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      • Novice Infection Prevention Series
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Emergency Management

Disaster Recovery—Ian

FHA Emergency Management
Florida providers, please contact John Wilgis at (850) 524-2037 for more information and assistance.

Emergency Management Notices

Instructions for Counties Designated by FEMA for Hurricane Ian Disaster

The purpose of this alert is to provide an update to the previous provider alert issued on 9/27/22 regarding Hurricane Ian.
As of 9/29/22, the Federal Emergency Management Agency (FEMA) issued a major disaster declaration for the following Florida counties affected by Hurricane Ian (DR-4673): Brevard, Charlotte, Collier, DeSoto, Flagler, Glades, Hardee, Hendry, Highlands, Hillsborough, Lake, Lee, Manatee, Monroe, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, and Volusia.
The Agency for Health Care Administration (Agency) will ensure reimbursement for all services provided in good faith to eligible Florida Medicaid recipients in FEMA designated counties during the Disaster Grace Period. The Agency is defining the Disaster Grace Period for Hurricane Ian as 9/29/22 through 11/30/22.
All updates in this alert apply ONLY to the FEMA designated counties.
Section A of this alert provides updated policy information and applies to providers rendering services through both the fee-for-service (FFS) delivery system and the Statewide Medicaid Managed Care (SMMC) program, unless otherwise stated.
Section B of this alert provides reimbursement and payment information and applies to services rendered in the FFS delivery system, unless otherwise specified.
Section C of this alert provides additional resources and contact information.
Section A: Policy Information


Services Provided During the Disaster Grace Period
Prior Authorization Requirements
  • Florida Medicaid will waive all prior authorization requirements for Medicaid services with dates of service during the Disaster Grace Period.
    • Exception: all prior authorizations for pharmacy services remain intact.
Limits on Services
  • Florida Medicaid will waive limits on services (specifically related to frequency, duration, and scope) that were exceeded in order to maintain the health and safety of recipients for dates of service during the Disaster Grace Period.
    • Florida Medicaid lifted all limits on early prescription refills during the disaster grace period for maintenance medications, with the exception of controlled substances. The edits prohibiting early prescription refills will remain lifted until further notice by the Agency.
    • Medicaid participating pharmacy providers may provide mobile pharmacy services, when provided in accordance with Department of Health Emergency Order 22-003.
    • Medicaid transportation providers will receive reimbursement for transportation of eligible recipients to medical services, such as chemotherapy and dialysis and inter-facility transfers, when the facilities providing those services remain available. Transportation providers will receive reimbursement for eligible recipients to shelters and other temporary housing when they are displaced from the storm during the Disaster Grace Period.
Provisional Enrollment
  • In order to be reimbursed for services rendered to eligible Florida Medicaid recipients on the dates of service in the Disaster Grace Period, providers not already enrolled in Florida Medicaid (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The process for provisional provider enrollment is located at http://www.mymedicaid-florida.com.
Waived Enrollment for Prescribing Providers
  • Enrollment is waived for providers not already enrolled in Florida Medicaid (out-of-state or in-state) to prescribe non-controlled substances during the Disaster Grace Period if the prescribing provider:
1.      holds a clear and active license
2.      holds a clear and active National Provider Identification (NPI) number
3.      provides services within their scope of practice
Services Provided Outside of the Disaster Grace Period
  • For dates of service beginning 12/01/22, Florida Medicaid (fee-for-service and Medicaid health plans) will return to normal business operations as it relates to the coverage and reimbursement of Medicaid services, except as described below:
    • Florida Medicaid will continue to reimburse for services furnished after the Disaster Grace Period without prior authorization and without regard to service limitations or whether such services are provided by a current Medicaid enrolled provider in those instances where the provider and/or recipient could not comply with policy requirements because of ongoing storm-related impacts. Providers must have rendered services in good faith to maintain the recipient’s health and safety. Examples of such instances include:
      • The provider still does not have access to the Internet or phone services as a result of continued power outages, therefore could not request prior authorization timely;
      • The recipient continues to be displaced and must receive services in a different region of the state or out-of-state; or
      • The recipient’s assigned primary care physician or specialist’s office remains closed due to the storm and urgent care is rendered at another provider’s location without prior authorization.
Section B: Reimbursement Information


General Requirements
The Agency and its Medicaid health plans will implement claims payment exceptions processes for any medically necessary services furnished during the Disaster Grace Period that normally would have required prior authorization, that were rendered by a non-participating provider, or that exceeded normal policy limits for the service.
Providers that furnished services to Medicaid health plan enrollees should work directly with each plan on reimbursement protocols. The Agency is requiring that Medicaid health plans create a web page dedicated to providing detailed instructions to providers for how to seek reimbursement through each Medicaid health plan’s claims payment exceptions process.
Providers that wish to receive payment for services rendered during and outside of the disaster grace period are required to be enrolled with Florida Medicaid or provisionally enrolled with Florida Medicaid prior to submitting claims. For services provided to recipients receiving services through the FFS delivery system, provisional providers should submit claims in accordance with the instructions located at: http://www.mymedicaid-florida.com.
Providers Currently Enrolled with Florida Medicaid
Providers that furnished services to recipients through the FFS delivery system must comply with the requirements below:
  • For services provided during the Disaster Grace Period, providers may submit electronic claims in accordance with normal HIPAA compliant transaction requirements if the service requires a prior authorization number, but prior authorization was not obtained.
  • For services provided during the Disaster Grace Period, providers may submit paper claims as described in the Agency’s exceptional claims process if:
1.      the provider cannot submit electronic claims because of storm-related impacts - or -
2.      service limitations exceeded those stated in the coverage policy or the respective fee schedule.
  • For services provided outside of the disaster grace period because of storm-related impacts (See Section I of the alert), providers may submit paper claims as described in the Agency’s exceptional claims process.
Reimbursement Rates (for services provided during the disaster grace period)
  • Florida Medicaid will reimburse for services provided through the FFS delivery system in accordance with the rates established on the Medicaid fee schedules and the provider reimbursement rates/reimbursement methodologies published on the Agency’s web page. This applies to current enrolled providers and providers that complete the provisional enrollment process.
    • The Agency’s web page includes links to the Diagnosis-Related Groups (DRG) and Enhanced Ambulatory Patient Grouping (EAPG) System rate calculator, which provisionally-enrolled providers can utilize.
  • The Medicaid health plans will reimburse participating network providers for services provided at the rates mutually agreed upon by the provider and the plan in their contract/agreement. The Medicaid health plans will reimburse non-participating providers (i.e., providers not already contracted with the Medicaid health plan), for services provided in accordance with the rates established on the Medicaid fee schedules and the provider reimbursement rates/reimbursement methodologies published on the Agency’s web page, unless otherwise mutually agreed upon by the provider and the Medicaid health plan and otherwise permitted under the contract.
Section C. Additional Information


Maintenance of Supporting Documentation
  • Providers rendering services must maintain as much documentation as possible to help properly and timely adjudicate claims. Nothing precludes the Agency or its Medicaid health plans from conducting retrospective reviews to detect any fraud or abuse.
Agency’s Hurricane Ian Info
  • Additional information for providers is located on the Agency’s website, http://www.ahca.myflorida.com. Click on the Hurricane banner at the top of the page for more information.
Medicaid Contact Center
  • Additional questions from providers may be directed to the Florida Medicaid Contact Center at 1-877-254-1055.

FEMA Individual Assistance Information

Register for an applicant briefing online. Available through Friday, October 14
​​

The Disaster Assistance Improvement Program (DAIP) provides disaster survivors with information, support, services, and a means to access and apply for disaster assistance through joint data-sharing efforts between federal, tribal, state, local, and private sector partners. The Federal Emergency Management Agency (FEMA), under the Department of Homeland Security (DHS), acts as the managing partner for individual assistance (IA) offered through DAIP.
Individuals and households in these designated counties are eligible to apply for financial and direct services. 
  • Charlotte
  • Collier
  • DeSoto
  • Flagler
  • Hardee
  • Highlands
  • Hillsborough
  • Lake
  • Lee
  • Manatee
  • Orange
  • Osceola
  • Pinellas
  • Polk
  • Putnam
  • Sarasota
  • Seminole
  • St. Johns
  • Volusia
​Individuals needing assistance should visit DisasterAssistance.gov for more information. The site allows you to:
  • Find disaster assistance that meets anyone’s personal needs.
  • Learn about more than 70 forms of assistance from 17 federal agencies.
  • Apply for disaster assistance online.
  • Check the status of an application.
  • Find a local FEMA Disaster Recovery Center (DRC).
  • Get help with housing.
  • Find programs to help with food and nutrition needs.
  • Change the address for Social Security, VA, or other federal benefits.
  • Learn about Small Business Administration (SBA) loans for homeowners, renters, and businesses.
Specific information related to Hurricane Ian is available online.
Please share this information with your staff, patients, and visitors as you deem appropriate. We will share more information as it becomes available. Please contact John Wilgis at (850) 524-2037 for questions.

​FEMA Public Assistance Information

Deadline Extended for Hurricane Ian Request for FEMA Public Assistance

The Federal Emergency Management Agency's (FEMA) Public Assistance (PA) Grant Program provides assistance to certain types of private non-profit organizations so that communities can quickly respond to and recover from major disasters or emergencies declared by the president. The application deadline for Requests for Public Assistance (RPA) has been extended to December 2. Application criteria and instructions can be found in our Emergency Management website.

Contact John Wilgis at (850) 524-2037 for questions dealing with recovery from the impact of Hurricane Ian.

​Original Message below.

​The Federal Emergency Management Agency's (FEMA) Public Assistance (PA) Grant Program provides assistance to certain types of private non-profit organizations so that communities can quickly respond to and recover from major disasters or emergencies declared by the president. The State of Florida manages this program for all sub-grants awarded to local eligible jurisdictions and agencies within the State of Florida.
Through the PA Grant Program, FEMA provides supplemental federal disaster grant assistance for debris removal and emergency protective measures. In addition, grant assistance may be provided for the repair, replacement or restoration of disaster-damaged, publicly owned facilities and the facilities of certain private non-profit organizations.
To be eligible for assistance from this grant program, prospective applicants must fill out a Request for Public Assistance (RPA) through the State of Florida’s Public Assistance Web Portal, within 30 days of the Presidential Disaster Declaration.
Private non-profit organizations applying for assistance should be prepared to provide the following when submitting their RPA:
  • A ruling letter from the Internal Revenue Service that was in effect on the declaration date and granted tax exemption under sections 501(c), (d), or (e) of the Internal Revenue Code.
  • Documentation from the State substantiating it is a non-revenue producing, non-profit entity organized or doing business under State law, including law citation.
  • If exempt from both the requirement to apply for 501(c)(3) status and tax-exempt status under State law, articles of incorporation, bylaws, or other documents indicating it is an organized entity and a certification that is is compliant with Internal Revenue Code section 501(c)(3) and State law requirements.
Approved Eligible Work
Public Assistance is categorized into two types of work: Emergency and Permanent. The performance period for Emergency Work Public Assistance Grants is normally within 6 months after the presidential declaration. The performance period for Permanent Work Public Assistance Grants is normally within 18 months after the presidential declaration. The performance period of both types of grants can be extended provided an appropriate request for extension is submitted to the state (grantee) by the local jurisdiction or agency (sub-grantee). Requests for extension of performance period are submitted through the FloridaPA.org website.
A Major Declaration, FEMA-4673-DR, was approved for Hurricane Ian. Amendments to the FEMA-4673-DR have been added to encompass additional Counties eligible for assistance through the FEMA PA Program:
  • FEMA-4673-DR Amendment 1
  • FEMA-4673-DR Amendment 2
  • FEMA-4673-DR Amendment 3
For a period of 30 days from the start of the incident period, FEMA is authorized to provide federal funding for debris removal and emergency protective measures (Categories A and B), including direct federal assistance, at 100 percent of the total eligible costs.
A map reflecting Florida’s Counties approved for eligible work is also available. The Fourth Edition of the Public Assistance Program and Policy Guide (PAPPG) is provided as a reference for your application.
PA Application
A Public Assistance 101 document is available to provide information about the FEMA PA program. This publication is intended for those applying for and/or receiving recovery grants through the FEMA PA program and other recovery and mitigation stakeholders. The Florida Division of Emergency Management also has provided an informational brochure for private non-profits who may be eligible for reimbursement.
To apply for Public Assistance, eligible applicants must be a registered user in FloridaPA.org and submit a Request for Public Assistance (RPA). 
For instructions on becoming a registered user in FloridaPA.org, retrieving lost or forgotten login information for current registered users, and instructions for current registered users to submit a RPA, view Submitting a Request for Public Assistance. RPAs submitted by the Applicant will follow standard review processes by the Recipient and FEMA. The Applicant will be able to view its RPA status in the FEMA Grants Portal. A Request for Public Assistance Quick Guide explains how to create a Public Assistance (PA) Grants Portal user account and submit a Request for Public Assistance (RPA).
Insurance
Applicants must understand insurance as it pertains to Federally Declared disasters and receiving FEMA PA funds. A disaster insurance brochure is provided to help hospital applicants that has received or might receive FEMA PA funds. 
Contact Information
Applicants may contact the Florida Division of Emergency Management, Bureau of Recovery regarding Public Assistance at (850) 815-4400 or by contacting the Melissa Shirah, Chief, Bureau of Recovery at (850) 815-4410.
If you are considering applying for assistance through the FEMA PA Grant Program, please share this information with your team members as you deem appropriate. The FHA will continue to provide more information as it becomes available. Please contact John Wilgis at (850) 524-2037 for questions.

AHCA's Health Facility Reporting System

Facilities must report status updates by 10:00 a.m. EST Daily​
Pursuant to Section 408.821(4) Florida Statute, the Agency for Health Care Administration (AHCA), in partnership with the Florida Department of Health (FDOH), is requesting all health care providers report their statuses for Ian regarding census, available beds, evacuation status, and generator status information into the Health Facility Reporting System by 10:00 am, ET daily and when your situation changes until further notice. Accurate data and timely participation will help ensure we have up-to-date information for your facility.
  • Health Facility Reporting System (HFRS)
  • AHCA HFRS Website
​
​
When reporting your generator status, remember that the question "generator currently running" should only be answered yes if you have lost power and have your generator providing power at the time you are reporting. You will only be able to report your generator status if you have added your generator details in the "Generators" section; please ensure all details are entered. 

If you require assistance reporting information into the system for your facility, please get in touch with your AHCA Hospital and Outpatient Services Unit at (850) 412-4549 during regular business hours from 08:00 am to 05:00 pm, ET.

The Agency has also provided a list of emergency preparedness resources for providers on its website.

Medicaid Non-Emergency Transportation
How to Access Non-Emergency Medical Transportation
If you are a Florida Medicaid recipient enrolled in a managed care plan and need assistance with non-emergency medical transportation, please contact your health plan’s transportation provider. Click here for a list of the transportation provider phone numbers listed by plan.
If you are a Florida Medicaid recipient and do not receive your Medicaid benefits through a managed care plan and need medical non-emergency transportation, contact Modivcare if you live in regions 1,2,9,10 or 11 at 866-726-1457. If you live in regions 3,4,5,6,7 or 8 contact MTM at 844-239-5974. For help locating your region, please click here for the region map.


Hospital Updates

Healthcare Ready
  • Hurricane Ian Situation Report #14

Lee Health
  • Lee Health Location Closures - At this time, most of our Lee Physician Group and outpatient locations are open or will be open as of Wednesday, Oct. 12, 2022.

Sarasota Memorial Healthcare System
  • Blood Donors Needed - With other hospitals in our area are caring for an influx of patients from S. FL. We are in need of blood supplies, now more than ever, for patients seeking emergency care. Donating blood is one of the ways you can help our community during this crisis.

HCA Healthcare
  • HCA Re-openings - Cape Coral freestanding emergency room now re-opened. 
  • The HCA Healthcare Hope Fund is a colleague-run, colleague-supported 501(c)(3) charity that helps HCA Healthcare colleagues through unexpected crises, disasters and other challenging situations. If you are a colleague impacted by Hurricane Ian, visit the Hope Fund website to learn more and submit an application to request assistance. Apply for help here.

Executive Orders

  • Executive Order 22-219, expanding the state of emergency to include all 67 counties in Florida.
  • Executive Order 22-218, declaring a state of emergency for 24 counties in the path of Tropical Depression 9

Regulatory Updates

Florida Agency for Health Care Administration (AHCA) 
  • Ian Website - health care facilty updates, regulatory information, Medicaid updates and more.
  • Hurricane Ian Medicaid Resources -  resources and information available to assist recipients and providers with Medicaid issues during the emergency.
Florida Department of Health (FDOH)
  • Emergency Order DOH No. 22-005 was issued by the State Surgeon on Wednesday, October 5. 
  • State Surgeon General Letter addressed to Local Law Enforcement Partners for use by essential healthcare personnel when traveling outside established curfew
  • DOH No. 22-003, which affects Mobile Pharmacies, Prescription Drug Monitoring Reporting Renewal Extension issued by DOH on September 28, 2022.
Centers of Medicare & Medicaid Services (CMS) Ian Resources Announcement
  • Click here for additional resources and flexibilities available in response to Ian. The CMS 1135 Blanket waivers can be found here. 
  • COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

State Actions

Governor DeSantis
Governor Ron DeSantis Issues Updates on Hurricane Ian Recovery - on October 11, 2022
Governor Ron DeSantis Announces Major Update on Power Restoration Efforts on Sanibel Island - on October 11, 2022

Federal Actions

President Joseph R. Biden, Jr. approved an Emergency Declaration for Florida
  • FEMA announced that federal emergency aid has been made available to the state of Florida to supplement the state, tribal and local response efforts due to emergency conditions resulting from Tropical Storm Ian beginning Sept. 23 and continuing.
HHS Secretary Becerra Declares Public Health Emergency for Florida in Response to Tropical Storm Ian
  • he declaration follows President Biden’s emergency declaration and gives the Centers for Medicare & Medicaid Services (CMS) beneficiaries and their health care providers and suppliers greater flexibility in meeting emergency health needs.

Resources

Federal Emergency Management Agency (FEMA)
For the latest information, alerts and updated visit https://www.disasterassistance.gov/.
  • Emergency Non-Congregate Sheltering
  • Grants Portal Account and Request for Public Assistance
  • Help After Disaster English Trifold
  • Help After Disaster Spanish Trifold
  • ​Who’s Knocking at Your Door?
  • Disaster Recovery Resources
  • FDOT Situation Report​​

​Florida Division of Emergency Management (FDEM) Disaster
  • Florida Disaster Fund—In response to impacts from Hurricane Ian, Volunteer Florida has activated the Florida Disaster Fund. The Florida Disaster Fund is the State of Florida's official private fund established to provide financial assistance to our communities as they respond to and recover from times of emergency or disaster. In partnership with public, private, and other non-governmental organizations, the Florida Disaster Fund supports response and recovery activities.
    Donations to the Florida Disaster Fund are made to the Volunteer Florida Foundation, 501(c)(3) charitable organization, and are tax-deductible. To contribute, please visit https://www.volunteerflorida.org/donatefdf/ or text DISASTER to 20222.
  • Preparedness Maps – Evacuation Zones and Routes, and Storm Surge Maps 

Florida Department of Health
  • County Emergency Preparedness Planner Staff List
  • The FDOH Emergency Support Function (ESF) 8 phone number is 850-445-1380.
    This is the direct line to the Department of Health emergency support function room at the state EOC - If a member cannot reach their county emergency operations center to request assistance, they can call the ESF-8 number to make a request for evacuation assistance.
    The list of County Emergency Managers is here: https://www.floridadisaster.org/globalassets/maps/em_managers.pdf

Administration for Strategic Preparedness and Response (ASPR) Resources 
As of September 28, 253 pharmacies in Florida are reported as closed due to impacts from Hurricane Ian. Pharmacy status is available through RxOpen.
  • ASPR TRACIE Hurricane-Related Resources Page to prepare for, respond to, and recover from hurricanes and flooding.
  • After the Flood: Mold-Specific Resources
  • Disaster Behavioral Health Resources 

​Contact information for Utility Partners and Power Outage Update:
  • Florida Power Outages Map
    https://poweroutage.us/area/state/florida​
  • FPL – Online reporting  here
    Call to Report - 800-4OUTAGE  (800-468-8243)
    FPL App for iPhone and Android
  • Duke Energy - Online Reporting here
    Call to Report - 800-228-8485
    Duke Energy App for iPhone and Android
    TEXT “OUT” to 57801 to report
    Contact at Duke Energy, Michele Cavallo, Florida Director, Business Markets at Duke Energy - 727-698-0204 michele.cavallo@duke-energy.com
  • TECO - Online Reporting here
    Call to Report 877-588-1010
    Text “OUT” to 35069 or “UPDATE” to 35069 to receive messages
  • JEA – Jacksonville Electric Authority- Online Reporting here
    Call to Report (904) 665-6000

Florida Department of Transportation (FDOT)
  • ​Road Monitoring (FL511)
  • Traffic Updates from FloridaDisaster.org
  • Live road closure tracking
  • Statewide Private Sector Re-Entry Program
  • ​The GasBuddy Fuel Availability Tracker has been activated in response to Hurricane Ian impacts.
  • Ian Toll Suspension 

Dialysis Patient Assistance ​
  • Open/Closed Dialysis Facilities (10/11/2022)
  • Dialysis Patient Assistance Hotlines

News Clips

  • Hurricane Ian’s death toll rises as crews in Florida go door-to-door in search for survivors in decimated neighborhoods – CNN
  • Hospitals struggle with evacuations, lack of water in Hurricane Ian’s wake – Health Care Dive
  • Hurricane Ian rips part of roof off Florida hospital – Roofing Journal
  • Ian gone, but rescuers still saving Floridians – Arkansas Democrat-Gazette
  • Even 'relatively weak' hurricane could sideline hundreds of coastal hospitals, study warns – Fierce Healthcare
  • How hospitals prepare for and respond to hurricanes in Florida – FOX Weather
  • Florida hospitals are struggling to provide care to patients after Hurricane Ian – NPR
  • Another Challenge for Hardest-Hit Parts of Florida: Finding Clean Drinking Water – NY Times
  • Hospitals face evacuations, water disruptions amid Ian: 3 updates – Becker’s Hospital Review 
  • Hospitals report evacuations, lockdowns and water outages as Florida reels from Ian – NBC News 

Disasters can happen at any time and hospitals serve as a valuable resource by preparing their staff, facilities and the community for an emergency. Through workshops, training and strategic partnerships, the Florida Hospital Association equips hospitals with the knowledge and tools to effectively prepare for and manage an emergency.
Emergency Resources
The Florida Hospital Association (FHA) provides a strong, effective voice for Florida's hospital community, advocating to improve access to affordable, quality health care for all Floridians.
 
FHA serves as the Florida Department of Health's organizational lead for hospital response in times of disasters and in preparing for any public health emergency. FHA's emergency response team staffs the state emergency operations center to deliver real-time response to impacted hospitals. FHA coordinates the safe movement and placement of patients and serves as a communication hub for critical information to members while working with our federal and state partners to ensure Florida's hospitals have the resources they need in time of crisis.
​
Planning Resources
  • FHA Hospital Emergency Evacuation Toolkit
  • FHA Hospital Disaster Mutual Aid Information and Resources
  • FHA Emergency Volunteer Management Planning Considerations and Resources​

Meeting Archive

FHA EMResource Training - August 5, 2021
  • Recording

FHA eICS Super User Training - July 15, 2021
  • Recording

Exclusive Discussion with State Surgeon General Concerning J&J Vaccine and COVID-19 Variants ​- April 13, 2021
  • Recording
  • Slides

Operation Warp Speed: Convalescent Plasma (CCP) Collection Q&A Session - November 16, 2020
  • Slides

Planning for a Tropical Storm Response in the Middle of a Pandemic - June 23, 2020
  • Slides

An Overview of AHCA's Emergency Status System (ESS) - June 18, 2019
  • Slides

​Expanding Hospital Participation in Florida's Federal Coordinating Centers - May 29, 2019
  • Slides

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