Ransomware Resources for HIPAA Regulated Entities

Ransomware attacks on health care organizations are a growing threat, so the HHS Office for Civil Rights (OCR) shared with us the following information to ensure that HIPAA regulated entities are aware of the resources available to assist in preventing, detecting, and mitigating breaches of unsecured protected health information caused by hacking and ransomware. HHS…

U.S. Renews Public Health Emergency Again

On October 15, 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…

Info on Provider Relief Funds & American Rescue Plan Rural Funding

The U.S. Department of Health and Human Services (HHS) has announced $25.5 billion in new funding for health care providers impacted by the COVID-19 pandemic. This includes $17 billion in Provider Relief Fund Phase 4 funding for providers who have experienced changes in operating revenues and expenses, as well as $8.5 billion in American Rescue…

HHS Announces New Provider Fund Distribution & Grace Period for Reporting Obligations

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS) announced it will accept applications from providers for new relief funds this week, as well education for providers to help navigate the application portal.

In addition, there will be a grace period for the reporting deadline of September 30, 2021 for Period 1 recipients of Provider Relief Funds (PRF).

New Distributions

On September 29, 2021, health care providers will be able to apply for $25.5 billion in relief funds, including $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) and $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers with changes in operating revenues and expenses. The application will be open for a period of four weeks. Providers must submit their completed application by the final deadline of October 26 at 11:59 p.m. ET.

Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application.

In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application and HRSA will use existing Medicaid, CHIP, and Medicare claims data in calculating portions of these payments.

  • Phase 4 General Distribution — $17 billion based on providers’ changes in operating revenues and expenses from July 1, 2020 to March 31, 2021.
    • To promote equity and to support providers with the most need, HRSA will:
      • Reimburse smaller providers for changes in operating revenues and expenditures at a higher percentage compared to larger providers.
      • Provide “bonus” payments based on the amount of services they provide to Medicaid, CHIP, and Medicare patients, priced at the generally higher Medicare rates.
  • American Rescue Plan (ARP) Rural — $8.5 billion based on the amount of services providers furnish to Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy (FORHP)-defined rural areas.
    • To promote equity, HRSA will price payments at the generally higher Medicare rates for Medicaid/CHIP patients.

PRF Period 1 Reporting Grace Period

HRSA also recently announced a 60-day grace period for PRF recipients that are unable to meet the September 30, 2021, reporting deadline, allowing providers to remain in compliance by fulfilling the obligations of the reporting deadline prior to November 30, 2021. These providers will not face collection activities or similar enforcement actions during the grace period. The deadline to use Period 1 PRF funds remains June 30, 2021. HRSA also notes that providers must return unused funds as soon as possible after submitting their report, and no later than December 30, 2021.

Phase 4 and ARP Rural Technical Assistance Webcasts

HRSA will be hosting webinar sessions for Phase 4 and ARP Rural applicants, featuring guidance on how to navigate the application portal.

  • Thursday, September 30, 3:00 – 4:00 p.m. ET – register to attend
  • Tuesday, October 5, 3:00 – 4:00 p.m. ET – register to attend
  • Two additional webinars during the weeks of October 11th and 18th (dates, times, and registration details forthcoming)

HHS recently hosted a briefing session to provide information about these upcoming funding opportunities – view the video.

What is ARP Rural?

ARP Rural funding is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers, and funding will be available to providers who serve patients in these communities. ARP Rural payments are administered jointly with the Provider Relief Fund, and eligible applicants can apply through the same Application and Attestation Portal that will be available to apply for the Phase 4 General Distribution to be considered for both opportunities simultaneously.

ARP Rural payments will be determined based on the location of the patients, not the provider. Applicants do not need to verify whether their patients live in an area that meets the definition of rural, and can select whether their organization (including any included subsidiaries) would like to be considered for ARP rural payments during the application process. HRSA will base payments on data already available to it on the amount and type of Medicare, Medicaid, and CHIP services provided to rural patients. HRSA will use the Federal Office of Rural Health Policy definition of rural.

HHS Announces New Provider Fund Distribution & Grace Period for Reporting Obligations

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS) announced it will accept applications from providers for new relief funds this week, as well education for providers to help navigate the application portal. In addition, there will be a grace period for the reporting deadline of September…

Webinar on Enhancements to HHS Security Risk Assessment Tool

The Office of the National Coordinator for Health Information Technology (ONC) and the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services are hosting a new webinar for users of the Security Risk Assessment Tool. Learn about the SRA Tool and how it can be used at your organization, hear…

HHS Announces $25.5 Billion in COVID-19 Provider Funding

  • Combined application for American Rescue Plan rural funding and Provider Relief Fund Phase 4 will open on September 29

The Biden Administration announced Friday, September 10, that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.

“Home health and hospice will have an opportunity to tap these new funds,” says NAHC President William A. Dombi. “Our concern is that non-Medicare, non-Medicaid home care is still not included. We have been pushing for their inclusion for months, but have seen no movement on such. These are primarily the home care companies that do home care aide services that are private pay along with VA or Area Agency on Aging  funded.”

“This funding critically helps health care providers who have endured demanding workloads and significant financial strains amidst the pandemic,” said HHS Secretary Xavier Becerra. “The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need.”

Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based on providers’ lost revenues and expenditures between July 1, 2020, and March 31, 2021. PRF Phase 4 will reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers.

 Who Is Eligible To Apply and How Will Payments Be Calculated?

Phase 4 General Distribution: Consistent with the requirements included in the December appropriations bill, PRF Phase 4 payments will be based on providers’ lost revenues and increased expenditures between July 1, 2020 and March 31, 2021. Phase 4 will also include new elements specifically focused on equity, including reimbursing smaller providers for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers, and bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patient.

  • 75% of the Phase 4 allocation will calculated based on revenue losses and COVID-related expenses.
    • Large providers will receive a minimum payment amount that is based on a percentage of their lost revenues and COVID-related expenses.
    • Medium and small providers will receive a base payment plus a supplement, with small providers receiving the highest supplement, as smaller providers tend to operate on thin margins and often serve vulnerable or isolated communities.
    • HHS will determine the exact amount of the base payments and supplements after analyzing data from all the applications received to ensure we stay within our budget and funds are distributed equitably.
    • No provider will receive a Phase 4 payment that exceeds 100% of their losses and expenses.
    • HHS will continue to use risk mitigation and cost containment measures in Phase 4 to protect program integrity and preserve taxpayer dollars.
  • 25% of the Phase 4 allocation will be put towards bonus payments that are based on the amount and type of services provided to Medicaid, CHIP, and Medicare patients.
    • HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.
    • Providers who serve any patients living in Federal Office of Rural Health Policy-defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

ARP Rural Distribution: Providers who serve Medicaid, CHIP, and Medicare patients who live in rural communities are eligible for the ARP Rural payments.

  • HHS will make payments to providers based on the amount and type of Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) services provided to rural patients.
    • HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.
    • Providers who serve any patients living in Federal Office of Rural Health Policy-defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

Terms and Conditions: To help ensure that these provider funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with or acquisition of another healthcare provider during their Payment Received Period. Providers who report a merger or acquisition may be more likely to be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy.

PRF Phase 4 will also include bonus payments for providers who serve Medicaid, CHIP, and/or Medicare patients, who tend to be lower income and have greater and more complex medical needs. HRSA will price these bonus payments at the generally higher Medicare rates to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.

Similarly, HRSA will make ARP rural payments to providers based on the amount of Medicaid, CHIP and/or Medicare services they provide to patients who live in rural areas as defined by the HHS Federal Office of Rural Health Policy. As rural providers serve a disproportionate number of Medicaid and CHIP patients who often have disproportionately greater and more complex medical needs, many rural communities have been hit particularly hard by the pandemic. Accordingly, ARP rural payments will also generally be based on Medicare reimbursement rates.

In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. HRSA will use existing Medicaid, CHIP and Medicare claims data in calculating payments. The application portal will open on September 29, 2021. To help ensure that these provider relief funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with, or acquisition of, another health care provider during the period in which they can use the payments. Providers who report a merger or acquisition may be more likely to be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy.

“We know that this funding is critical for health care providers across the country, especially as they confront new coronavirus-related challenges and respond to natural disasters,” said Acting HRSA Administrator Diana Espinosa. “We are committed to distributing this funding as equitably and transparently as possible to help providers respond to and ultimately defeat this pandemic.”

To promote transparency in the PRF program, HHS is also releasing detailed information – PDF (PDF – 175 KB) about the methodology utilized to calculate PRF Phase 3 payments. Providers who believe their PRF Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration. Further details on the PRF Phase 3 reconsideration process are forthcoming.

Additionally, in light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS is announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.

For more information about eligibility requirements, the documents and information providers will need to complete their application, and the application process for PRF Phase 4 and ARP Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.

HHS Announces $25.5 Billion in COVID-19 Provider Funding

Combined application for American Rescue Plan rural funding and Provider Relief Fund Phase 4 will open on September 29 The Biden Administration announced Friday, September 10, that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care…

Biden Administration Issues Sweeping Vaccine Rules for Health Care, Businesses

The Biden administration announced yesterday that his administration will require COVID-19 vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement. NAHC is currently studying the administration’s announcement and we look forward to receiving more details in the very near future.

“NAHC has encouraged vaccinations throughout the pandemic. We look forward to seeing the details of the President’s Executive Order,” said NAHC President Bill Dombi in response to the news.

That said, we believe the policy will include, but is not limited to:

  • home health agencies
  • hospices
  • hospitals
  • dialysis facilities
  • ambulatory surgical settings.

According to the White House, these requirements will apply to approximately 50,000 providers and cover over 17 million health care workers, a majority of health care workers across the country. “This action will create a consistent standard across the country, while giving patients assurance of the vaccination status of those delivering care,” said the White House in a statement released Thursday.

The Administration’s plan is to include the mandate as part of the federal Medicare Conditions of Participation (CoPs). The CoPs also affect state Medicaid programs as federal requirements incorporate those standards into the conditions under which states are entitled to receive federal matching supports for a state’s Medicaid spending.

In response to a question from NAHC President Bill Dombi, the CMS told NAHC that the “staff vaccination requirement would only apply to Medicare and Medicaid-certified provider and supplier types that are regulated under the Conditions of Participation. If an entity is not regulated under the CoPs, then this requirement would not apply.”

Noncompliance with the Conditions of Participation can trigger a range of penalties including termination from Medicare and/or Medicaid, Civil Monetary Penalties as high as $20,000 per  day, suspension of Medicare and/or Medicaid payments, and the insertion of temporary management.

Notably for Medicaid home care, not all providers are subject to CoPs. Federal Medicaid standards specify CoP application only for “home health services” and “hospice” care. While states can require other home care services to be provided through entities that meet Medicare CoPs, most do not.  This means that the vaccination mandate is not likely to apply to a host of Medicaid home services such as private duty nursing, personal care services, home and community-based services (HCBS) optional services for the elderly, and section 1915 waiver programs for HCBS.

 

 

CMS is developing an Interim Final Rule with Comment Period that will be issued in October to lay out the vaccination requirements for health care providers. Nevertheless, CMS expects Medicare and Medicaid facilities to comply with the new vaccination requirements now and health care workers in covered facilities are being urged to begin vaccination without further delay. Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.

“There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health,” said Xavier Becerra, Secretary for Health & Human Services. “Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential.”

Additionally, the Department of Labor, through the Occupational Safety and Health Administration (OSHA), will issue an Emergency Temporary Standard requiring all businesses with more than 100 employees to either mandate vaccinations for all workers or require them to take weekly COVID-19 tests.  Each violation of the OSHA standard could trigger a $14,000 penalty. The White House believes the OSHA standard will cover 80 million workers, or two-thirds of the nation’s workforce.

The announcement leaves some important questions unanswered. Such as:

  • When will Interim Final Rule and the OSHA Emergency Temporary Standard be published?
  • What will be the vaccination deadline for employees in the Interim Final Rule?
  • What vaccination exemptions will exist in the Interim Final Rule?
  • How will the vaccination exemptions be managed and monitored?
  • How will employees be counted? Full-time, FTE, all individuals regarding duration of a workday?
  • How will the mandate apply to franchise operations that individually do not have 100 employees, but exceed that number in combination?
  • Are there other ways beside the federal CoPs that the Administration can use to expand the reach of the mandate?
  • How does the mandate apply to self-directed care programs where the state or locality may be considered a joint employer?
  • What are the penalties for non-compliance outside of the $14,000 penalty referenced for an OSHA requirement?

You can expect NAHC to be in frequent contact with the administration and health care officials to obtain answers to these questions. When we receive answers, we will pass them on to NAHC members as quickly as possible. Please stay tuned to NAHC Report and other NAHC communications for updates.

The home care, home health, and hospice sectors of our health care system already suffer from severe staffing shortages and here is the very real possibility of even more significant staffing shortages should workers walk off the job rather than submit to vaccination. Shortages in staff will inevitably impact patients and patient care. This is a delicate balancing act in trying to keep patients and the workforce safe. NAHC hopes the Biden administration couples this action with efforts to help providers attract and retain more employees.

This action by the Biden administration builds on the vaccination requirement for nursing facilities recently announced by the Centers for Medicare & Medicaid Services (CMS), and will apply to:

  • nursing home staff
  • hospital staff
  • staff in other CMS-regulated settings
  • clinical staff
  • persons providing services under arrangements
  • volunteers
  • staff not involved in direct patient, resident, or client care.

Requiring Employers to Provide Paid Time Off to Get Vaccinated

OSHA is developing a rule torequire employers with more than 100 employees to provide paid time off for the time it takes for workers to get vaccinated or to recover if they suffer post-vaccination illness. This requirement will be implemented through the ETS.

New Support for Small Businesses Impacted by COVID-⁠19

Small Business Administration (SBA) will increase the maximum amount of funding a small business can borrow through the COVID Economic Injury Disaster Loan (EIDL) program, which provides long-term, low-cost loans, from $500,000 to $2 million. (An SBA analysis of current COVID EIDL borrowers who qualify for the increase shows that more than 80 percent have 25 employees or less.)

SBA will ensure that no small business has to start repaying these loans until two years after they receive the funding, so small businesses can get through the pandemic without having to worry about making payments.

Next, SBA will make it easier for small businesses with multiple locations in hard-hit sectors like restaurants, hotels, and gyms to access these loans.

SBA will offer a 30-day exclusive window of access where only small businesses seeking loans of $500,000 or less will receive awards after the new improved loan product launches.

Paycheck Protection Program (PPP) Loan Forgiveness Process

The administration’s plan is to make it easier for more than 3.5 million PPP borrowers with loans of $150,000 or less to get their loans wiped clean. Under the new streamlined approach, SBA sends a pre-completed application form to the borrower who can review, sign, and send back to SBA, which then works with the lender to complete the forgiveness process.

SBA expects more than 2.5 million additional small businesses to take advantage of this streamlined process in the months ahead, helping them avoid needless bureaucracy and avoid costly principal and interest payments on their loans.

Launching Community Navigator Program to Connect Small Businesses to Assistance

The ARP invested $100 million to establish a new SBA Community Navigator program, which will deploy trusted community partners in underserved communities to better connect business owners to federal, state, and local resources. Community Navigators will work with small business owners every step of the way to ensure that they are able to access the help that they need. Under the President’s plan, the SBA will complete the competitive review process to select Community Navigators and put them to work in underserved communities this Fall.

Access to Booster Shots

The Administration is preparing for COVID-19 vaccine boosters to start as early as the week of September 20th, subject to authorization or approval by the FDA and a recommendation from the CDC’s Advisory Committee on Immunization Practices (ACIP). Booster shots will be free and are to be made available at 80,000 locations around the country.

The National Association for Home Care & Hospice has strongly communicated to HHS how important it is that shipments of booster vaccines be sent directly to home care providers, so that safe and efficient booster vaccinations of the elderly and disabled – the most at-risk population – can take place in the home. NAHC will continue to make this case and we will keep our members up to date on this critically important topic.

Affordable and Available At-Home Tests

Walmart, Amazon, and Kroger will offer to sell rapid at-home tests at-cost for the next three months. In addition, Medicaid must cover at-home tests for free for beneficiaries, and states should ensure that any tools they use to manage at-home testing do not establish arbitrary barriers for people seeking care. The administration also plans to expand the number of retail pharmacy sites around the country where anyone can get tested for free through the HHS free testing program to 10,000 pharmacies.

The administration is also urging:

  • states to require school employees to be vaccinated;
  • schools to set up regular testing in their schools for students, teachers, and staff consistent with CDC guidance.

Getting Monoclonal Antibody Treatment to Those Who Need It

The Administration will increase the average weekly pace of shipments of free monoclonal antibody treatment to states by a further 50 percent in September. Monoclonal antibody treatments have been shown to reduce the risk of hospitalization by up to 70 percent for unvaccinated people at risk of developing severe disease. As hospital systems experience increased COVID-19 cases, many have identified monoclonal antibody treatment as a key tool to improve health outcomes, prevent hospitalizations and reduce the strain on overburdened hospitals.

Expanding the Pool of Health Care Professionals Providing Treatment by Deploying Federal Monoclonal Antibody Strike Teams

The COVID-19 Surge Response Teams have conducted in-person technical assistance and virtual trainings for physicians and health system officials to increase education and interest in administering these treatments. To ensure that more patients can access these lifesaving COVID-19 therapeutics, the Administration’s COVID-19 surge response effort will launch monoclonal antibody strike teams to deploy clinical personnel through HHS, FEMA, and DOD to help hospitals and health systems stand up the delivery of this key treatment option. HHS will also take action to amend the Public Readiness and Emergency Preparedness (PREP) Act declaration to allow more providers, including pharmacists, to administer this treatment.

This is a critical topic for our industry and our country and NAHC is heavily engaged in both studying and communicating concerns on this topic. Please stay tuned for updates.

Biden Administration Issues Sweeping Vaccine Rules for Health Care, Businesses

The Biden administration announced yesterday that his administration will require COVID-19 vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement. NAHC is currently studying the administration’s announcement and we look forward to receiving more details in the very near future. “NAHC has encouraged vaccinations throughout the pandemic. We look forward to…