Eligible Patients Can Receive Free 2nd COVID Booster

On April 6, the Center for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine, and there is no applicable copayment, coinsurance, or deductible. People with Medicaid coverage can also get COVID-19 vaccines, including boosters, at no cost.

The CDC recently updated its recommendations regarding COVID-19 vaccinations. Certain immunocompromised individuals and people ages 50 years and older who received an initial booster dose at least 4 months ago are eligible for another booster to increase their protection against severe disease from COVID-19. Additionally, the CDC recommends that adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago can receive a second booster dose of a Pfizer-BioNTech or Moderna COVID-19 vaccine.

The COVID-19 vaccine, including the booster doses, is the best defense against severe illness, hospitalization, and death from the virus. CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations. More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html and through the CMS COVID-19 Provider Toolkit.

People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.

Eligible Patients Can Receive Free 2nd COVID Booster

On April 6, the Center for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine,…

CDC Proposes Updates to Controversial 2016 Opioid Prescribing Guidelines

On February 10, 2022, the Centers for Disease Control and Prevention (CDC) issued new proposed guidelines for prescribing of opioids for acute, sub-acute and chronic pain. The clinical practice guideline updates and expands the CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016, and provides evidence-based recommendations for clinicians who provide pain care, including those prescribing opioids, for outpatients age 18 years and older with acute pain (duration less than 1 month), subacute pain (duration of 1–3 months), or chronic pain (duration of 3 months or more).

The guideline explicitly EXCLUDES sickle cell disease-related pain management, cancer pain treatment, palliative care, and end-of-life care.

The clinical practice guideline includes recommendations for primary care clinicians (including physicians, nurse practitioners, and physician assistants) as well as for outpatient clinicians in other specialties (including those managing dental and postsurgical pain in outpatient settings and emergency clinicians providing pain management for patients being discharged from emergency departments).

This voluntary clinical practice guideline provides recommendations and does not require mandatory compliance; and the clinical practice guideline is intended to be flexible so as to support, not supplant, clinical judgment and individualized, patient-centered decision-making.

As part of the guideline issuance, CDC is asking interested persons or organizations to submit written views, recommendations, and data. In order to be considered, written comments must be received on or before April 11, 2022.  Instructions for submitting comments and various materials are available HERE; the revised guideline and other supporting materials are located in the “Enhanced Content” box in the lower right hand corner of the page.

A major area of concern associated with the 2016 guideline was the emergence of misapplication of the guideline by various state and local governments. In 2018 the National Association for Home Care & Hospice (NAHC) was invited to testify before the House Energy & Commerce Committee regarding hospice disposal of controlled substances.

As part of his testimony, NAHC’s representative Dr. John Mulder of the Trillium Institute and Faith Hospice in Michigan, commented on the misapplication of the 2016 CDC guideline by states that have resulted in delayed treatment for pain experienced by individuals receiving palliative or hospice care. In 2019, CDC issued a Media Statement  on the 2016 guideline cautioning against:

  • Misapplication of recommendations to populations outside of the Guideline’s scope;
  • Misapplication of the Guideline’s dosage recommendation that results in hard limits or “cutting off” opioids;
  • Abrupt tapering or sudden discontinuation of opioids; and
  • Misapplication of the Guideline’s dosage recommendation to patients receiving or starting medication-assisted treatment for opioid use disorder.

These concerns, in part, led to issuance of the revised guideline that is currently under review.

CDC Proposes Updates to Controversial 2016 Opioid Prescribing Guidelines

On February 10, 2022, the Centers for Disease Control and Prevention (CDC) issued new proposed guidelines for prescribing of opioids for acute, sub-acute and chronic pain. The clinical practice guideline updates and expands the CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016, and provides evidence-based recommendations for clinicians who provide pain care,…

CMS Rescinds Focused Infection Control Survey and Visitor Restrictions for Home Health and Hospice Providers

In January 2021, the Centers for Medicare & Medicaid Services (CMS) implemented a revised COVID-19 Focused Infection Control Survey for Acute and Continuing Care (ACC) for providers which included home health and hospice.  This was the focused survey tool that surveyors would use for hospice and home health agency providers for any type of survey being conducted except a complaint survey where the complaint allegation is not related to infection control. At the same time, CMS clarified guidance for screening of individuals entering a health care facility which would include hospice inpatient units. See previous NAHC Report coverage here. Late on February 4, 2022 CMS revised the memo pertaining to the Focused Infection Control (FIC) survey tool and visitor screening.

CMS developed the FIC survey and tool at the beginning of the PHE to help surveyors and facilities absorb the critical infection prevention and control practices for combating COVID-19. CMS believes ACC facilities, including home health and hospice providers, have incorporated COVID-19 management strategies into their infrastructure and operations, and there is no longer a need to continue the required use of the special FIC survey and tool on a national basis. Therefore, CMS is rescinding the survey requirement to conduct FIC surveys.

State Survey Agencies (SAs) and Accrediting Organizations (AOs) should now return to the existing standard survey processes and continue to assess COVID-19 infection prevention and control elements by focusing on the regulatory requirements, while incorporating lessons learned about infection control oversight during the PHE. For example, the Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule guidance requires home health and hospice providers to develop and maintain approved policies and procedures for minimizing transmission of infectious disease that are established based on nationally recognized standards of practice. Surveyors will assess whether those polices are developed appropriately and followed.

While the contents of the FIC survey tool are generally still applicable, if providers wish to continue use of the tool as a template for their own self-assessment CMS encourages them to carefully review the Centers for Disease Control and Prevention (CDC) guidelines as there have been changes to the recommendations since the original tool and update were released (see the “Additional Resource Links” section in the memo linked above for more information on CDC guidelines).

Regarding visitation restrictions CMS stated it recognizes that restricting visitation from family and other loved ones during the COVID-19 pandemic has taken a physical and emotional toll on patients. While the COVID-19 Public Health Emergency (PHE) remains, CMS finds continued federal guidance on visitation restrictions for ACC providers are no longer necessary, which is consistent with the nursing home guidance in QSO-22-39Facilities should continue to adhere to basic COVID-19 infection prevention principles consistent with national standards of practice.

Providers should note that there may be more prescriptive requirements at the State level for infection control and visitor screening and visitation restrictions. CMS expects health care staff and surveyors (AOs, contractors, Federal, State, and Local) to comply with basic infection control practices such as hand hygiene, wearing masks, and the use of other personal protective equipment, as appropriate for the situation (i.e., standard, contact, airborne, etc).

Surveyors should focus on the regulatory requirements for each provider and supplier type and whether the facility consistently follows processes that are based on national standards of practice. Guidelines produced by the CDC are an example of a source for national standards.

Any COVID-19 infection prevention policy developed by a health care facility to meet the Medicare conditions should be approved by the facility’s governing body, or equivalent group as defined by regulation, before implementation. Health care providers should review their own infection prevention and control policies and practices to prevent the spread of infectious disease and illness, including COVID-19.

Should COVID-19 case rates increase in certain geographic locations, CMS instructs that concerned SAs should strongly consider doing a FIC survey in consultation with the applicable CMS location office.

CMS Rescinds Focused Infection Control Survey and Visitor Restrictions for Home Health and Hospice Providers

In January 2021, the Centers for Medicare & Medicaid Services (CMS) implemented a revised COVID-19 Focused Infection Control Survey for Acute and Continuing Care (ACC) for providers which included home health and hospice.  This was the focused survey tool that surveyors would use for hospice and home health agency providers for any type of survey…

New Sepsis Training Module Now Available

Health care providers now have a new resource at their disposal to help identify and treat sepsis patients in austere environments: a free, 70-minute online training module entitled Disaster Medicine: Sepsis. Please consider sharing the information across your networks. The module provides recommendations to identify and manage sepsis under austere conditions. The training features insights from…

New Sepsis Training Module Now Available

Health care providers now have a new resource at their disposal to help identify and treat sepsis patients in austere environments: a free, 70-minute online training module entitled Disaster Medicine: Sepsis. Please consider sharing the information across your networks.

The module provides recommendations to identify and manage sepsis under austere conditions. The training features insights from four federal physicians with extensive experience with the challenges of delivering critical care during disasters and public health emergencies.

The Division of Research, Innovation and Ventures (DRIVe) within the Biomedical Advanced Research and Development Authority (BARDA), part of the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR), and the Sepsis Alliance collaborated with experts from ASPR and the Centers for Disease Control and Prevention (CDC) to develop the training module to assist emergency management and disaster response personnel, as well as medical staff responsible for triage in disaster settings.

According to the CDC, nearly 87 percent of sepsis originate outside the hospital. Therefore, it is critical to recognize these patients early within non-traditional clinical environments. The module is intended to address a gap identified in traditional disaster medicine training available to health care providers: education on the recognition and management of patients at risk of or presenting with sepsis. By focusing on disaster scenarios, this module emphasizes the identification, screening, stabilization, and evacuation of those suspected of developing sepsis and septic patients in austere conditions, with non-traditional clinical environments, and where there is a lack of laboratory testing.

Populations affected by disasters can be exposed to a variety of health hazards, such as trauma, burns, poor sanitation, and mass sheltering, all of which place them at increased risk of infection and, in turn, sepsis. Under the austere, resource-limited conditions typical of disaster zones, the clinical identification and management of sepsis can be more challenging than normal operating conditions in conventional health care settings.

Hopefully, those who utilize the training come away with greater insight into recognizing, assessing and evacuating sepsis or at-risk patients, and an increased awareness of the impact of sepsis as a health security threat on a national scale. This new online training module covers the foundational principles underlying all sepsis care; the identification of sepsis patients in field conditions where recognizing at-risk populations and the signs and symptoms of sepsis can be especially challenging; the screening and stabilization of septic patients in the field; and the challenges of coordinating evacuation of septic patients from a disaster site.

Health care professionals can receive AMA PRA Category 1 Credit or nursing continuing education contact hours upon successful completion of the training. Sepsis Alliance has made the free training available at the Sepsis Alliance Institute. Sepsis Alliance is an accredited provider approved by the California Board of Registered Nursing (Provider Number CEP17068). In support of improving patient care, this activity has been planned and implemented by Medical Education Resources (MER) and Sepsis Alliance. MER is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Statement from HHS Secretary on COVID-19 Vaccine for 5-11-year-olds

Following the Centers for Disease Control and Prevention’s (CDC) recommendation to make 5-11 year old children eligible for COVID-19 vaccines after the Food and Drug Administration’s (FDA)’s authorization, HHS Secretary Xavier Becerra issued this statement on the landmark moment to increase children’s protection during this pandemic:

“This is another major milestone in our efforts to protect more children, their families, and our communities as we work to end the pandemic. We are following the data and science, and after a thorough review by FDA and CDC, we are ready to get millions of children vaccinated. Thanks to their rigorous, comprehensive and independent review of the data, we know that vaccination of younger children against COVID-19 proved to be safe and effective.

“As we deliver millions of doses nationwide, we are working with states, localities, pediatricians’ offices, children’s hospitals, pharmacies and other trusted health care providers for families to ensure equitable access to the vaccine for our nation’s kids. Looking toward winter and the holiday season, we have another significant opportunity to get ahead of this pandemic and protect kids ages 5-11 from what has become a cause of death in this age group. We know many families are trying to decide what is right for them, and we encourage anyone seeking additional information talk to a doctor or health care provider to get the facts. COVID-19 vaccines are the best way to protect yourself and those you love from COVID-19, and the Biden-Harris Administration will continue working every day to get as many people vaccinated and protected from COVID-19 as possible.”

OIG Reports on Home Health Agency Infection Control Audit

An audit of eight home health agencies (HHAs) by the Office of the Inspector General (OIG) found that most had infection control policies and procedures that met the stndards set by the Centers for Medicare & Medicaid Services (CMS) and followed CMS COVID-19 guidance to safeguard Medicare beneficiaries, caregivers, and staff during the coronavirus pandemic, according…