Biden-Harris Administration Takes Action to Expand Access to Emergency Care Services in Rural Communities

CMS proposes new rule that creates a pathway for rural hospitals and critical access hospitals to increase access to emergency and outpatient care

Today, as part of the Biden-Harris Administration’s ongoing effort to strengthen rural health, the Centers for Medicare & Medicaid Services (CMS) is releasing a new proposed rule protecting access to emergency care and additional outpatient services for people in rural communities. CMS is establishing the Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs). The proposed rule will allow small rural hospitals to seek this new health care provider designation and provide continued access to emergency services, observation care, and additional medical and outpatient services. In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after January 1, 2023. This is a significant step in building on the Administration’s efforts to reduce health care disparities and maintain access to services in rural communities.

Rural communities represent a fifth of the U.S. population, and the Department of Health and Human Services (HHS) is committed to improving health outcomes and promoting health equity in rural America. Since 2010, 138 rural hospitals have closed — with a record-breaking 19 hospitals closing in 2020 alone. These closures occur disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates. Rural communities experience shorter life expectancy, higher mortality, and have fewer local health care providers, leading to worse health outcomes than in other communities. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential health care services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is committed to advancing health equity, driving high-quality person-centered care, and promoting the sustainability of our programs. Today’s action to strengthen rural health furthers our goal of ensuring everyone served by our programs the has access to quality, affordable health care.”

To address these concerns, CMS is implementing a new Medicare provider designation called REHs, which will provide an opportunity for small rural hospitals and CAHs to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities. The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals. . .

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For more information on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.federalregister.gov/public-inspection/current

To read the Fact Sheet on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.cms.gov/newsroom/fact-sheets/conditions-participation-rural-emergency-hospitals-and-critical-access-hospital-cop-updates-cms-3419.

To read the Fact Sheet on HHS actions to strengthen rural health, click here. 
 

Dems Want to Tax High Earners to Protect Medicare Solvency

Associated Press | By ALAN FRAM
 
WASHINGTON (AP) — Senate Democrats want to boost taxes on some high earners and use the money to extend the solvency of Medicare, the latest step in the party’s election-year attempt to craft a scaled-back version of the economic package that collapsed last year, Democratic aides told The Associated Press.
 
Democrats expect to submit legislative language on their Medicare plan to the Senate’s parliamentarian in the next few days, the aides said. It was the latest sign that Majority Leader Chuck Schumer, D-N.Y., and Sen. Joe Manchin, D-W.Va., could be edging toward a compromise the party hopes to push through Congress this summer over solid Republican opposition. Manchin scuttled last year’s bill.
 
Under the latest proposal, people earning more than $400,000 a year and couples making more than $500,000 would have to pay a 3.8% tax on their earnings from tax-advantaged businesses called pass throughs. Until now, many of them have been using a loophole to avoid paying that levy.
 
That would raise an estimated $203 billion over a decade, which Democrats say would be used to delay until 2031 a shortfall in the Medicare trust fund that pays for hospital care. That fund is currently projected to start running out of money in 2028, three years earlier.
 
Most U.S. businesses are pass throughs, which include partnerships and sole proprietorships and range from one-person law practices to some large companies. Owners count the profits as income when they pay individual income taxes, but such companies do not pay corporate taxes — meaning they avoid paying two levels of taxation.
 
Democrats this week also sent the parliamentarian a separate 190-page piece of the emerging Schumer-Manchin compromise that would lower prescription drug costs for patients and the government. Provisions include requiring Medicare to negotiate drug prices, limiting beneficiaries’ out-of-pocket costs to $2,000 annually and increasing federal subsidies for copays and premiums for some low-income people.

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FDA Advisers Recommend Updating COVID Booster Shots for Fall

Associated Press | By Lauran Neergaard and Matthew Perrone

At least some U.S. adults may get updated COVID-19 shots this fall, as government advisers voted Tuesday that it's time to tweak booster doses to better match the most recent virus variants.

Advisers to the Food and Drug Administration wrestled with how to modify doses now when there's no way to know how the rapidly mutating virus will evolve by fall — especially since people who get today's recommended boosters remain strongly protected against COVID-19's worst outcomes.

Ultimately the FDA panel voted 19-2 that COVID-19 boosters should contain some version of the super-contagious omicron variant, to be ready for an anticipated fall booster campaign.

"We are going to be behind the eight-ball if we wait longer," said one adviser, Dr. Mark Sawyer of the University of California, San Diego.

The FDA will have to decide the exact recipe, but expect a combination shot that adds protection against either omicron or some of its newer relatives to the original vaccine

"None of us has a crystal ball" to know the next threatening variant, said FDA vaccine chief Dr. Peter Marks. But "we may at least bring the immune system closer to being able to respond to what's circulating" now rather than far older virus strains.

It's not clear who would be offered a tweaked booster — they might be urged only for older adults or those at high risk from the virus. But the FDA is expected to decide on the recipe change within days and then Pfizer and Moderna will have to seek authorization for the appropriately updated doses, time for health authorities to settle on a fall strategy.

Current COVID-19 vaccines have saved millions of lives globally. With a booster dose, those used in the U.S. retain strong protection against hospitalization and death but their ability to block infection dropped markedly when omicron appeared. And the omicron mutant that caused the winter surge has been replaced by its genetically distinct relatives. The two newest omicron cousins, called BA.4 and BA.5, together now make up half of U.S. cases, according to the Centers for Disease Control and Prevention.

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Colorado Health Facilities Interaction

From CDPHE

[Late last month] the Colorado Department of Public Health and Environment (CDPHE) announced that it, “does not intend to seek another set of emergency rules, nor does it intend to seek to make the current Chapter 2 regulations permanent. As such, the Chapter 2 COVID-19 Vaccine Requirements shall expire July 14, 2022.”

The Board of Health indicated that they have decided to change the policy due to the following:

First, the vaccination rate, as well as medical and religious exemption numbers, have remained steady for the past 3+ months.

“Second, HB22-1401 was signed into law by Governor Polis on May 18, 2022. While the bulk of this bill pertains to licensed Hospitals, there is language directing the Department to enact requirements for all licensed facilities and agencies related to infection prevention and control. While the Department has not yet determined what these requirements will be, the statute requires that they include provisions related to testing, vaccination, and treatment for COVID-19 in accordance with applicable recommendations and guidance. While the specifics will be worked out with stakeholders in the future, the Department envisions COVID-19 vaccination will be part of this conversation.

“Third, while the Department intends to let its state licensure vaccination requirement expire in July, it is important to note that the federal requirement for staff to be vaccinated or obtain a valid medical or religious exemption, through the Centers for Medicare and Medicaid Services (CMS), will still apply to any licensed facility that is certified by CMS to receive federal reimbursement. Approximately one-third of all licensed facilities are certified by CMS, and therefore their staff will still be subject to a vaccination requirement.

“Key takeaways for licensed facilities and agencies:

  • Effective July 14, 2022, current obligations under Part 12 of 6 CCR 1011-1, Chapter 2 related to COVID-19 vaccination expire. 
    • This includes the associated obligation to report into Colorado Health Facilities Interactive (COHFI) on a twice-monthly basis. 
  • The requirements of Part 11 of Chapter 2 regarding vaccination against influenza are still in effect and not impacted by the expiration of these emergency rules. 
  • Despite the expiration of these rules, facilities and agencies may maintain any mandatory vaccination policies they have adopted to date. 
  • Long-term and residential care facilities (Skilled Nursing Facilities, Assisted Living Residences, Intermediate Care Facilities, and Group Homes) are still subject to the requirements of Public Health Order 20-20 and the Comprehensive Mitigation Guidance document. 
  • Facilities certified by CMS are still subject to the federal government’s vaccine mandate. 
  • CDPHE’s Health Facilities and EMS divisions will engage in conversations with stakeholders later regarding the implementation of HB22-1401, which will likely include some requirements around vaccination and vaccination policies."
 

2023 Home Health Rule: 4.2% Reduction With Warnings of More to Come

APTA

After holding off on any big changes to home health payment in 2022, CMS plans to take some major steps in 2023 to address what it describes as the gaps between "assumed behavior changes and actual behavior changes" resulting from the Patient-Driven Groupings Model payment system implemented in 2020. Translation: The PDGM has cost significantly more than CMS hoped, so to reach its goal of budget neutrality compared with the previous system, the agency has proposed changes that would reduce payment by 4.2%, or about $810 million compared with 2022 amounts.

The bulk of the cuts is directed at the 30-day payment rate, but even if those reductions are put into place in 2023, CMS believes more changes will need to be made in the future to recoup the payment differences that have already occurred under the PDGM — an estimated $2 billion gap so far. To that end, the proposed rule also seeks public comment on how to best make up the difference.

APTA is preparing comments on the rule to submit by the Aug. 16, 2022, deadline. APTA members may submit their own comments directly to CMS here.

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