Hurricane Katrina creates challenges in handling dislocated residents

CMS offers relief — associations coordinate volunteers

The devastation and human suffering caused by Hurricane Katrina is mind-boggling. While the television and radio talk shows were filled with people blaming each other for the slow federal response, home health agencies joined together to address the needs of patients who found themselves away from their homes, unable to reach their own health care providers, and in some cases, separated from their families.

Within the first week after the storm, staff members at Archbold Home Health Care in Thomasville, GA, were caring for their first displaced home health patient in their area, says Carissa S. Hill, community relations coordinator for the agency. "Our nurse went to the hotel where the patient was staying to perform the initial assessment after we were contacted by the patient," she says.

With no previous medical records and no record of medications, the nurse relied on the patient for information, says Hill. Because a home health agency needs a physician to sign a plan of care and agree to serve as the patient's primary care physician, the nurse found a primary care doctor who agreed to take the patient. "We provided the services we could, but the physician and our nurse agreed that the patient's health care needs were more than we anticipated and the physician admitted the patient to the hospital," she says.

This first patient gave the agency a chance to look at how other evacuees who come into their area in the following weeks will be admitted into service, says Hill. "We have identified a local physician who has agreed to accept and give orders for these patients," she says. "We will also work with family members and the patient to build as complete a medical history as possible."

Ensuring payment for services may require more research for the home health staff, admits Hill. You can find policy numbers and verify coverage by contacting Medicare, Medicaid, and private insurance companies with the names of the patients.

One of the issues that the National Association of Home Care & Hospice (NAHC), as well as the state home care associations in affected states, is addressing is Medicaid reimbursement for providers in other states, says Melanie Golson, executive director of the Alabama Home Care Association in Montgomery.

"We are working with the governors of Mississippi and Louisiana to obtain executive orders that will enable agencies outside of those states to receive payment for care of evacuees from their states," she explains.

While there currently is no executive order, Medicaid offices for Louisiana and Mississippi have relaxed their rules to allow out-of-state providers to register as providers within those two states, reports Golson. "An agency can go to their web sites and register as a provider with Medicaid in the home state of any evacuee for whom they are providing services," she says. (See resources at end of article.)

One difficulty that must be addressed is communications with the state Medicaid agencies to determine how many allowable visits within a period of time already may have been made to the patient, says Golson. "It isn't that Medicaid doesn't want to share the information; it is the sporadic communications that still exist in the storm areas, particularly Louisiana," she says. "People can generally call out from Louisiana, but many times calling into Louisiana gets a recorded message that all circuits are busy," she adds.

The Centers for Medicaid & Medicare Services (CMS) already have taken steps to speed the delivery of care to hurricane victims, she says. "It's good to see that the attitude of CMS is, You take care of the patients, and we'll work out the red tape as we move forward,'" Golson adds.

NAHC has established a special task force to coordinate the home care industry's response to Hurricane Katrina's devastation. In addition to working with CMS, the task force has set up a mechanism to coordinate home care volunteers who want to help in the areas affected by the storm. "We are collecting names of people willing to travel to Mississippi, Louisiana, or Alabama to care for victims," says Mark Marble, office manager of RBC Limited, a Staatsburg, NY-based health care management and consulting company. "In addition to contact information for the volunteer, we ask for their professional or job title, a description of any special training or experience that will be valuable in this situation, and the agency for which they work," he says. (For information on how to volunteer, see resources.)

In the first few days of the database setup, 26 volunteers had signed up, reports Marble. Most were RNs, some with past experience as an emergency medical technician or in an emergency department, but there was also a bereavement counselor and a pharmacist, he says. "At the end of each day, I send the updated file of volunteers to the associations in the state that will be needing volunteers," he adds.

At press time, most volunteers were working at shelters, Golson said. "While we have a number of agencies that are trying to care for patients, it is difficult when patients were evacuated to unknown locations and when some agencies still have employees from whom they've not heard," she says. "As communications are restored and people are able to check in with supervisors, things will become more organized."

Resources

  • For information on Louisiana Medicaid, go to www.dhh.louisiana.gov/offices/?ID=92. Under "Hurricane Katrina Resource for," click on "Providers."
  • For information on Mississippi Medicaid, go to www.dom.state.ms.us/. See hyperlinks for "Important Information for All Providers and Provider Associations RE: Provisions of Essential Services to Medicaid Beneficiaries Displaced by Hurricane Katrina" and "Mississippi Division of Medicaid Emergency Provider Enrollment Form for Out-of-State Providers."
  • To volunteer to work in areas affected by Hurricane Katrina, send an email with your name, contact information, agency, job title, professional designation, and a description of any special training or experience, to rbc@netstep.net.
  • To view updated information on emergency procedures and information about Medicare payment procedures during Katrina regarding patients who were relocated as a result of Katrina, go to www.homecarealabama.org and choose the appropriate link on the home page.
  • For the latest Medicare news related to changes in procedures and requirements for victims of Hurricane Katrina, go to www.cms.hhs.gov/katrina.