Hurricane Isaias emergency loosens Medicare Advantage and refill rules for Florida practices

The federal public health emergency declared after Hurricane Isaias gives Florida practices a list of Medicare waivers, but the telehealth items at the top of that list change little. The flexibilities that matter more for physician offices are in Medicare Advantage network rules, prescription refill limits and equipment replacement.

HHS Secretary Robert F. Kennedy Jr. declared the emergency Oct. 13, retroactive to Oct. 6 in Florida, according to the HHS announcement. The determination followed President Donald Trump's Oct. 9 emergency declaration. Isaias made landfall near Destin at about 9:30 p.m. Oct. 9 as a Category 2 hurricane with 105 mph winds. The state emergency covers 27 counties, according to Gov. Ron DeSantis' office.

Telehealth waivers mostly duplicate current law

CMS' waiver list, published Oct. 15, allows audio-only equipment for telephone evaluation and management services and for behavioral health counseling. It also lifts limits on where Medicare patients can receive telehealth, including at home. Practices already have most of that. The Consolidated Appropriations Act, 2026, extended Medicare's home originating site, geographic and audio-only flexibilities through Dec. 31, 2027, as Medical Economics reported. The blanket waivers apply automatically, and practices do not need to file for them.

Medicare Advantage network rules relax

For physician offices, the bigger change is in Medicare Advantage. Once a disaster is declared, federal rules at 42 CFR 422.100(m) require MA plans to cover Part A and Part B services at non-contracted providers, waive referral requirements and charge in-network cost sharing. Optimum HealthCare's Isaias notice lists those terms for members in Citrus, Hillsborough, Pasco and Pinellas counties, for example.

That means a practice outside a displaced patient's network may be able to see that patient at in-network cost sharing while the declaration lasts. Before front desk staff turn a patient away or quote out-of-network costs, they should check the plan's disaster notice.

Refill limits lift under state and federal rules

Florida law loosens refill limits as well. Executive Order 26-202 triggers section 252.358, Florida Statutes. Under that section, health insurers, managed care organizations and pharmacy benefit managers must suspend "refill too soon" edits and pay for at least a 30-day supply when refills remain, according to an Oct. 7 notice from the Office of Insurance Regulation. The waiver covers refills requested within 30 days, and the office can extend it in 15- or 30-day increments. State officials also said the Agency for Health Care Administration lifted early refill edits for Medicaid maintenance medications, a flexibility that excludes controlled substances.

On the federal side, CMS expects Part D plans to cover out-of-network pharmacy fills for displaced enrollees and to remove refill-too-soon edits for patients who lost their medications. Medicare patients who lost or damaged durable medical equipment, prosthetics, orthotics or supplies in the storm can get replacements by calling 1-800-MEDICARE.

People in HealthCare.gov states, including Florida, who missed an enrollment window because of a FEMA-declared disaster can qualify for a special enrollment period. It runs up to 60 days after the incident period ends.

What the emergency does not cover

Practices should not count on HIPAA relief. CMS said the limited waiver of HIPAA sanctions applies to hospitals that have put a disaster protocol in place, and only for up to 72 hours.

Practices in affected counties should save the CMS waiver list and brief front desk staff on MA plans' disaster terms. They should also document visits tied to the storm, especially out-of-network MA encounters. A practice that needs flexibility beyond the blanket waivers can submit CMS' 1135 waiver request form.

The blanket waivers remain in effect through the end of the public health emergency or until they are no longer needed. CMS has urged providers to return to normal operations as soon as possible.