Declared Emergencies

The Secretary of Health and Human Services has the right to exercise his or her waiver authority under Section 1135 of the Social Security Act if, in addition to a Presidential declaration of a disaster or emergency under the Stafford Act or National Emergencies Act, the Secretary declares a public health emergency under Section 319 of the Public Health Service Act. If an 1135 waiver is issued, CMS will identify all plan requirements and responsibilities. Detailed guidance and requirements for MA plans will be posted on the Department of Health and Human Services site and on the CMS site.

Under the Secretary’s Section 1135 waiver, CMS may authorize DME and A/B MAC’s to pay for Part C-covered services furnished to enrollees and seek reimbursement from Vibra Health Plan for those healthcare services, retrospectively.

In the event of a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, but absent, or prior to the issuance of, a Section 1135 waiver by the Secretary, VHP will:

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

Typically, the source that declared the disaster will clarify when the disaster or emergency is over. If the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if CMS has not indicated an end date to the disaster or emergency, Vibra Health Plan will resume normal operations 30 days from the initial declaration. If Vibra Health Plan cannot resume normal operations after 30 days, CMS will be notified.

If you are a Vibra Health Plan member and your state has issued a warning of a potential emergency or disaster, read the information below.

• If you're not able to go to your usual network pharmacy to replace your prescription drugs, contact us or MyPrime to find another network pharmacy nearby.
• Contact us or MyPrime if you had to leave your home without your drugs, or your drugs have been damaged or lost because of the emergency or disaster.
• If you can't reasonably get to a network pharmacy, Vibra Health Plan or MyPrime can help you get drugs during an emergency or disaster at an out-of-network pharmacy. You may pay more for drugs you get at an out-of-network pharmacy.

• You'll be able to move most prescriptions from one network pharmacy to another, and back to your regular pharmacy when the emergency or disaster ends.
• You'll need to tell the new pharmacy the name of your regular pharmacy and which drugs you need refilled.

Continue to pay your Vibra Health Plan premium on or before it is due.

Contact us to determine replacement of DME or supplies damaged or lost during the emergency or disaster.