U.S. Renews Public Health Emergency Again

On Wednesday, April 13, Secretary of Health & Human Services (HHS) Xavier Becerra renewed the Public Health Emergency (PHE) that has been in effect since January 27, 2020 due to the outbreak of the novel coronavirus COVID-19.

As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective April 16, 2022, the ​January 31, 2020, determination by former Secretary Alex M. Azar II… that a public health emergency exists and has existed since January 27, 2020, nationwide.

This latest renewal of the PHE will last for 90 days, at which point it will lapse or be renewed again.

This news is not a surprise, as the Biden administration had hinted for some time that a renewal was coming.

The most recent renewal of the PHE occurred on January 14, 2022.

A declaration of a PHE permits, among other things, emergency use authorization of vaccines, the access to funding to address the emergency, and deployment of military trauma care providers.

Renewing the public health emergency declaration ensures health care providers and state and territorial health departments have continued flexibility to respond to the pandemic, helping save lives. These flexibilities support efforts such as rapid patient care during emergencies, including waivers from the Centers for Medicare and Medicaid Services for certain requirements under section 1135 of the Social Security Act. Examples of such requirements include preapproval requirements and temporarily reassignment of state, territorial, tribal or local staff who typically are funded by federal grants in order to respond to the emergency.

HHS will provide states and territories with no less than 60 days’ notice prior to the termination of the public health emergency declaration for COVID-19.

HHS to Provide $110 Million in HCBS for Seniors & Disabled

Scroll down for more info on webinars for funding applicants The Centers for Medicare & Medicaid Services (CMS) announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. First authorized in 2005, MFP has provided states with $4.06 billion to…

HHS to Provide $110 Million in HCBS for Seniors & Disabled

  • Scroll down for more info on webinars for funding applicants

The Centers for Medicare & Medicaid Services (CMS) announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program.

First authorized in 2005, MFP has provided states with $4.06 billion to support people who choose to transition out of institutions and back into their homes and communities. The new Notice of Funding Opportunity (NOFO) makes individual awards of up to $5 million available for more than 20 states and territories not currently participating in MFP. These funds will support initial planning and implementation to get the state/territory programs off the ground, which would ensure more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose.

“NAHC has long supported the Money Follows the Person program,” said NAHC Director of Government Affairs Calvin McDaniel. “The announced funds will provide additional investment and opportunities for states to enhance their HCBS offerings. Continued investments in HCBS further rebalances spending on long-term services and supports in favor of the home. This investment is consistent with President Biden’s goals of improving access to care in the home. NAHC encourages the eligible states and territories to apply for these new funds.”

HCBS is a critical component of the Medicaid program and the MFP program has been a critical tool, now with the potential to do more in a broader array of states and territories.

To help additional states and territories implement MFP, these awards will support the early planning phase to get an MFP program off the ground. This includes:

  • Establishing partnerships with community stakeholders, including those representing diverse and underserved populations, Tribal entities and governments, key state and local agencies (such as state and local public housing authorities), and community-based organizations;
  • Conducting system assessments to better understand how HCBS support local residents;
  • Developing programs for the types of community transitions MFP supports;
  • Establishing or enhancing Medicaid HCBS quality improvement programs;
  • Recruiting HCBS providers as well as expert providers for transition coordination and technical assistance; and
  • Conducting a range of planning activities deemed necessary by the award recipients and approved by CMS.

State Medicaid agencies not currently participating in the MFP demonstration may apply through the NOFO no later than May 31, 2022. To access the NOFO, visit Grants.gov or here https://www.grants.gov/web/grants/view-opportunity.html?oppId=334196

For states already participating in MFP, CMS also announced that the agency is increasing the reimbursement rate for MFP “supplemental services.” These services will now be 100% federally funded with no state share. Further, CMS is expanding the definition of supplemental services to include additional services that can support an individual’s transition from an institution to the community, including short-term housing and food assistance. These changes will help further address critical barriers to community living for eligible individuals, as well as increase community transition rates and the effectiveness of the MFP demonstration overall. For more information on current and previous grantees, visit Medicaid.gov. CMS will provide additional information on these changes to MFP grantees.

“Everyone deserves the opportunity to live at home, in their communities, and with their loved ones,” said Health & Human Services (HHS) Secretary Xavier Becerra. “This funding will bring dignity and peace of mind to even more seniors and people with disabilities across the country. We will continue expanding these programs to ensure all Americans have equitable access to the high-quality health care they deserve—no matter where they live.”

Money Follows the Person Demonstration Expansion: Notice of Funding Opportunity (NOFO) Webinars for Applicants

CMS released a Notice of Funding Opportunity that will offer up to $110 million to expand access to home and community-based services (HBCS) through Medicaid’s Money Follows the Person (MFP) program. The new NOFO authorized under the Consolidated Appropriations Act of 2021 (CAA) will make individual awards of up to $5 million to states and territories that are not currently participating in MFP. These funds will support states during the initial planning and implementation of their programs.

CMS will hold two webinars to provide details about the MFP Demonstration Expansion, and to answer questions from potential applicants regarding this funding opportunity. Registration is required. The webinars will be held:

April 13, 2022 1:00 pm to 2:00 pm (ET)

Registration: Click on https://cms.zoomgov.com/j/1601853787?pwd=Vm9UTUoyRnpVVStjSEo1QlZYWURPUT09

April 27, 2022 1:00 pm to 2:00 pm (ET)

Registration: Click on  https://cms.zoomgov.com/j/1612862544?pwd=MGd3YW5nUVJ4T050bWFraTV6V0Y1UT09

U.S. Renews Public Health Emergency Again

On Wednesday, April 13, Secretary of Health & Human Services (HHS) Xavier Becerra renewed the Public Health Emergency (PHE) that has been in effect since January 27, 2020 due to the outbreak of the novel coronavirus COVID-19.

As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective April 16, 2022, the ​January 31, 2020, determination by former Secretary Alex M. Azar II… that a public health emergency exists and has existed since January 27, 2020, nationwide.

This latest renewal of the PHE will last for 90 days, at which point it will lapse or be renewed again.

This news is not a surprise, as the Biden administration had hinted for some time that a renewal was coming.

The most recent renewal of the PHE occurred on January 14, 2022.

A declaration of a PHE permits, among other things, emergency use authorization of vaccines, the access to funding to address the emergency, and deployment of military trauma care providers.

Renewing the public health emergency declaration ensures health care providers and state and territorial health departments have continued flexibility to respond to the pandemic, helping save lives. These flexibilities support efforts such as rapid patient care during emergencies, including waivers from the Centers for Medicare and Medicaid Services for certain requirements under section 1135 of the Social Security Act. Examples of such requirements include preapproval requirements and temporarily reassignment of state, territorial, tribal or local staff who typically are funded by federal grants in order to respond to the emergency.

HHS will provide states and territories with no less than 60 days’ notice prior to the termination of the public health emergency declaration for COVID-19.

U.S. Renews Public Health Emergency Again

On Wednesday, April 13, Secretary of Health & Human Services (HHS) Xavier Becerra renewed the Public Health Emergency (PHE) that has been in effect since January 27, 2020 due to the outbreak of the novel coronavirus COVID-19. As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation…

HHS Issues Clarity on the Application of the No Surprise Billing Requirements

On April 6, 2022 the Department of Health and Human Services (HHS) issued an FAQs document providing some clarity on which health care providers are subject to the “No Surprise Billing” requirements. Since most discussions and regulatory actions havebeen around the balance billing provisions of the No Surprise Billing Act, there has been a great…

President’s FY2023 Budget Request Includes Few Home Care-Specific Policies

  • Boosts HHS Funding & Extends Sequestration to 2023

On Monday, March 28th, President Biden released a $5.8 trillion proposed budget for fiscal year (FY) 2023, which begins October 1st, 2022. While the White House budget is simply a request and Congress has final say on government spending, it does provide a window into the president’s priorities and where his administration wants to direct its efforts going forward. As a reminder, lawmakers just this month finalized spending for the current fiscal year — which runs through Sept. 30 — and will soon begin negotiating funding legislation for FY2023. 

The budget requests more than $127 billion to fund the Department of Health and Human Services (HHS) in FY2023, a roughly 15 percent spike from 2022 funding that includes major increases for pandemic preparedness and public health surveillance. Notably, the budget also would extend the Medicare sequester cuts by one year until 2032 (they were previously extended through 2031 by The Infrastructure Investment and Jobs Act of 2021), which would provide savings of around $7.6 billion.  

Over the coming weeks members of the Executive Branch will be testifying before key committees in the House and Senate to provide additional detail around the recommendations put forth in the budget documents. As additional relevant detail is made available, it will be covered in NAHC Report.  

Provisions of interest in the Budget include: 

Medicare: 

Multiple provider types: 

  • Extension of the Medicare sequestration provider rate cuts through 2032 (they are currently in place through 2031) 

Home Health: 

  • Standardize Data Collection to Improve Quality and Promote Equitable Care: Current law requires post-acute providers (inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies) to report standardized patient assessment data on five health assessment categories, as well as “other categories deemed necessary and appropriate by the Secretary.” However, there is no express statutory requirement for data reporting on social determinants of health. This proposal would add a new category of standardized patient assessment data, “drivers of health”, for post-acute care providers. These data could include, for example, transportation, housing, social isolation, and food insecurity. This new data would enable real-time information exchange between the healthcare system and those resources best equipped to address individual needs—activating government, community agencies, and healthcare providers to work together to support individuals of underserved populations and be responsive to respond to public health needs. 

Health Care Workforce 

  • Requests a total of $2.1 billion for numerous Health Resources and Services Administration (HRSA) workforce programs—including $430 million in mandatory and other sources of funding—an increase of $324 million above FY 2022 enacted, including additional investment to support the resiliency, mental health, and well-being of health care providers. 

Program Integrity and Oversight Efforts: 

  • Requests $899 million in discretionary funding for the Health Care Fraud and Abuse Control (HCFAC) program, $26 million above the FY 2022 enacted level ($692.2 million for CMS; $109.6 million for the HHS OIG; $97.2 million for DOJ) (this would be on top of the $1.4 billion in mandatory HCFAC resources for FY 2023) 
  • Mentions that CMS would use some of this money to invest in new advancements in predictive modeling and artificial intelligence to enhance existing efforts to reduce improper payments, prevent fraud, and target bad actors, while limiting burden. For example, CMS is exploring methods of using machine learning to conduct more rapid review of chart documentation to improve payment accuracy. 
  • Mentions that a top priority for this increased investment is Medicare medical review, and that CMS has a long-term goal to increase the percentage of fee-for-service claims subject to medical review, which currently stands at less than one-tenth of one percent, to one percent. 
  • Prohibit Unsolicited Medicare Beneficiary Contacts: Since the start of the COVID-19 pandemic, Medicare scams have proliferated that utilize unsolicited contacts with Medicare beneficiaries for the purpose of ordering or rendering high-cost items and services, such as medically unnecessary laboratory testing and COVID-19 personal protective equipment, as well as to collect beneficiaries’ personal information. This proposal would disallow certain ordering or referring providers, home health agencies, laboratories, other providers and suppliers as identified by the Secretary, and other individuals or entities acting on behalf of such providers and suppliers from making certain unsolicited contacts with Medicare beneficiaries. Prohibited contacts would include phone calls, text messages, direct messaging applications, and e-mail. The proposal would also grant the Secretary authority to announce rulemaking to modify the parameters restricting unsolicited provider contacts with beneficiaries to address emerging fraud threats CMS identifies in the future. 
  • Expand Tools to Identify and Investigate Fraud in the Medicare Advantage Program: This proposal would require Medicare Advantage plans to collect referring provider identifiers for healthcare services and report this information as part of encounter data submissions to CMS. By requiring Medicare Advantage Organizations to collect key provider data to assist with investigations, this proposal would provide CMS and the HHS-OIG with improved capabilities to hold wrongdoers accountable. CMS would have improved capabilities to prevent program losses and beneficiary harm. Medicare Advantage Organizations would benefit from more actionable data in their own systems and the Federal Government’s broader visibility into fraud affecting multiple plans. This proposal would not require additional funding. 

Health Equity: 

  • Improving Equity in Medicare and Medicaid Programs: Requests $35 million for CMS to invest in a new initiative to systematically identify and resolve barriers to equity in each CMS program through research, data collection and analysis, stakeholder engagement, building upon rural health equity efforts, and technical assistance. 
  • Increase Social Security Administration Sharing and Collection of Race and Ethnicity Data for Medicare Beneficiaries: The primary source of race and ethnicity data on Medicare beneficiaries has been the Social Security Administration (SSA). Currently, SSA collects limited race and ethnicity data on some Medicare beneficiaries and does not collect any data on other beneficiaries, which hinders CMS’s ability to identify and reduce health disparities. The current collection of race and ethnicity data complies with certain 1997 OMB guidelines but does not comply with the more expansive 2011 HHS Data Standards that, for example, provide more detail on the diversity of Asian populations in the United States, such as Chinese, Vietnamese, and Filipino. This administrative proposal would have SSA increase sharing of race and ethnicity data with CMS for current and prospective Medicare beneficiaries, and consider expanding collection of detailed data, e.g., at 2011 HHS data standards or newer data standards. CMS will assist by conducting appropriate research and user testing for collection of this data to ensure it is useful for the purposes of tracking disparities in healthcare treatment and outcomes by race and ethnicity. 

Surveys and Certifications (Medicare & Medicaid) 

  • Requests $494 million for Survey and Certification, an increase of $97 million or 24 percent above FY 2022 enacted. This investment will strengthen health, quality, and safety oversight for approximately 67,000 participating Medicare or Medicaid provider facilities. Survey workloads and costs continue to increase due to factors such as a growing number of beneficiaries and surveyor wage growth, as well as an increase in serious complaints against facilities, which can lead to costly ongoing enforcement activities once a deficiency is identified. The COVID-19 pandemic has underscored the Survey and Certification program’s critical oversight role for holding nursing homes and other facilities accountable to meet minimum infection control standards and protect public health for beneficiaries in these facilities from COVID-19. 
  • At the FY 2023 request level, CMS projects that states will have the resources to fully complete surveys for all provider types, including complaint surveys, statutorily required surveys, and non-statutory surveys. This level of survey completion, which has not been projected since the submission of the FY 2017 President’s Budget, would permit the program to provide oversight for the relevant facility types and is the first step in shifting from a reactive to proactive posture. 

Department of Labor (DoL) 

  • Priorities for DoL Rulemaking: In FY 2023, the Occupational Safety & Health Administration (OSHA) is planning to publish five final rules, seven proposed rules, and complete one Small Business Regulatory Enforcement Fairness Act panel. The highest priorities among the rulemaking projects on the agency’s regulatory agenda include Infectious Disease, Workplace Violence, Hazard Communications, Personal Protective Equipment (PPE) Fit, and Heat Illness Prevention. 
  • Increased Funding for OSHA Inspections and Staff: An increased funding request of $27,876,000 to strengthen OSHA’s enforcement program. This includes funding to hire 179 Compliance Safety and Health Officers (CSHOs) to carry out front line compliance inspections. OSHA also plans to create 10 specialized technical CSHO positions to address highly technical inspections across the nation, such as process safety management, electrical safety, ergonomic hazards, combustible dust, and biohazards/infectious diseases, such as COVID-19. The Administration has previously stated its commitment to double the number of OSHA inspectors by the end of President Biden’s first term. 
  • Increased funding for DoL’s Wage and Hour Division (WHD) Enforcement: A $61 million increase for WHD’s budget to combat worker misclassification, protect essential workers by safeguarding their pay and recovering back wages, and more fully enforce rules around other areas such as prevailing wages and family and medical leave. 

Health Information Technology 

  • The budget directs $52 million at the program level for the Office of the National Coordinator for Health Information Technology (ONC) towards improving standards to increase interoperability and equity among various health IT activities, in coordination with industry-led standards development organizations, as well as using the resources for fulfilling unmet legislative requirements. 

CMS Data 

  • Improve CMS Analytic Capabilities and Data Sharing: As the largest payer for healthcare in the United States, CMS holds an enormous amount of unique health data on a large proportion of the U.S. population. The budget invests $15 million in a new initiative to improve the accessibility, timeliness, and comprehensiveness of CMS data made available to stakeholders and the public. This increase in funding will lead to greater analytic and data sharing capabilities while also continuing to safeguard individual privacy. Better, more timely use of these datasets holds the potential to strengthen the evaluation of federal and state programs, assess the impact of policy changes, improve outcomes of people served by multiple programs, and generate knowledge to inform federal and state policymaking. 

HIPAA 

  • Enhancing HIPAA Protections by Increasing Civil Monetary Penalty Caps and Authorizing Injunctive Relief: The proposal seeks to increase the amount of civil money penalties that can be imposed in a calendar year for HIPAA non-compliance and authorizes OCR to work with the U.S. Department of Justice to seek injunctive relief in federal court for HIPAA violations 

Administration for Community Living (Funding for aging and disability community-based-organizations) 

  • Provides $3.1 billion for ACL, an increase of $668 million above FY 2022 enacted. The budget recognizes the significantly increased demand for critical services caused by growing populations and the long-term effects of the COVID-19 pandemic.  
  • In FY 2023, the budget provides $266 million, an increase of $61 million above FY 2022 enacted, for the Family Caregivers and Native American Caregiver Support programs, and nearly doubles funding, from $8 million to $14 million, for the Lifespan Respite Care program. These programs provide more than 1.5 million caregivers counseling, training, respite care, and other coordinated services to allow them to support their loved ones while maintaining their own health and well-being. 

Mental Health Care 

  • Improve access to Medicare mental health services by allowing Licensed Professional Counselors and Marriage and Family Therapists to directly bill Medicare for their servicesremoving limits on the scope of services for which Clinical Social Workers, Licensed Professional Counselors, and Marriage and Family Therapists can be paid by Medicare; allow these practitioners to bill Medicare directly for their mental health services for covered Part A qualifying Skilled Nursing Facility stays; establish Medicare payment under Part B for services provided under an Assertive Community Treatment delivery system; allow payment to Rural Health Clinics and Federally Qualified Health Centers for Licensed Professional Counselors and Marriage and Family Therapists providing mental health services; and enable Medicare coverage of evidence-based digital applications and platforms that facilitate the delivery of mental health services. 

Community Health Workers: 

  • Add Medicare Coverage of Services Furnished by Community Health Workers: Under current law, services provided by community health workers are not paid under Medicare. This proposal would provide coverage and reimbursement to community health workers acting within the scope of their license or certification under Medicare’s Physician Fee Schedule for select, evidence-based preventive, chronic, and behavioral care management services, as well as certain social determinants of health evaluation and navigation services, effective CY 2024. Such services would be exempt from Medicare cost-sharing. Services must be furnished under the direction of—and billed by—a Medicare-enrolled supplier or provider in accordance with a comprehensive community needs assessment and engagement plan. In addition to existing Medicare providers, the Secretary would be permitted to enroll community-based organizations (e.g., non-profits, public health departments, etc.) as community health worker suppliers to broaden access to services, subject to program integrity and patient safety guardrails. 

Agency for Healthcare Research and Quality (AHRQ) 

  • All-Payer Claims Database: Provides $5 million to develop the infrastructure to regularly create and disseminate an All-Payers Claims Database. AHRQ will partner with states and other data holders to create a framework for a secure claims database that will enhance value to individual participating states and provide analytics to federal policy makers to inform decision making, address equity issues, and improve healthcare quality. 
  • Telehealth Centers for Excellence: The establishment of two Centers of Excellence in Telehealth Implementation. These centers will play a role in evaluating the effects of telehealth on healthcare delivery and health outcomes to ensure the promise of telehealth is delivered through evidence-based practice and policy. This work is especially important given the rapid expansion of telehealth during the COVID-19 pandemic, which created both historic opportunities and unique challenges. With this unprecedented rapid expansion of telehealth, it is important to understand telehealth’s effect on key health policy priorities and thoroughly evaluate the effect of the telehealth on healthcare quality, safety, equity, access, utilization, and value. 

President’s FY2023 Budget Request Includes Few Home Care-Specific Policies

Boosts HHS Funding & Extends Sequestration to 2023 On Monday, March 28th, President Biden released a $5.8 trillion proposed budget for fiscal year (FY) 2023, which begins October 1st, 2022. While the White House budget is simply a request and Congress has final say on government spending, it does provide a window into the president’s…

New Law Funds Support for Health Care Workers’ Mental Wellness

On March 18, 2022, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law. The law is named for Dr. Lorna Breen, who served as the Medical Director of New York-Presbyterian Allen Hospital before her suicide in April 2020, a death her family attributes to the immense mental, emotional, and physical toll that responding to the first COVID-19 surge in New York City took on her well-being.

Dr. Breen declined getting help for the stress she was experiencing because she was concerned that seeking mental health support would negatively impact her career and ostracize her from colleagues. The law will direct $140 million in grant funding over the next 3 years for training programs on treatment to reduce burnout for health care professionals, offer mental health services and prevent deaths by suicide by health care workers. A recent study found that home care workers report poor mental health at double what typical American workers experience.

Funding for the law’s implementation was included in last year’s American Rescue Plan Act, over $100 million of which has already been allocated to 46 institutions across the country working to help health care professionals. Grantee organizations must use the funding to establish or enhance evidence-based or evidence-informed programs dedicated to improving mental health and resilience in the health professional workforce. Hospitals, community health centers, rural health clinics, and medical professional associations, among other health care entities, are eligible to receive these grants and contracts. In awarding these grants and contracts, HHS must give priority to entities that are in health professional shortage areas or in rural areas. Examples of the kinds of activities that can be supported by the grants include:

  • Improving awareness among health care providers about risk factors and signs of suicide, mental health, or substance use disorders
  • Establishing or enhancing programs for suicide prevention and the improvement of mental health and resilience amongst health care providers
  • Providing mental health care, follow up, or referrals to such services and care to health care providers
  • Creating or improving peer-support programs for health care providers.

Th law also requires HHS to collaborate with stakeholders, such as health care professional associations, to establish a mental health education and awareness initiative. This initiative must encourage health care providers to seek care and support when experiencing mental health or substance abuse issues, help them learn to identify risk factors for these conditions, and teach them how to respond to such risks. This initiative must also seek to reduce stigma associated with pursuing help for mental health and substance use disorders. And no later than two years after enactment, HHS must also identify and disseminate evidence-based or evidence-informed best practices for improving health care provider mental health, preventing suicide, and strengthening mental resilience.

NAHC is encouraged by passage of this law. The mental and behavioral health impact of the COVID-19 pandemic and response on health care workers of all kinds, including those working for home-based care providers, has been profound. Stigma, lack of awareness of treatment options, and inadequate programmatic funding have and continue to stymie efforts to connect workers with mental health supports. We are hopeful that this law, the first of its kind, is the beginning of a broader effort to better scale effective behavioral health interventions and strategies for the health care workforce.

New Law Funds Support for Health Care Workers’ Mental Wellness

On March 18, 2022, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law. The law is named for Dr. Lorna Breen, who served as the Medical Director of New York-Presbyterian Allen Hospital before her suicide in April 2020, a death her family attributes to the immense mental, emotional, and physical…