- Telehealth Study Recruiting Veterans Now
- USDA Delivers Immediate Relief to Farmers, Ranchers and Rural Communities Impacted by Recent Disasters
- Submit Nominations for Partnership for Quality Measurement (PQM) Committees
- Unleashing Prosperity Through Deregulation of the Medicare Program (Executive Order 14192) - Request for Information
- Dr. Mehmet Oz Shares Vision for CMS
- CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid Partnership
- Social Factors Help Explain Worse Cardiovascular Health among Adults in Rural Vs. Urban Communities
- Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation: Request for Input
- Secretary Kennedy Renews Public Health Emergency Declaration to Address National Opioid Crisis
- Secretary Kennedy Renews Public Health Emergency Declaration to Address National Opioid Crisis
- 2025 Marketplace Integrity and Affordability Proposed Rule
- Rural America Faces Growing Shortage of Eye Surgeons
- NRHA Continues Partnership to Advance Rural Oral Health
- Comments Requested on Mobile Crisis Team Services: An Implementation Toolkit Draft
- Q&A: What Are the Challenges and Opportunities of Small-Town Philanthropy?
Pennsylvania Releases New COVID-19 Advisory and Updates
The Pennsylvania Department of Health released three new advisories related to COVID-19:
· Health Update – 634 – 04/07/22 – UPD – UPDATE: Therapeutics to Prevent and Treat COVID-19
· Health Advisory – 633 – ADV – Updated Reporting Requirements for COVID-19 Test Results
· Health Update – 632 – UPD – Update to Recommendations Regarding COVID-19 Booster Vaccination
Click here for all the latest Health Alerts, Advisories and Updates.
Pennsylvania Extends Postpartum Medicaid Coverage from 60 Days to a Year
The Pennsylvania A Department of Human Services (DHS) visited Scranton Primary Health Care Center this week to celebrate Pennsylvania’s extension of postpartum coverage for mothers and birthing people eligible for Medicaid because of their pregnancy to one year after giving birth. The change, effective April 1, 2022, was made possible to states as part of the American Rescue Plan Act. Typically, Medicaid (Medical Assistance in Pennsylvania) coverage for people eligible due to their pregnancy ended 60 days after giving birth. Expanding postpartum coverage for mothers covered through Medicaid will provide continuity in health care by allowing mothers to maintain relationships with and access to care providers undisrupted through a critical period in the mother’s life Read more.
April Is National Donate Life Month – “Bee” Involved!
April is National Donate Life Month, and HRSA is celebrating how sweet life is when someone who needs an organ transplant finds a match. Help celebrate and honor the generosity of organ, eye, and tissue donors, donor families, as well as the lives saved through donation. This year’s theme is “Bee a Donor!” and HRSA encourages health centers to help create a buzz and to “bee” part of this life-saving community. Thank you for all you do to promote organ donation and encourage more donor registrations!
HRSA Announces Availability of New Funding to Support Community-Based Doulas
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the availability of $4.5 million for hiring, training, certifying, and compensating community-based doulas in areas with high rates of adverse maternal and infant health outcomes. This announcement builds on the Biden-Harris Administration’s commitment to reduce maternal mortality and morbidity and address the nation’s Black maternal health crisis.
This funding, provided through HRSA’s Healthy Start Initiative, will increase the total number of Healthy Start doula programs from 25 to approximately 50 nationwide. HRSA’s Healthy Start Initiative works to improve health before, during, and after pregnancy and reduce racial and ethnic disparities in rates of infant deaths and adverse maternal health outcomes.
Read the press release.
What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access
From the Kaiser Family Foundation
With more than two years having passed since the COVID-19 pandemic began in early 2020, questions are being raised about when to end the public health emergency declarations made by the federal government early on, with some advocating for their extension and others calling for their expiration. There are numerous implications to ending these emergency declarations, each of which gave the federal government flexibilities to waive or modify certain requirements in a range of areas, including in the Medicare, Medicaid, and CHIP programs, and in private health insurance, as well as to allow for the authorization of medical countermeasures and to provide liability immunity to providers who administer services, among other things. In addition, Congress also enacted legislation that provided additional flexibilities tied to one or more of these emergency declarations, and as such they too are scheduled to expire when (or at a specified time after) the emergency period(s) expires.
This brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made, summarizes the flexibilities triggered by each, and identifies the implications for their ending, in the following areas:
- Coverage, costs, and payment for COVID-19 testing, treatments, and vaccines
- Medicaid coverage and federal match rates
- Telehealth
- Other Medicaid and CHIP flexibilities
- Other Medicare payment and coverage flexibilities
- Other private insurance coverage flexibilities
- Access to medical countermeasures (vaccines, tests, and treatments) through FDA emergency use authorization (EUA)
- Liability immunity to administer medical countermeasures
This is not meant to be an exhaustive list of all federal policy and regulatory provisions made in response to COVID-19 emergency declarations. For example, we do not cover the entire range of federal and state emergency authorities exercised under Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 waivers; Section 1135 waivers; and 1915 (c) waiver Appendix K strategies. The Centers for Medicare & Medicaid Services maintains a more complete list of coronavirus waivers and flexibilities that have been exercised since early 2020; some state actions to respond to the emergency may have expiration dates that are not tied to the end of the federal emergency declarations.
Click here to read the full brief.
State Telehealth and Licensure Expansion COVID-19 Dashboard: A State-by-State Comparison
During the public health emergency, all 50 states and the District of Columbia used emergency authority to waive some aspect(s) of state licensure requirements to facilitate patients getting care. This has provided an unprecedented opportunity for patients, providers, and policymakers to explore the impact of cross-state care. This has benefited the delivery of health care in many ways, but perhaps most notably, it has opened up many new avenues for patient choice and access to care.
As states begin to lift their COVID-19 emergency waivers or let them expire, many of the telehealth and licensure flexibilities enacted at the start of the pandemic to ensure continuity and access to care for patients are also expiring. The Alliance has created a chart outlining which states have lifted their COVID-19 emergency waivers, and how this has impacted telehealth and licensing flexibilities in each state. This document will be updated regularly, and can be found below.
As of March 8, 2022:
- 29 states and D.C. have ended their emergency declarations: AL, AK, AR, CO, DC, FL, IA, IN, KS, ME, MA, MD, MI, MN, MS, MO, MT, ND, NE, NH, NJ, OH, OK, PA, SC, SD, TN, UT, VT, WI.
- IN and PA, however, have licensure flexibilities still in place through March.
- IA is giving providers through May 17 to obtain licensure.
- KS, NJ and VT have extended licensure flexibilities through state legislation.
- Out-of-state professionals can provide telemedicine services to MN residents if they are registered with the Medical Board per Minnesota Statute § 147.032.
- OK allows out-of-state providers to obtain a temporary critical needs license through September 14, 2022.
- 21 states continue to have emergency declarations in place:
- States with declarations in place include: AZ, CA, CT, DE, GA, HI, ID, IL, KY, LA, NV, NM, NY, NC, OR, RI, TX, VA, WA, WV, WY.
- Of these 21 states, 18 states still have licensure flexibilities in place. Licensure flexibilities have expired in NM and ID, despite emergency declarations still in place. This is also true in AZ given HB 2454 (see below).
- CA is going through a phased rollback of COVID-era waivers, however waivers on telehealth and licensure are still in place.
- In total, 24 states still have licensure flexibilities in place.
Click here for the full report and map.
USDA Invites Applications to Strengthen Rural Cooperatives and Expand Economic Opportunities for People in Rural America
U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small announced that the department is accepting applications for grants to help start, expand or improve rural cooperatives and other mutually-owned businesses.
USDA is offering priority points to projects that advance key priorities under the Biden-Harris Administration to help communities recover from the COVID-19 pandemic, advance equity and combat climate change. These extra points will increase the likelihood of funding for projects seeking to address these critical challenges in rural America.
USDA is making the grants available under the Rural Cooperative Development Grant (RCDG) program to help improve economic conditions in rural areas through cooperative development. For fiscal year 2022, the maximum award is $200,000. Grants are awarded on a competitive basis through a national competition.
Nonprofit organizations and institutions of higher education are eligible to apply for grants to provide technical and cooperative development assistance to individuals and rural businesses.
Electronic applications must be submitted to grants.gov by 11:59 p.m. Eastern Time on June 6, 2022. Interested applicants are encouraged to contact their local USDA Rural Development State Office well in advance of the application deadline to discuss their project and ask any questions about the RCDG program or the application process. Contact information for state offices can be found at http://www.rd.usda.gov/contactus/state-offices.
Additional information on the required materials and how to apply for the RCDG program are available on page 19842 of the April 6, 2022, Federal Register.
If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.
Request for Comment: Medicare FY23 Hospice Payment Rate Update Proposed Rule
From the National Rural Health Association
On March 30, 2022, Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to provide routine updates to the Medicare Hospice payment system for Fiscal Year (FY) 2023.
Total estimated payments to hospices of a 2.7% ($580 million) increase in their payments for FY 2023. Further, the per patient that is made to a hospice annually. The proposed aggregate cap that limits the overall hospice payments for FY 2023 is $32,142.65.
Other key proposals include:
- Establish a permanent, budget neutral, mitigation policy to smooth the impact of year-to-year changes in hospice payments related to changes in the hospice wage index through a permanent cap on decreases greater than 5%.
- Improve data collection to measure and analyze disparities across programs and policies that apply to the Hospice Quality Reporting Program (HQRP) including development of a new HOPE tool, updates to quality measures, CAHPS hospice survey, and advancing HIE.
At this point, NRHA is not planning to submit comments on the proposed changes. Please share any questions or concerns with NRHA staff before the May 31, 2022 deadline. To submit comments, please do so through the federal register here. CMS’s FY23 Hospice Payment Rate Update NPRM Fact Sheet can be found here.
CMS: Eligible Individuals Can Receive Second COVID-19 Booster Shot at No Cost
The Centers 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 Centers for Disease Control and Prevention (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 four 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 four 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.
OSHA ETS Reopening: Occupational Exposure to COVID-19 in Healthcare Settings
From the National Rural Health Association
On March 23, 2022, the Occupational Safety and Health Administration (OSHA) reopened the rulemaking record partially and scheduled an informal public hearing to seek comments on specific topics that relate to the development of a final standard to protect healthcare and healthcare support service workers from workplace exposure to the COVID-19 virus.
The original 2021 OSHA Emergency Temporary Standard (ETS) aimed to protect workers in healthcare settings from occupational exposure to COVID-19. The ETS – which also served as a proposed rule – focused on healthcare workers most likely to have contact with people infected with the virus. The healthcare ETS required covered healthcare employers to develop and implement COVID-19 response plans to identify and control COVID-19 hazards in healthcare settings.
The agency is reopening the rulemaking record to allow for new data and comments on topics, including the following:
- Alignment with the Centers for Disease Control and Prevention’s recommendations for healthcare infection control procedures.
- Additional flexibility for employers.
- Removal of scope exemptions.
- Tailoring controls to address interactions with people with suspected or confirmed COVID-19.
- Employer support for employees who wish to be vaccinated.
- Limited coverage of construction activities in healthcare settings.
- COVID-19 recordkeeping and reporting provisions.
- Triggering requirements based on community transmission levels.
- The potential evolution of SARS-CoV-2 into a second novel strain.
- The health effects and risk of COVID-19 since the ETS was issued.
Comments on OSHA’s limited reopening of the COVID-19 healthcare ETS are due by April 22, 2022, and the informal public hearing will begin on April 27, 2022. Individuals interested in testifying at the online public hearing must submit a notice of intention to appear by April 6, 2022. View OSHA’s Federal Register Notice on govinfo.gov. View OSHA’s press release on the Notice on osha.gov.
NRHA plans to submit comments on the limited reopening reflective consistent with the intent of our 2021 comments. Please reach out if there are specific issues or concerns you’d like NRHA to reflect in our comment letter. For more information, please contact ccochran@ruralhealth.us.