The head of the U.S. Department of Health and Human Services (HHS) now has the authority to let a Medicare Advantage plan’s enrollees seek care out of network, if he believes that’s necessary to help an area cope with the Covid-19 pneumonia outbreak.
President Donald Trump included a provision giving HHS Secretary Alex Azar II that authority today, in the new proclamation declaring a national emergency concerning severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19.
- A copy of the emergency proclamation is available here.
- A copy of Social Security Act Section 1135 is available here.
- An overview article about the proclamation is available here.
The main effect of the proclamation is to give the HHS secretary the emergency powers described in Section 1135 of the Social Security Act (SSA).
SSA Section 1135 gives the HHS secretary the authority to waive many different federal requirements to make sure that people in Medicare, Medicaid and other government programs can get health care in an area affected by a national emergency.
Most of the provisions of SSA Section 1135 relate to the federal programs’ relationships with the providers.
One provision, for example, lets the HHS secretary ease Health Insurance Portability and Accountability Act (HIPAA) health information privacy rules.
Another provision lets the HHS secretary have federal programs pay licensed health care providers for services delivered outside the providers’ states of licensure.