have such situations, please call (212) 273-0047/48 or e-mail Maria Ortiz-Quezada at ortiz-quezadam@hra.nyc.gov.

Please be reminded, however, that almost all Medicaid actions can be completed by phone or mail. Additionally, most Medicaid consumers can renew their Medicaid coverage on-line at ACCESS NYC.

• The relaxation of Medicaid rules and procedures described above occurred in part because the federal Department of Health and Human Services (HHS) has declared a public health emergency in NYS. This means NYS can work with HHS to relax some rules in Medicaid and Medicare to assist health care facilities responding to patient transfers and disaster related needs. See PHE Declaration and Section 1135 Waiver for New York 

Managed Long Term Care & Managed Care --

• The State suspended "auto-assignment" of individuals to managed long term care (MLTC) and mainstream Medicaid managed care (MMC) plans from November 1 - 15th, 2012.   For MLTC, this only affects NYC.  For MMC, the suspension of auto-assignment was statewide because the computer system apparently could only be changed statewide.

For more links re Medicare and other disaster related information, see the Empire Justice Center link. 

Other Benefits --

• SSI Check Delivery After Sandy.  Mail has been delayed in certain areas of NYC and will resume within certain zip codes.  In some areas, delivery of mail will not resume for some time and checks are to be picked up at designated location.  Please see the Postal News Bulletin.

• http://www.mynewyorklegalhelp.com/hurricanesandynyassistance/

Con Edison --  UPDATED 11/21/12- Con Ed has clarified that it will NOT reimburse residential customers for actual losses of food spoiled due to lack of refrigeration due to Hurricane Sandy. There may be some limited circumstances where the power outage was caused by ConEd's own post-storm actions...  

•     See more info at  http://www.coned.com/customercentral/lawclaims.asp
•     Download claim form