Puerto Rico Gov Warns CMS Healthcare System Could Collapse Under Covid-19 Strain these Peak Weeks

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Puerto Rico Gov Warns CMS Healthcare System Could Collapse Under Covid-19 Strain these Peak Weeks

By Caribbean Business on April 15, 2020ShareTweetShareShareShareShare

Requests CMS to Include Hospitals’ MA Revenues in Cares Act

SAN JUAN — Puerto Rico Gov. Wanda Vázquez Garced sent a letter to the administrator of the Centers for Medicare & Medicaid Services (CMS), Seema Verma, urging the agency to include Medicare Advantage (MA) revenues in the definition of “Medicare revenues” for the distribution of Public Health and Social Services Emergency Funds appropriated under the recently enacted Cares Act (PL 116-136).

The MA program in Puerto Rico currently serves more than 585,000 seniors on the island—with the highest participation rate in the U.S., at 75 percent.

As Puerto Rico continues to combat the Covid-19 pandemic, the Puerto Rico Federal Affairs Administration (PRFAA) said in a press release about the letter, “hospitals are at the front and center of the island’s healthcare system and essential to providing an effective response during this emergency.”

The PRFAA further stressed that the governor’s Covid-19 Medical Task Force anticipated the peak of cases on the island would be from April 15 to May 8.

“Thus, it is a priority to provide immediate resources to Puerto Rico’s healthcare system and hospitals,” the release reads. “If Puerto Rico doesn’t receive the necessary funding, the island’s healthcare could collapse from the anticipated strain on the system.”

Hospitals in Puerto Rico are facing much lower than anticipated funds being available from the CARES Act because MA revenues were not included in the definition of “Medicare revenues,” the PRFAA explained.

“While the CARES Act provided resources for the pandemic, it failed to consider the impact of MA enrollment on hospital operating revenues,” the release adds. 

In the letter, the governor requested that within CMS’s discretionary authority, CMS advances advance funds equivalent to the historical Medicare Advantage (MA) reimbursements for services rendered to Medicare-eligible beneficiaries “to remedy this inequity as soon as possible,” as put by the administration.

For Puerto Rico, the CMS formula only applies to approximately 20 percent of hospital reimbursements under the Medicaid Program.

“We urge Administrator Verma, to use CMS’s discretionary authority to provide our hospitals with the necessary resources to continue effectively combating this emergency,” PRFAA Executive Director Jennifer M. Storipan said in the release.

“It is essential that CMS includes the MA revenues in the definition of Medicare Revenues as our hospitals are in dire need of these funds. This would address in the short-term, several challenges of our healthcare system,” Storipan said, stressing that she “our most vulnerable population must have access to quality healthcare, as the COVID-19 continue to disproportionally affect our elderly.”

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