In this Policy Roundup:
- COVID-19 updates
- Extension of public health emergency
- CMS ends two blanket waivers for nursing facilities
- Mask requirement for public transportation lifted
- People with Medicare and Medicaid can receive a second booster shot for free
- Department of Justice issues guidance on opioid use disorder and the Americans with Disabilities Act
- HHS releases new information on hospital and nursing home ownership
- Input Needed:
- Proposed rule - 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) Comments due June 10, 2022.
- Proposed Rule to Update Medicare Eligibility and Enrollment Rules and Coverage for Immunosuppressive Medication
- ICYMI: HHS to Provide $110 Million to Expand Community Services for Older Adults and People with Disabilities.
HHS extends Public Health Emergency for 90 days on April 12, 2022
The COVID-19 Public Health Emergency (PHE) was initially declared January 31, 2020 (retroactive to January 27). It has been renewed several times, most recently on April 12, 2022. If it is not renewed again, the PHE declaration will now end July 11, 2022.
This PHE allowed the Department of Health and Human Services (HHS) to provide significant flexibility to Medicare, Medicaid and providers to respond to the health care crisis posed by the COVID-19 pandemic. When the PHE expires, many of these flexibilities will need to be rolled back. These changes, which will particularly affect older adults, people with disabilities and people with chronic conditions, may be confusing to people affected. We will share information about changes to the PHE as soon as we know about them to ensure the aging and disability networks have as much time as possible to plan ahead and educate the communities we serve.
CMS ends two blanket waivers for nursing facilities
Under the PHE, HHS granted waivers of compliance with certain provisions of federal law in order to provide flexibility to health care providers to meet needs during the pandemic. These waivers will expire at the end of the public health emergency, but HHS also has discretion to them sooner if it determines they are no long necessary or are resulting in harm to consumers.
In an April 7 policy memo to states, CMS announced that it will end several waivers affecting long-term care facilities, including two of particular relevance to the aging and disability networks related to discharge planning and nurse staffing. Specifically, nursing facilities must:
- By May 7: Provide all legally required data and information to patients and their representatives on post-acute care providers, including standardized patient assessment data and quality measures. This will ensure aging and disability networks have necessary information to assist residents with discharge and transfer. (Waiver of Pre-Admission Screening and Annual Resident Review (PASARR) requirements, which affect nursing facility requirements surrounding community discharge for people with serious mental illness and intellectual and developmental disabilities remains in place.)
- By June 6: Ensure all nurse aides and feeding assistants complete full legally required staff training. Many of these requirements were suspended via waiver during the pandemic to increase staff capacity. However, CMS has raised resident safety concerns as a result of loosened requirements. Returning to full staff training requirements is important for resident safety, but the nursing home industry has warned it could lead to staff shortages in the short term.
Mask requirement for public transportation lifted
On April 18, a federal judge in Florida struck down the CDC's mask requirement for public transportation. The CDC continues to recommend that all people wear masks on indoor public transportation, and the Department of Justice has appealed the Florida court’s ruling. For now, however, masks are not required on public transportation or in transportation hubs like train stations and airports.
The CDC mask mandate had been extended less than a week before the court’s ruling, and local rules may still require masking. For example, some cities, including New York, Boston, San Francisco and Philadelphia, continue to require masks on public transportation and in transportation hubs like airports. Certain international flights may also require masking, based on rules in the country of departure and/or arrival. Consequently, there may be confusion in the community about the requirements.
In addition, the end of the transportation mask mandate has raised serious concern for people at higher risk of severe COVID-19 illness, including older adults and people who are immunocompromised.
The aging and disability network has an important role in ensuring those at high risk are informed of the changes to the masking mandate prior to planning a trip on a plane or train. The networks also may see increased demand for services, as some older adults and people with disabilities may seek alternate forms of transportation, such as services provided by the aging and disability network. We will share information as it becomes available.
People with Medicare and Medicaid can receive a second booster shot for free
People enrolled in Medicare and Medicaid are eligible for a second booster dose without any out-of-pocket costs, including copayments, coinsurance or deductibles. Full vaccination with a booster has been shown to provide maximum protection against serious illness and hospitalization from COVID-19. The Centers for Disease Control (CDC) suggests people fifty and older and those who are immunocompromised receive a second booster dose at least four months after their first booster dose. The CDC has published detailed information on what booster shots to get and when based on the brand and timing of initial vaccine and first booster, as well as age and immunocompromised status. Visit www.covid.gov for information on where to find local locations for vaccines and boosters.
Justice Department Issues Guidance on Opioid Use Disorder and the Americans with Disabilities Act
The Department of Justice recently published guidance on protections available to people with Opioid Use Disorder (OUD) under the Americans with Disabilities Act (ADA). The guidance discusses a range of topics including ADA compliance for covered entities,* information on when OUD is considered a disability, the protections available to individuals taking legally prescribed medication to treat their OUD, and how to file a complaint. The guidance is a valuable resource for the aging and disability network as they assist people with OUD and their families exercising their rights under the ADA.
<*Editor's note: An original link used in this paragraph was no longer working and was replaced with an alternative link.>
HHS Releases New Data and Report on Hospital and Nursing Home Ownership
The Centers for Medicare & Medicaid Services (CMS) is releasing data publicly -- for the first time -- on mergers, acquisitions, consolidations, and changes of ownership from 2016-2022 for hospitals and nursing homes enrolled in Medicare. The aging and disability network has been at the forefront of advocacy for increased quality and accountability for Medicare participating hospitals and nursing homes; this new data is an important new tool for their work.
Input Needed: Proposed rule - 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) Comments due June 10, 2022
The Centers for Medicare & Medicaid Services (CMS) issued its fiscal year (FY) 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) proposed rule. The aging and disability network can provide valuable feedback on the following elements:
- Staffing in nursing homes: How to establish minimum staffing requirements that nursing homes will need to meet to ensure all residents are provided safe, high-quality care, and nursing home workers have the support they need
- Health equity: How to arrange or classify measures in nursing home quality reporting programs by indicators of social risk to better identify and reduce disparities. Social risk factors are non-clinical factors that negatively impact patient outcomes, like socioeconomic status, housing availability, and nutrition often inequitably affecting historically marginalized communities.
Comments can be submitted online until June 10. The agency has also published a fact sheet on the proposed rule.
Request for input: Proposed Rule to Update Medicare Eligibility and Enrollment Rules and Coverage for Immunosuppressive Medication
On April 22, 2022 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to implement sections of the Consolidated Appropriations Act, 2021 (CAA) that would simplify Medicare enrollment rules and extend coverage of immunosuppressive drugs for certain beneficiaries.
The proposed rule creates a number of new Special Enrollment Periods (SEP) to allow beneficiaries affected by disasters such as the COVID-19 pandemic and those who lose Medicaid coverage to obtain Medicare Part B without a late enrollment penalty or delay in coverage. The proposed rule also creates new SEPs for formerly incarcerated individuals, people given erroneous information by their employer and a catch-all, case-by-case SEP for exceptional circumstances.
The proposed rule also establishes a new benefit for beneficiaries who receive a kidney transplant allowing for Medicare payment of immunosuppressive medication past the current 36-month post-transplant cut-off
ICYMI: HHS to Provide $110 Million to Expand Community Services for Older Adults and People with Disabilities:
On March 31, 2022, the Centers for Medicare and Medicaid Services (CMS) announced it will offer $110 million to expand access to home and community-based services (HCBS) through Medicaid's Money Follows the Person (MFP) program.
- 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 ensures more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose. 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
- 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 form 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. The disability and aging network can engage with their state to implement these changes, which will 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.