Health New England (“HNE”) is dependent upon the availability of automated information capabilities to serve its customers in an effective manner. HNE utilizes a variety of computer systems that may be vulnerable in the event of a disaster or emergency. The result of a significant outage or a catastrophic event has potential to create a substantive impact to HNE and its members. HNE will ensure that there is continued access to benefits during a public health emergency or disaster. “Disasters” include a:
- Presidential emergency declaration
- Declaration of emergency or disaster by a Governor
- Presidential (major) disaster declaration
- Public health emergency announcement by the Secretary of Health and Human Services
HNE’s Business Continuity Plan is based on the premise of:
- An obligation to continue furnishing access to health benefits and exercise care over resources critical to servicing our members.
- A requirement to comply with the regulations set forth by federal, state, and local agencies.
The business continuity process is designed to recover and restore the core business infrastructure of HNE in the event of a disaster declaration or emergency. HNE maintains a documented plan of responsibilities, processes, actions, guidelines, and critical information necessary to effectively restore services in a timely manner.
HNE’s Medicare Advantage plan must provide access to covered benefits in the following manner:
- Cover Medicare Parts A and B services and supplemental Part C plan benefits furnished at non-contracted facilities
- Waive, in full, requirements for gatekeeper referrals where applicable.
- Provide the same cost-sharing as if the service or benefit had been furnished at an in-network facility.
- Changes that help the member will be effective right away without the 30-day notice requirement.
Typically, the source that declared the disaster will clarify when the disaster or emergency is over. If, however, 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, we will resume normal operations 30 days from the initial declaration. If HNE is not able to resume normal operations after 30 days, we will notify CMS.