Hurricane Isaias Waivers: A Florida Physician Guide 2026

A family physician in Fort Walton Beach reopens her office this week with a generator on the loading dock, a boil-water notice on the door, and a waiting room that includes two evacuees from Alabama and a Medicare Advantage patient whose plan is asking why a referral went out of network. Each of those encounters is governed by emergency rules signed in Tallahassee and Washington over the past ten days, and most physicians in the affected counties have not read any of them.

On October 14, the Department of Health and Human Services announced that Secretary Robert F. Kennedy, Jr. had determined that a public health emergency exists in Florida and Alabama because of Hurricane Isaias, which made landfall near Destin on October 9 as a Category 2 hurricane. The determination is retroactive to October 6 for Florida, and its practical consequence is a Section 1135 waiver, signed October 13 and effective October 16, that changes licensure, EMTALA, Stark, Medicare Advantage network, and HIPAA obligations for physicians inside the declared area.

What the Federal Waiver Covers

The Section 1135 document, posted by the Administration for Strategic Preparedness and Response, authorizes CMS to waive or modify five categories of requirements in the emergency area. The first is conditions of participation and certification requirements, including pre-approval requirements, which is the category CMS has used after past storms to relax prior authorization and documentation rules. The second is state-specific licensure for physicians who hold an equivalent license in another state and are not barred from practice in Florida. The third is EMTALA sanctions for directing patients to an alternate screening site under a state emergency plan, or for transferring an unstabilized patient when the emergency requires it. The fourth is Stark Law sanctions, to the extent CMS deems appropriate. The fifth lifts the payment limits that normally apply when a Medicare Advantage enrollee is seen out of network.

The waiver also modifies deadlines for providers acting in good faith, and it includes a limited HIPAA waiver that applies only to hospitals under an activated disaster protocol, and only for 72 hours. None of it applies to any action that discriminates based on source of payment or ability to pay.

The Secretary’s waiver is an authorization. CMS implements it through blanket waivers and individual requests, and the Florida Medicare Administrative Contractor publishes the operational guidance, so a physician who relies on a category in the Secretary’s letter without checking what CMS has implemented is taking on risk.

What the State Orders Already Changed

Florida’s rules moved first. Governor DeSantis signed Executive Order 26-202 on October 6, declaring a state of emergency in 25 counties from Escambia east to Columbia and Dixie, and later orders added Citrus and Levy. Under that order and Section 252.358, Florida Statutes, pharmacists in a covered county may dispense an existing refill early, state-regulated insurers must waive their early-refill time limits, and controlled substances other than Schedule II are included. Section 465.0275 separately lets a pharmacist dispense up to a 30-day supply of a maintenance medication when the prescriber cannot readily be reached.

State Surgeon General Joseph Ladapo signed Emergency Order 26-001 on October 7. It extends the one-business-day E-FORCSE reporting deadline by up to 30 days, waives licensure for out-of-state paramedics, EMTs, and their medical directors, and allows out-of-state physicians, social workers, and counselors to provide free services under the American Red Cross or the Department of Health. A separate Surgeon General letter lets essential health care personnel travel under local curfews.

The Agency for Health Care Administration activated its Health Facility Reporting System on October 7 for all 27 counties, and every licensee providing residential or inpatient services must report its status there. The state’s October 10 update counted six evacuations, including one hospital with 12 patients, and the Department of Health has begun preparing dengue messaging for the standing water that will follow.

Why It Matters for Florida Physicians

Emergency waivers are written for hospitals and nursing homes. Physicians in private practice inherit them without being named in them, and that creates two kinds of exposure. The first is the physician who assumes the rules are suspended and bills, refers, or discloses in ways the waiver never authorized. After prior storms CMS has published a specific list of permitted Stark arrangements, and anything outside it remains a violation. The HIPAA waiver reaches hospitals under a disaster protocol and not the physician office, which must still apply the Security Rule to every record it moves to a temporary site.

The second exposure runs the other way. A physician who does not know the Medicare Advantage out-of-network limits have been lifted will turn away a displaced patient who could have been seen. The waiver is retroactive to October 6, so encounters that already happened can be reconciled under it, but only if someone in the practice knows to do so.

The 27-county area also holds thousands of physicians in solo and small groups who were never briefed on which flexibilities apply to them. The Florida Medical Association should ask CMS for a physician-specific waiver summary each time a declaration is signed.

What Florida Physicians Should Do Now

1. Confirm whether your practice sits in one of the 27 counties under Executive Order 26-202 as amended. The waivers attach to the emergency area, not to the storm’s path, so a practice in Leon County is covered even where damage was light.

2. Pull the CMS waiver list for Hurricane Isaias from the CMS emergency response page and from First Coast Service Options before you rely on any category in the Secretary’s letter, and keep a dated copy in your compliance file.

3. Tell your front desk and billing staff that Medicare Advantage out-of-network limits are lifted inside the emergency area, retroactive to October 6, and reprocess any displaced patient turned away or billed out of network since that date.

4. Document every late filing or missed deadline with the date, the storm-related reason, and the waiver provision you relied on. The relief in Section 1135(b)(5) applies to providers acting in good faith, and the record is what proves it later.

5. If you have moved charts or a server to a temporary location, apply the Security Rule as if no emergency existed. The HIPAA waiver covers hospitals under disaster protocol for 72 hours and does not reach a physician office. None of this constitutes legal advice, so a practice with a Stark or HIPAA question should have its health care counsel check the implemented CMS waiver before acting on it.

6. Give local pharmacists a reachable number so the Section 465.0275 emergency dispensing pathway stays the exception rather than the routine.

The Bigger Picture

Isaias came ashore in a part of the state that absorbed Michael in 2018 and Sally in 2020, and the official response was quick, with the presidential declaration on landfall day and the HHS determination five days later. What has not improved is the path by which any of this reaches the physician in a two-exam-room office in Milton or Niceville. Florida’s emergency law treats the physician as a resource to be deployed rather than a licensee to be informed, and until that changes, Panhandle physicians will read the orders themselves and lead their own practices through the gap. The Medicare Advantage withdrawals we reported on October 5 reach many of the same counties in January, and the displaced patients being seen out of network this month are a preview of that problem.

Frequently Asked Questions

Which Florida counties are covered by the Hurricane Isaias emergency waivers?

Executive Order 26-202 named 25 counties: Baker, Bay, Calhoun, Columbia, Dixie, Escambia, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Suwannee, Taylor, Walton, Wakulla, and Washington. Executive Order 26-211 added Citrus and Levy. The federal Section 1135 waiver applies to the area covered by the presidential and public health emergency declarations.

Does the Section 1135 waiver let out-of-state physicians practice in Florida?

The Secretary’s waiver authorizes CMS to waive the requirement that a physician hold a Florida-specific license for Medicare, Medicaid, and CHIP purposes, provided the physician holds an equivalent license in another state and is not barred from practice. State licensure law is separate, and the Department of Health’s Emergency Order 26-001 addresses out-of-state professionals only for free services under the Red Cross or the Department of Health. A paid out-of-state physician should confirm both layers before seeing patients.

Are HIPAA rules suspended for Florida physician offices during the emergency?

No. The limited HIPAA waiver applies only to hospitals that have activated a disaster protocol, covers five specific Privacy Rule provisions, and lasts no more than 72 hours after the protocol begins. Physician offices remain fully subject to the Privacy Rule and the Security Rule, including the minimum necessary standard, although treatment disclosures and disclosures to prevent imminent danger were always permitted.

Can my patients get early prescription refills in the affected counties?

Yes. Under Executive Order 26-202 and Section 252.358, Florida Statutes, pharmacists may dispense an existing refill early to residents of a covered county, and state-regulated insurers must waive early-refill time restrictions. Controlled substances other than Schedule II drugs are included. Pharmacists may also dispense up to a 30-day supply of a maintenance medication under Section 465.0275 when the prescriber cannot readily be reached.

When do the Hurricane Isaias waivers end?

The federal waivers run for the period described in Section 1135(e) of the Social Security Act, which is tied to the presidential and public health emergency declarations. The HIPAA waiver ends 72 hours after a hospital activates its disaster protocol or when the declaration terminates, whichever comes first. The Florida early-refill authority lasts as long as the executive order remains in effect. CMS and the Department of Health announce terminations on the same pages that carry the orders.

This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Sean C. Orr, M.D., who holds full editorial responsibility for its content. The header illustration was created with AI image tools.

References

1. U.S. Department of Health and Human Services, “HHS Declares Public Health Emergencies for Florida, Alabama following Hurricane Isaias,” October 14, 2026. hhs.gov
2. Administration for Strategic Preparedness and Response, “Waiver or Modification of Requirements Under Section 1135 of the Social Security Act … Hurricane Isaias in the States of Florida and Alabama,” signed October 13, 2026. aspr.gov
3. HHS Office for Civil Rights, “Limited Waiver of HIPAA Sanctions and Penalties During a Declared Emergency: 2026 Public Health Emergency for the States of Florida and Alabama as a Result of Hurricane Isaias.” hhs.gov
4. Florida Department of Health, Emergency Orders page listing Executive Order 26-202 (October 6, 2026) and DOH Emergency Order 26-001. floridahealth.gov
5. Florida Board of Pharmacy, “Important Updates Regarding Prescription Refills During Hurricane Isaias.” floridaspharmacy.gov
6. Agency for Health Care Administration, “Hurricane Isaias 2026” emergency preparedness resources, including HFRS activation and the Surgeon General’s health care personnel curfew letter. ahca.myflorida.com
7. Florida Division of Emergency Management, “Governor Ron DeSantis Issues Updates on State Response and Recovery Efforts for Hurricane Isaias,” October 10, 2026. floridadisaster.org
8. Florida Office of the Governor, Executive Order 26-211 (adding Citrus and Levy counties). flgov.com
9. American Hospital Association, “HHS declares public health emergencies for Florida, Alabama following Hurricane Isaias,” October 14, 2026. aha.org
10. CBS News, “Hurricane Isaias makes landfall on Gulf Coast,” October 9, 2026. cbsnews.com
11. AccuWeather live coverage, “At least 4 dead as Isaias leaves widespread damage,” October 10–11, 2026. accuweather.com
12. Centers for Medicare and Medicaid Services, Emergency Response: Hurricanes and Tropical Storms (waiver lists by event). cms.gov