Monkeypox Prevention and Control

Monkeypox Fact Sheet The World Health Organization declared the monkeypox outbreak a global health emergency, as the number of confirmed cases has increased to over 30,000 across 88 countries, with more than14,000 cases in the U.S. On August 4, 2022, President Biden declared monkeypox a national public health emergency. Although patients infected with monkeypox may…

Feds Extends American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

  • States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services

On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports.

As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. Section 9817 of the American Rescue Plan provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS — an estimated $12.7 billion. As a result of the ARP increase in the federal matching rate on activities, states originally had a three-year period — from April 1, 2021 through March 31, 2024 — to use the available state funds, attributable to the ARP’s increased FMAP, on activities to enhance, expand, or strengthen HCBS in Medicaid. The extended timeframe, of an additional year, will help to facilitate high-quality, cost-effective, person-centered services for people with Medicaid. This will allow Medicaid beneficiaries to remain in the setting of their choice—whether it is their home or another setting—and remain a valued part of their communities.

This ARP funding allows states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues. It will also help expand states’ capacity to provide critical services and meet the needs of family caregivers and people on HCBS waitlists. Moreover, states can use these funds to tailor HCBS activities based on the needs and priorities of their residents. For example, states can use the funds to provide additional support to address the continued impact of the COVID-19 pandemic on individuals who need long-term services and supports, who are at higher risk for contracting COVID-19, and who might otherwise be in more costly nursing homes and other institutions instead of their own homes. Some states are also using the funds to increase pay and benefits for direct service workers, which many states were unable to do before the ARP funding increase due to funding shortages and restrictions.

“Everyone deserves the dignity to live in their own homes and communities, and the Biden-Harris Administration is committed to protecting that right,” said HHS Secretary Xavier Becerra. “Thanks to extended funding from President Biden’s American Rescue Plan, we are expanding home- and community-based services for millions of aging Americans and people with disabilities across the country. We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce.”

“With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities,” said CMS Administrator Chiquita Brooks-LaSure.

The COVID-19 pandemic has exposed the risks of institutional and congregate settings for older Americans and people with disabilities, underscoring the urgent need to expand access to high-quality HCBS to improve outcomes for people who need long-term services and supports. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

Critical safeguards are in place through the ARP legislation and CMS’ guidance to certify that these funds are used appropriately. Between now and the March 2025 deadline, CMS will continue to monitor states’ progress and compliance to ensure funding is used to strengthen HCBS under their Medicaid program.

Additional information on states’ spending plans — including a recently updated infographic summarizing planned activities and key investments — can be found at Medicaid.gov https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

To review the guidelines for the use of the ARP funds, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

To review the State Medicaid Director Letter extending the spending deadline, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd22002.pdf.

Feds Extend American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

  • States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services

On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports.

“This is very good news,” said NAHC President William A. Dombi. “The ARPA funds are desperately need in Medicaid HCBS but using those founds properly has been a complex undertaking for the states. The added time to use the funds is very welcome.”

As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. Section 9817 of the American Rescue Plan provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS — an estimated $12.7 billion. As a result of the ARP increase in the federal matching rate on activities, states originally had a three-year period — from April 1, 2021 through March 31, 2024 — to use the available state funds, attributable to the ARP’s increased FMAP, on activities to enhance, expand, or strengthen HCBS in Medicaid. The extended timeframe, of an additional year, will help to facilitate high-quality, cost-effective, person-centered services for people with Medicaid. This will allow Medicaid beneficiaries to remain in the setting of their choice—whether it is their home or another setting—and remain a valued part of their communities.

This ARP funding allows states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues. It will also help expand states’ capacity to provide critical services and meet the needs of family caregivers and people on HCBS waitlists. Moreover, states can use these funds to tailor HCBS activities based on the needs and priorities of their residents. For example, states can use the funds to provide additional support to address the continued impact of the COVID-19 pandemic on individuals who need long-term services and supports, who are at higher risk for contracting COVID-19, and who might otherwise be in more costly nursing homes and other institutions instead of their own homes. Some states are also using the funds to increase pay and benefits for direct service workers, which many states were unable to do before the ARP funding increase due to funding shortages and restrictions.

“Everyone deserves the dignity to live in their own homes and communities, and the Biden-Harris Administration is committed to protecting that right,” said HHS Secretary Xavier Becerra. “Thanks to extended funding from President Biden’s American Rescue Plan, we are expanding home- and community-based services for millions of aging Americans and people with disabilities across the country. We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce.”

“With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities,” said CMS Administrator Chiquita Brooks-LaSure.

The COVID-19 pandemic has exposed the risks of institutional and congregate settings for older Americans and people with disabilities, underscoring the urgent need to expand access to high-quality HCBS to improve outcomes for people who need long-term services and supports. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

Critical safeguards are in place through the ARP legislation and CMS’ guidance to certify that these funds are used appropriately. Between now and the March 2025 deadline, CMS will continue to monitor states’ progress and compliance to ensure funding is used to strengthen HCBS under their Medicaid program.

Additional information on states’ spending plans — including a recently updated infographic summarizing planned activities and key investments — can be found at Medicaid.gov https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

To review the guidelines for the use of the ARP funds, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

To review the State Medicaid Director Letter extending the spending deadline, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd22002.pdf.

Feds Extend American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year…

New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests

The Biden administration is announcing today that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to Food and Drug Administration (FDA) approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. People with Medicare can get up to eight tests per calendar month…

UPDATE! Current Status of the Federal Vaccine Mandates

The status of the COVID-19 vaccine mandates from the Centers for Medicare & Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) vaccine mandates continue to evolve with extensive ongoing litigation and policy adjustments by the respective federal agencies. NAHC’s outside employment law counsel, Polsinelli, has prepared a detailed memorandum setting forth the status of the mandate rules and policy.

It looks like that the ultimate outcome will lie in the hands of the U.S. Supreme Court in the near term. The Court has ordered expedited briefing on the emergency petitions pending before the Court following several Court of Appeals rulings.  That generally means we may see some preliminary decisions from the Court early in 2022.

Meanwhile, NAHC continues to advise members to be prepared for implementation and enforcement of the CMS and OSHA requirements, although holding off on termination or suspension of staff that are not compliant. Also, it is essential that you keep in mind state and local requirements relative to a vaccine mandate or other infection control measures.

We urge you to read the entire memo.

From Polsinelli

Authors: Angelo Spinola & Will Vail

On November 4, 2021, the Biden Administration made three vaccine mandate announcements. Since then, there has been robust litigation bringing these mandates into question. This updated memo will detail these announcements, offer ideas on how to determine their impact (if any) on your business and tell you about some solutions we have created.

One of the announcements came from the Occupational Safety and Health Administration (OSHA). It announced a new Emergency Temporary Standard (ETS) that gives “large” employers the option of requiring vaccinations or allowing employees to test weekly for COVID-19. The Centers for Medicare & Medicaid Services (CMS) also simultaneously issued an Interim Final Rule that requires covered providers to implement a mandatory vaccination policy for “staff” to keep safe those who are receiving care. And finally, the Biden Administration pushed back the compliance date for federal contractors to January 18, 2022 (meaning the second of two shots would need to be administered by January 4, 2022).

Read the entire memo.

UPDATE! Current Status of the Federal Vaccine Mandates

The status of the COVID-19 vaccine mandates from the Centers for Medicare & Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) vaccine mandates continue to evolve with extensive ongoing litigation and policy adjustments by the respective federal agencies. NAHC’s outside employment law counsel, Polsinelli, has prepared a detailed memorandum setting forth the…

Build Back Better Passes the House of Representatives

  • Here is what it means for NAHC members and their patients

The Build Back Better Act, a signature legislative priority for the Biden administration and its allies in Congress, passed the House of Representatives this morning on a party line vote of 220-213. The legislation now heads to the Senate for consideration.

The Build Back Better Act (BBB) is a roughly $1.7 trillion social spending package that, among other things, creates new Medicare benefits for hearing services and enables the government to negotiate some prescription drug prices to lower the costs that seniors pay for lifesaving medicines such as insulin.

The legislation also contains substantial implications for the future of home and community-based services in the United States, as well as training and development of the direct care workforce.

“Today’s historic vote of support for home care comes at a time when the country needs it more than ever,” said NAHC President William A. Dombi, moments after the vote in the House. “Health care at home is widely recognized as high value, high quality, and highly preferred. From pediatric nursing care to home care aide services for those with multiple chronic illnesses as they age, this legislation will provide improved access to home care. We now look to the Senate to complete the work to protect our families and friends who need this essential care. “

NAHC has analyzed the legislation to see how it will impact our members and the wider home care and hospice community.

  • Bill text can be found HERE
  • A section-by-section overview of the bill’s provisions can be found HERE

The BBB bill is the cornerstone of President Biden’s and congressional Democrats’ domestic agenda. Initially proposed spending targets for the package were around $3.5 trillion, but lack of Democratic consensus on the topline figure and scope, as well as narrow margins for Democrats in both the House and Senate forced lawmakers to shrink the overall size and ambition of the bill. This legislation will impact nearly every sector of American society, and there are a number of policies with direct relevance for home health, home care, and hospice providers, some of which are NAHC advocacy priorities.

Below is background information on some of those most consequential policies included in the House BBB legislation:

Medicaid Home and Community-Based Services (HCBS) Investment (“Better Care Better Jobs Act”)

  • $150 billion investment to bolster Medicaid HCBS, with the goal of increasing access to services, reducing waitlists, and better supporting the direct care workers that provide the bulk of HCBS. Specifically, the approved language would:
    • Provide a 6% FMAP increase for HCBS;
    • Require coverage of personal care services;
    • Require caregiver supports such as respite care;
    • Require updated of payment rates that “support the recruitment and retention of the direct care workforce”;
    • Require an update of HCBS payment rates at least every three years;
    • Make permanent the protections against spousal impoverishment for recipients of Medicaid HCBS;
    • Make permanent the Medicaid Money Follows the Person (MFP) demonstration that helps those in institutional facilities transition back to the community.
      • See the legislative language for this provision HERE
      • See an overview of the provision HERE

Direct Care Worker Training and Support Investments

  • $400 million/yr for FY2023-2026 for a grant-based program that would bolster frontline caregivers’ access to economic and educational supports. These grants would go to states and territories, to be spent on things like worker wage subsidies, student loan repayment or tuition assistance for a degree or certification in a relevant field, childcare for eligible workers, and transportation assistance, amongst other approved activities that benefit direct care workers. The bill makes clear that aides working in home health, personal care, and hospice, as well as LPNs and LCSWs, are eligible to receive support under these grants.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $1 billion over 10 years for a separate program to support the direct care workforce through renewable three-year grants administered by the Dept of Labor. Grants can be used to invest in strategies to recruit, retain, and advance the direct care workforce; implement models and strategies to make the field of direct care more attractive; and improve wages, including through training and registered apprenticeships, career pathways, or mentoring.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $20,000,000 to fund a national technical assistance center through HHS’ Administration for Community Living which will develop and disseminate evidence-based strategies for recruitment, education and training, retention, and career advancement of direct care workers and provide recommendations for activities to further support paid and unpaid family caregivers.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Additional Health Workforce Investments

  • $400 million for the Health Profession Opportunity Grant (HPOG) program, which awards grants to organizations to provide education and training to low-income individuals for occupations in the health care field that are expected to either experience labor shortages or be in high demand. Home care and home health aides are identified as being HPOG-eligible professions.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Paid Family and Medical Leave

  • Starting in January 2024, all workers would be eligible for up to four weeks of paid leave for new parents, workers dealing with their own serious medical conditions, and workers who need leave to care for a loved one with a serious medical issue. Benefits would be progressive, with lower-income workers receiving higher levels of wage replacement. Wage replacement would be about two-thirds for the average worker.
    • See the legislative language for this provision HERE

Increases in OSHA Fine Amounts

  • Amends the Occupational Safety and Health Act of 1970 to:
    • Increase the maximum penalty to $700,000 for willful and repeat violations (current penalty is $136,532);
    • Increase the minimum penalty to $50,000 for willful violations (current penalty if $9,753);
    • increase the maximum penalty for both serious and failure-to-abate violations to $70,000. (current penalties are $13,653);
  • See the legislative language for these provisions HERE

The bill also includes a number of provisions that would:

  • Expand Medicaid coverage;
  • Lower prescription drug costs;
  • Extend ACA marketplace health plan subsidies;
  • Add hearing coverage to the Medicare program;
  • Invest tens of billions of dollars in bolstering public health infrastructure and training;
  • Boost funding by over $1 billion for Older Americans Act (OAA) programs that support older adults and family caregivers;
  • Provide $40 million in funding for programs to support family caregivers’ mental health and well-being;
  • Provide $500 million in new grant funding to support medical-legal partnerships (programs that integrate patient-centered legal services into health care settings to address their patient and families’ health-related social needs).

Major health and care-related provisions that were not incorporated into the House bill include:

  • A separate tax credit for family caregivers (A NAHC policy priority issue);
  • New Medicare dental and vision benefits.

As negotiations over the legislation move to the Senate, NAHC will continue to advocate for polices that will benefit patients, families and the home-based providers that care for them. We are closely tracking the movement on this massive bill, and will be updating members on relevant developments as they arise. Stay tuned to NAHC Report for updates.

Build Back Better Passes the House of Representatives

  • Here is what it means for NAHC members and their patients

The Build Back Better Act, a signature legislative priority for the Biden administration and its allies in Congress, passed the House of Representatives this morning on a party line vote of 220-213. The legislation now heads to the Senate for consideration.

The Build Back Better Act (BBB) is a roughly $1.7 trillion social spending package that, among other things, creates new Medicare benefits for hearing services and enables the government to negotiate some prescription drug prices to lower the costs that seniors pay for lifesaving medicines such as insulin.

The legislation also contains substantial implications for the future of home and community-based services in the United States, as well as training and development of the direct care workforce.

“Today’s historic vote of support for home care comes at a time when the country needs it more than ever,” said NAHC President William A. Dombi, moments after the vote in the House. “Health care at home is widely recognized as high value, high quality, and highly preferred. From pediatric nursing care to home care aide services for those with multiple chronic illnesses as they age, this legislation will provide improved access to home care. We now look to the Senate to complete the work to protect our families and friends who need this essential care. “

NAHC has analyzed the legislation to see how it will impact our members and the wider home care and hospice community.

  • Bill text can be found HERE
  • A section-by-section overview of the bill’s provisions can be found HERE

The BBB bill is the cornerstone of President Biden’s and congressional Democrats’ domestic agenda. Initially proposed spending targets for the package were around $3.5 trillion, but lack of Democratic consensus on the topline figure and scope, as well as narrow margins for Democrats in both the House and Senate forced lawmakers to shrink the overall size and ambition of the bill. This legislation will impact nearly every sector of American society, and there are a number of policies with direct relevance for home health, home care, and hospice providers, some of which are NAHC advocacy priorities.

Below is background information on some of those most consequential policies included in the House BBB legislation:

Hospice and Palliative Care Training Support

  • $90 million for various investments to train, educate, and bolster the specialty hospice and palliative care provider workforce, including $25 million in funding for broad-based palliative care and hospice education and training, $20 million for palliative medicine physician training, $20 million for palliative care and hospice academic career awards, $20 million for hospice palliative care nursing, and $5 million for dissemination of palliative care information.
    • See the legislative language for this provision HERE

Medicaid Home and Community-Based Services (HCBS) Investment (“Better Care Better Jobs Act”)

  • $150 billion investment to bolster Medicaid HCBS, with the goal of increasing access to services, reducing waitlists, and better supporting the direct care workers that provide the bulk of HCBS. Specifically, the approved language would:
    • Provide a 6% FMAP increase for HCBS;
    • Require coverage of personal care services;
    • Require caregiver supports such as respite care;
    • Require updated of payment rates that “support the recruitment and retention of the direct care workforce”;
    • Require an update of HCBS payment rates at least every three years;
    • Make permanent the protections against spousal impoverishment for recipients of Medicaid HCBS;
    • Make permanent the Medicaid Money Follows the Person (MFP) demonstration that helps those in institutional facilities transition back to the community.
      • See the legislative language for this provision HERE
      • See an overview of the provision HERE

Direct Care Worker Training and Support Investments

  • $400 million/yr for FY2023-2026 for a grant-based program that would bolster frontline caregivers’ access to economic and educational supports. These grants would go to states and territories, to be spent on things like worker wage subsidies, student loan repayment or tuition assistance for a degree or certification in a relevant field, childcare for eligible workers, and transportation assistance, amongst other approved activities that benefit direct care workers. The bill makes clear that aides working in home health, personal care, and hospice, as well as LPNs and LCSWs, are eligible to receive support under these grants.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $1 billion over 10 years for a separate program to support the direct care workforce through renewable three-year grants administered by the Dept of Labor. Grants can be used to invest in strategies to recruit, retain, and advance the direct care workforce; implement models and strategies to make the field of direct care more attractive; and improve wages, including through training and registered apprenticeships, career pathways, or mentoring.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $20,000,000 to fund a national technical assistance center through HHS’ Administration for Community Living which will develop and disseminate evidence-based strategies for recruitment, education and training, retention, and career advancement of direct care workers and provide recommendations for activities to further support paid and unpaid family caregivers.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Additional Health Workforce Investments

  • $400 million for the Health Profession Opportunity Grant (HPOG) program, which awards grants to organizations to provide education and training to low-income individuals for occupations in the health care field that are expected to either experience labor shortages or be in high demand. Home care and home health aides are identified as being HPOG-eligible professions.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Paid Family and Medical Leave

  • Starting in January 2024, all workers would be eligible for up to four weeks of paid leave for new parents, workers dealing with their own serious medical conditions, and workers who need leave to care for a loved one with a serious medical issue. Benefits would be progressive, with lower-income workers receiving higher levels of wage replacement. Wage replacement would be about two-thirds for the average worker.
    • See the legislative language for this provision HERE

Increases in OSHA Fine Amounts

  • Amends the Occupational Safety and Health Act of 1970 to:
    • Increase the maximum penalty to $700,000 for willful and repeat violations (current penalty is $136,532);
    • Increase the minimum penalty to $50,000 for willful violations (current penalty if $9,753);
    • increase the maximum penalty for both serious and failure-to-abate violations to $70,000. (current penalties are $13,653);
  • See the legislative language for these provisions HERE

The bill also includes a number of provisions that would:

  • Expand Medicaid coverage;
  • Lower prescription drug costs;
  • Extend ACA marketplace health plan subsidies;
  • Add hearing coverage to the Medicare program;
  • Invest tens of billions of dollars in bolstering public health infrastructure and training;
  • Boost funding by over $1 billion for Older Americans Act (OAA) programs that support older adults and family caregivers;
  • Provide $40 million in funding for programs to support family caregivers’ mental health and well-being;
  • Provide $500 million in new grant funding to support medical-legal partnerships (programs that integrate patient-centered legal services into health care settings to address their patient and families’ health-related social needs).

Major health and care-related provisions that were not incorporated into the House bill include:

  • A separate tax credit for family caregivers (A NAHC policy priority issue);
  • New Medicare dental and vision benefits.

As negotiations over the legislation move to the Senate, NAHC will continue to advocate for polices that will benefit patients, families and the home-based providers that care for them. We are closely tracking the movement on this massive bill, and will be updating members on relevant developments as they arise. Stay tuned to NAHC Report for updates.

 

Build Back Better Passes the House of Representatives

Here is what it means for NAHC members and their patients The Build Back Better Act, a signature legislative priority for the Biden administration and its allies in Congress, passed the House of Representatives this morning on a party line vote of 220-213. The legislation now heads to the Senate for consideration. The Build Back…