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.

Even after she’s clocked out, Sarah Lewin keeps a Ford Explorer outfitted with medical gear parked outside her house. As one of just four paramedics covering five counties across vast, sprawling eastern Montana, she knows a call that someone had a heart attack, was in a serious car crash, or needs life support and is 100-plus miles away from the nearest hospital can come at any time.

“I’ve had as much as 100 hours of overtime in a two-week period,” said Lewin, the battalion chief for the Miles City Fire and Rescue department. “Other people have had more.”

Paramedics are often the most highly skilled medical providers on emergency response crews, and their presence can make a lifesaving difference in rural areas where health services are scarce. Paramedics are trained to administer specialized care from the field, such as placing a breathing tube in a blocked airway or decompressing a collapsed lung. Such procedures are beyond the training of emergency medical technicians.

But paramedics are hard to come by, and a long-standing workforce shortage has been exacerbated by turnover and resignations related to pandemic burnout.

Larger departments are trying to attract paramedics by boosting pay and offering hefty signing bonuses. But small teams in underserved counties across the U.S. don’t have the budgets to compete. Instead, some rural crews are trying to train existing emergency responders for the roles, with mixed results.

Miles City is among the few communities in rural eastern Montana to have paramedic-level services, but the department doesn’t have enough paramedics to offer that care 24/7, which is why medics like Lewin take calls on their time off. The team received a federal grant so four staffers could become paramedics, but it could fill only two slots. Some prospects turned down the training because they couldn’t balance the intense program with their day jobs. Others didn’t want the added workload that comes with being a paramedic.

If you’re the only paramedic on, you end up taking more calls,” Lewin said.

What’s happening in Miles City is also happening nationwide. People who work in emergency medical care have long had a name for the problem: the paramedic paradox.

“The patients who need the paramedics the most are in the more rural areas,” said Dia Gainor, executive director of the National Association of State EMS Officials. But paramedics tend to gravitate to dense urban areas where response times are faster, the drives to hospitals are shorter, and the health systems are more advanced.

“Nationally, throw a dart at the map, the odds are that any rural area is struggling with staffing, with revenue, with access to training and education,” Gainor said. “The list goes on.”

The Michigan Association of Ambulance Services has dubbed the paramedic and EMT shortage “a full-blown emergency” and called on the state legislature this year to spend $20 million to cover the costs of recruiting and training 1,000 new paramedics and EMTs.

At the beginning of this year, Colorado reactivated its crisis standard of care for short-staffed emergency medical service crews experiencing mounting demand for ambulances during a surge in COVID cases. The shortage is such a problem that in Denver a medical center and high school teamed up to offer courses through a paramedic school to pique students’ interest.

In Montana, 691 licensed paramedics treat patients in emergency settings, said Jon Ebelt, a spokesperson for the Montana Department of Public Health and Human Services. More than half are in the state’s five most-populous counties — Yellowstone, Gallatin, Missoula, Flathead, and Cascade — covering a combined 11% of the state’s 147,000 square miles. Meanwhile, 21 of Montana’s 56 counties don’t have a single licensed EMS paramedic.

Andy Gienapp, deputy executive director of the National Association of State EMS Officials, said a major problem is funding. The federal Medicaid and Medicare reimbursements for emergency care often fall short of the cost of operating an ambulance service. Most local teams rely on a patchwork of volunteers and staffers, and the most isolated places often survive on volunteers alone, without the funding to hire a highly skilled paramedic.

If those rural groups do find or train paramedics in-house, they’re often poached by larger stations. “Paramedics get siphoned off because as soon as they have those skills, they’re marketable,” Gienapp said.

Gienapp wants to see more states deem emergency care an essential service so its existence is guaranteed and tax dollars chip in. So far, only about a dozen states have done so.

But action at the state level doesn’t always guarantee the budgets EMS workers say they need. Last year, Utah lawmakers passed a law requiring municipalities and counties to ensure at least a “minimum level” of ambulance services. But legislators didn’t appropriate any money to go with the law, leaving the added cost — estimated to be up to $41 per resident each year — for local governments to figure out.

Andy Smith, a paramedic and executive director of the Grand County Emergency Medical Services in Moab, Utah, said at least one town that his crew serves doesn’t contribute to the department’s costs. The team’s territory includes 6,000 miles of roads and trails, and Smith said it’s a constant struggle to find and retain the staffers to cover that ground.

Smith said his team is lucky — it has several paramedics, in part because the nearby national park draws interest and the ambulance service has helped staffers pay for paramedic certification. But even those perks haven’t attracted enough candidates, and he knows some of those who do come will be lured away. He recently saw a paramedic job in nearby Colorado starting at $70,000, a salary he said he can’t match.

“The public has this expectation that if something happens, we always have an ambulance available, we’re there in a couple of minutes, and we have the highest-trained people,” Smith said. “The reality is that’s not always the case when the money is rare and it’s hard to find and retain people.”

Despite the staffing and budget crunches, state leaders often believe emergency crews can fill gaps in basic healthcare in rural areas. Montana is among the states trying to expand EMS work to nonemergency and preventive care, such as having medical technicians meet patients in their homes for wound treatment.

A private ambulance provider in Montana’s Powder River County agreed to provide those community services in 2019. But the owner has since retired, and the company closed. The county picked up emergency services last year, and County Commissioner Lee Randall said that providing basic healthcare is on the back burner. The top priority is hiring a paramedic.

Advancing the care that EMT crews can do without paramedics is possible. Montana’s EMS system manager, Shari Graham, said the state has created certifications for basic EMTs to provide some higher levels of care, such as starting an IV line. The state has also increased training in rural communities so volunteers can avoid traveling for it. But those steps still leave gaps in advanced life support.

“Realistically, you’re just not going to have paramedics in those rural areas where there’s no income available,” Graham said.

Back in Miles City, Lewin said her department may get an extension to train additional paramedics next year. But she’s not sure she’ll be able to fill the spots. She has a few new EMT hires, but they won’t be ready for paramedic certification by then.

“I don’t have any people interested,” Lewin said. For now, she’ll keep that emergency care rig in her driveway, ready to go.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

The U.S. Department of Health & Human Services (HHS), through the Health Resources and Services Administration (HRSA), released a Request for Information (RFI) seeking input on ways to strengthen and improve the Organ Procurement and Transplantation Network (OPTN) through the upcoming Fiscal Year 2023 Request for Proposal (RFP).

The National Organ Transplant Act of 1984 established the OPTN to coordinate and improve the effectiveness of the nation’s organ procurement, distribution and transplantation systems and to increase the availability of, and access to, donor organs for patients with end-stage organ failure.  The law specifies that the OPTN be operated under federal contract.  In the coming months, HRSA will be issuing a Request for Proposal (RFP) for the next OPTN contract.

The RFI will support HRSA’s efforts to increase accountability in OPTN operations, modernize performance of the OPTN IT system and related tools, and improve engagement with donors and patients.  It specifically focuses on opportunities to strengthen equity, access, and transparency in the organ donation, allocation, procurement, and transplantation process in the contract arrangement that results from the forthcoming RFP.

“HRSA is committed to making organ procurement and transplantation more equitable, accessible, and transparent,” said HRSA Administrator Carole Johnson. “The Request for Information released today is an important step in advancing these goals and we look forward to receiving robust feedback on ways to increase organ donation, improve patient and donor engagement, strengthen accountability throughout the system, and best leverage modern technology to support this life-saving work.”

In addition to seeking feedback on the governance, finance, IT, data collection, policy, and operational components of the OPTN contract more broadly, this RFI specifically solicits feedback on ways to incorporate the findings and recommendations of the February 2022 National Academies of Science, Engineering, and Medicine (NASEM) report titled Realizing the Promise of Equity in the Organ Transplantation System, as well as the lessons learned from HRSA’s 2019 market research, conducted in partnership with the U.S. Digital Service, on ways the OPTN IT system should leverage modern IT architecture.

Interested parties may access information regarding the RFI here: https://sam.gov/opp/df25032b76b1467eabae79a2ba222ead/view.   The RFI is open for a 30-day period beginning April 8, 2022. Responses to the RFI are due to HRSA by May 9, 2022 at 1 p.m. ET.

To learn more about HRSA’s organ transplantation activities, please visit www.organdonor.gov.

Commonwealth citizens living with Autism Spectrum Disorder are important to our communities.

April is Autism Acceptance Month, and the Pennsylvania Department of Human Services (DHS) is recognizing services offered to individuals with intellectual disabilities and their families. However, this is not only important during April. Every day we celebrate individuals who are breaking barriers and contributing to their communities, excelling in employment, and promoting self-advocacy. All individuals living with autism or intellectual disabilities should have autonomy, choice, and opportunities to live everyday lives.

Autism in PA

What is Autism Spectrum Disorder (ASD)?

ASD is a complex, lifelong developmental condition that typically appears during early childhood and can impact a person’s social skills, communication, relationships, and self-regulation. Autism is experienced differently for everyone and to varying degrees. It is defined by a certain set of behaviors and is often referred to as a “spectrum condition.”

In 2021, the CDC reported that approximately 1 in 44 children in the U.S. is diagnosed with ASD. Currently, more than 180,000 Pennsylvanians are living with autism.

What are the characteristics of ASD?

• Signs and Symptoms of Autism Spectrum Disorder — CDC

How is ASD diagnosed?

A medical professional who may have experience with Autism — including pediatricians, neurologists, psychiatrists, and psychologists — may be able to make an assessment. The evaluation itself can vary depending on the professional administering it, the age of the person being assessed, the severity of his or her needs, and local available resources. A medical assessment for Autism typically includes:

• A medical history of the mother’s pregnancy
• Developmental milestones
• Sensory challenges
• Medical illnesses, including ear infections and seizures
• Any family history of developmental disorders
• Any family history of genetic and metabolic disorders
• An assessment of cognitive functioning
• An assessment of language skills
• An Autism-specific observational test, interview or rating scale

If you have questions or feel you need additional help, try reaching out to a local Autism Society affiliate, an Autism support group, your primary care provider, or possibly another parent with a child or family member with Autism.

Intervention & Support

Treatment

Every individual with autism has unique strengths and challenges, so there is no definitive approach to autism treatment and intervention. Each autism intervention or treatment plan should be tailored to address the person’s specific needs. A person’s treatment plan can include behavioral interventions, other therapies, and medicines.

Support through ASERT

DHS is responding to the increased prevalence of ASD by expanding access to services, while also working to address the need to build the capacity of professionals trained to assist individuals with autism and their families across their lifespan. The state-funded Autism Services, Education, Resources and Training (ASERT) initiative provides support and information to Pennsylvanians with ASD. ASERT also maintains a collaborative that brings together medical centers, centers for autism research and services, universities, and other providers involved in the treatment and care of individuals of all ages with autism and their families to support service providers, individuals with autism spectrum disorder, and their families.

• Finder a support group near you
• Join the conversation — Neurodiversity: Voices and Views 2022
• Justice Resource Collection
• Be Safe: Resources and Strategies for Sexual Abuse Prevention
• COVID-19 Resources
  • Coronavirus Social Story
  • Social Distancing Social Story
  • Wearing a Mask Social Story

Additional Autism Resources

• myODP — DHS Office of Developmental Programs
• Everyday Lives — DHS Office of Developmental Programs
• #ASDNext
• Autism Speaks
• Autism Society
• A Proclamation on World Autism Awareness Day, 2022 — The White House

The Biden-Harris Administration announced that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to Food and Drug Administration (FDA) approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. People with Medicare can get up to eight tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency.

“With today’s announcement, we are expanding access to free over-the-counter COVID-19 testing for people with Medicare Part B, including those enrolled in a Medicare Advantage plan. People with Medicare Part B will now have access to up to eight FDA-approved, authorized or cleared over-the-counter COVID-19 tests per month at no cost. This is all part of our overall strategy to ramp -up access to easy-to-use, at-home tests free of charge,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also delivering close to 250 million at-home, rapid tests to send for free to Americans who need them. Under the Biden-Harris Administration’s leadership, we required state Medicaid programs, insurers and group health plans to make tests free for millions of Americans. With today’s step, we are further expanding health insurance coverage of free over-the-counter tests to Medicare beneficiaries, including our nation’s elderly and people with disabilities.”

This is the first time that Medicare has covered an over-the-counter self-administered test at no cost to beneficiaries. This new initiative enables payment from Medicare directly to participating eligible pharmacies and other health care providers to allow Medicare beneficiaries to receive tests at no cost, in addition to the two sets of four free at-home COVID-19 tests Americans can continue to order from covidtests.gov. National pharmacy chains are participating in this initiative, including: Albertsons Companies, Inc., Costco Pharmacy, CVS, Food Lion, Giant Food, The Giant Company, Hannaford Pharmacies, H-E-B Pharmacy, Hy-Vee Pharmacy, Kroger Family of Pharmacies, Rite Aid Corp., Shop & Stop, Walgreens and Walmart.

“Testing remains a critical tool in mitigating the spread of COVID-19, and we are committed to making sure people with Medicare have the tools they need to stay safe and healthy,” said Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. “By launching this initiative, the Biden-Harris Administration continues to demonstrate that we are doing everything possible to make over-the-counter COVID-19 testing free and accessible for millions more Americans.”

Providers and suppliers eligible to participate include certain types of pharmacies and other health care providers who are enrolled in Medicare and able to furnish ambulatory health care services such as preventive vaccines, COVID-19 testing and regular medical visits. To ensure that people with Medicare have access to these tests, Medicare is not requiring participating eligible pharmacies and health care providers go through any new Medicare enrollment processes. If a health care provider currently provides ambulatory health care services such as vaccines, lab tests or other clinic type visits to people with Medicare, then they are eligible to participate in this initiative.

“For the first time in its history, Medicare is paying for an over-the-counter test,” said Deputy Administrator Dr. Meena Seshamani, Director of the Center for Medicare at CMS. “This is because COVID-19 testing is a critical part of our pandemic response. Combined with the free over-the-counter tests available through covidtests.gov, this initiative will significantly increase testing access for Americans most vulnerable to COVID-19 and will provide valuable information for future payment policy supporting accessible, comprehensive, person-centered health care.”

A list of eligible pharmacies and other health care providers that have committed publicly to participate in this initiative can be found here. Because additional eligible pharmacies and health care providers may also participate, people with Medicare should check with their pharmacy or health care provider to find out whether they are participating.

This initiative adds to existing options for people with Medicare to access COVID-19 testing, including:

• Requesting free over-the-counter tests for home delivery at gov. Every home in the U.S. is eligible to order two sets of four at-home COVID-19 tests.
• Access to no-cost COVID-19 tests through health care providers at over 20,000 testing sites nationwide. A list of community-based testing sites can be found here.
• Access to lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost through Medicare.
• In addition to accessing a COVID-19 laboratory test ordered by a health care professional, people with Medicare can also access one lab-performed test without an order and cost-sharing during the public health emergency.

For more information, please see this fact sheet https://www.cms.gov/newsroom/fact-sheets/medicare-covers-over-counter-covid-19-tests

People with Medicare can get additional information by contacting 1-800-MEDICARE and going to: https://www.medicare.gov/medicare-coronavirus. Medicare also maintains several resources to help ensure beneficiaries receive the correct benefits while also avoiding the potential for fraud or scams. More details—particularly on identifying scams due to COVID-19—can be found at https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse.

Pharmacies and other health care providers interested in participating in this initiative can get more information here: https://www.cms.gov/COVIDOTCtestsProvider

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgov

During April, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Minority Health Month. Officially established by Congress in 2002, this health observance offers an opportunity to build awareness about the health inequities that have historically affected underserved and marginalized communities.

In keeping with Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, our office is working to develop a comprehensive approach to advance equity for all including people of color and those adversely affected by persistent poverty and inequity to ensure those served by CMS can achieve their highest level of health and well-being. This is an effort that has involved furthering and embedding equity work across all CMS programs and continuing to provide resources to encourage advancing health equity for all the populations we serve. From the CMS Innovation Center, to the Medicare program, Medicaid and CHIP programs across the country, the Marketplace team, and more, CMS is committed to advancing health equity across Medicare, the Marketplaces, and Medicaid and CHIP.

This observance exemplifies our goal to help eliminate health disparities while improving the health of all minority populations. Below is a list of the resources offered by CMS OMH in order to help achieve this goal.

Resources

• Review the Health Equity Challenges and CMS Resources to Help Address Them infographic, which outlines various barriers to health equity and related challenges that populations often face and shares CMS resources that can help close the health equity gap.
• Review the Health Equity Technical Assistance Program which offers resources aimed at helping health care organizations take action against health disparities.
• Use the Mapping Medicare Disparities Tool to identify areas of disparity between subgroups of people with Medicare (e.g., racial and ethnic groups) in health outcomes, utilization, and spending.
• Download Improving Health in Rural Communities: 2021 Year in Review to learn about the activities and accomplishments that CMS has made in improving the health and wellbeing of individuals living and working in rural, frontier, and tribal communities in fiscal year 2021.
• Download Paving the Way to Equity: A Progress Report to learn more about the progress CMS has made in advancing health equity between 2015 and 2021.
• View our Coverage to Care initiative, which was developed to help people understand their health coverage and connect to the primary care and preventive services that are best for them.

The Biden-Harris Administration is announcing that as many as 720,000 pregnant and postpartum people across the United States could be guaranteed Medicaid and Children’s Health Insurance Program (CHIP) coverage for a full 12 months after pregnancy thanks to the American Rescue Plan (ARP). Medicaid covers 42 percent of all births in the nation, and this new option for states to extend Medicaid and CHIP coverage marks the Biden-Harris Administration’s latest effort to address the nation’s crisis in pregnancy-related deaths and maternal morbidity by opening the door to postpartum care for hundreds of thousands of people.

In addition to related updates in the 2023 federal budget request, for example, in December 2021, Vice President Kamala Harris hosted the first-ever federal Maternal Health Day of Action, where she announced a call to action to both the public and private sectors to help improve health outcomes for parents and infants in the United States. Today’s announcements are a part of the Biden-Harris Administration’s continued response to that call to action to support safe pregnancies and childbirth, and reduce complications and mortality in the year following birth.

“Having postpartum care can be life-saving and lead to better long-term health outcomes for new parents and newborns,” said Health & Human Services (HHS) Secretary Xavier Becerra. “Thanks to President Biden’s American Rescue Plan, we are able to make it easier for states like Louisiana to give thousands more pregnant and postpartum people across the country access to high-quality, affordable coverage for the essential first year after birth. The Biden-Harris Administration has made maternal health and equity a priority, and we are working to ensure every parent has access to the care they and their child deserve.”

Louisiana, the first state CMS is approving to take advantage of this new state plan opportunity under the ARP, today began offering its enhanced coverage to an estimated 14,000 pregnant and postpartum people. CMS is also working with an additional nine states to extend postpartum coverage. In 2021, Illinois, New Jersey, and Virginia were the first states to use Medicaid demonstration authority to provide 12 months of continuous postpartum coverage for all Medicaid and CHIP enrollees. In addition, a number of other states have announced that they are working to extend Medicaid coverage to 12 months after pregnancy, and CMS looks forward to working those states. In order to receive federal funds and to ensure consistency with federal standards, including those set by the ARP, states must go through a formal process run by CMS.

“This is an historic step for states to partner with us to provide life-saving coverage for postpartum people—and meaningfully address the maternal health crisis. For too long, families have been left behind by a health care system that breaks connections to care when they are needed most,” said CMS Administrator Chiquita Brooks-LaSure. “Everyone deserves an opportunity to attain and maintain health. The American Rescue Plan created a pathway to connect pregnant people to vital health coverage through that first critical year after birth, and I urge every state to adopt this option to extend lifesaving postpartum coverage.”

Under existing requirements, many Medicaid and CHIP enrollees receive coverage through the end of the month in which their 60-day postpartum period ends. Maintaining Medicaid and CHIP coverage for a full year provides access to critical health care services during the first year after pregnancy, which can help to address persistent health disparities. One-third of maternal deaths occur between one week to a year after the end of pregnancy, and rates of maternal mortality are up to five times higher among Black and American Indian/Alaska Native people than their white peers.

Beginning April 1, 2022, the ARP’s new state plan option offers state Medicaid and CHIP agencies an opportunity to provide 12 months of continuous postpartum coverage. States choosing to extend postpartum coverage must elect this option in both Medicaid and their separate CHIP programs, if applicable, and submit required state plan amendments to CMS. The new ARP state plan option is currently limited to a five-year period that ends on March 31, 2027.

States like Louisiana that adopt the new extended postpartum coverage must provide coverage to all eligible individuals who were enrolled in Medicaid or CHIP while they were pregnant. This extended coverage period will last from the day the pregnancy ends through the end of the month in which their 12-month postpartum period ends.

The postpartum coverage option extends to current beneficiaries who are enrolled in Medicaid or CHIP while pregnant but are no longer pregnant when the state implements the ARP option, if the individual is within their 12-month postpartum period when their state implements the option. It also applies to individuals who were pregnant at some point during the three months prior to applying for Medicaid, if they met the eligibility requirements at that time.

Advancing this state plan option comes at a critical time for pregnant individuals and families, many of whom are relying on continued Medicaid and CHIP coverage for the ongoing care they need during the postpartum period. Continuity of coverage can help postpartum people manage chronic conditions, like hypertension and diabetes, that last well beyond the first 60 days postpartum, as well as provide access to behavioral health and other mental health care services.

Other states interested in learning about extending postpartum coverage through the ARP can contact their CMS state lead or consult the state health official letter CMS issued in December 2021.