COVID-19 & HHS, Rural Healthcare RFI

This Week’s Dose

The Home Appropriations Committee superior a fiscal 12 months (FY) 2021 spending proposal for the Division of Well being and Human Companies (HHS), and the Administration revised steerage for hospital information submission. 

Congress

Home Appropriations Committee Superior HHS Funding Invoice and Issued Report with Implications for Non-public Fairness-Backed Healthcare Pursuits. The FY 2021 appropriations invoice would offer $96.four billion for HHS, a rise of $1.5 billion above the FY 2020 enacted stage and $11.1 billion above the President’s price range request. The invoice—which was accredited on a celebration line vote of 30 to 22—is predicted to cross the Home by the top of the month. As well as, the Committee launched its customary report to accompany the invoice. Committee reviews are merely explanatory paperwork and will not be enacted into regulation. They’re nonetheless expressions of congressional intent and are indicative of the place Home Democrats could attempt to push oversight of supplier aid sooner or later. The report contains language that will require entities receiving Medicare Accelerated and Superior Funds Program (AAP) funding to report if they’re owned and/or managed by a personal fairness sponsor. It will additionally direct the Secretary of HHS to think about requiring that these entities don’t furlough workers or implement cuts to pay or advantages as a situation of receiving AAP funds. Whereas not technically binding on the Secretary, government department companies severely consider and sometimes respect expressions of congressional intent and curiosity. It’s conceivable that HHS, particularly in a Biden Administration, may embrace these directives. Considerations about who ought to obtain COVID-19 aid funds have bubbled up throughout the business and within the press. This language additionally displays long-simmering concern amongst some lawmakers concerning the position of personal fairness in healthcare. Count on this debate to proceed to play out as lawmakers debate the following stimulus bundle.

Methods and Means Launched a Abstract of Rural Healthcare RFI Responses. 

The Home Methods and Means Committee Rural and Underserved Communities Healthcare Activity Drive launched a abstract of responses from a November 2019 Request for Data (RFI) searching for suggestions on precedence subjects that have an effect on the well being standing and outcomes of rural communities. The Committee’s evaluation of the suggestions acquired discovered a “bleak image” of the present standing of healthcare in rural and underserved communities with important healthcare and non-healthcare limitations limiting entry and high quality of care. Based mostly on responses to the RFI, the Activity Drive indicated it would deal with addressing direct social determinants of well being, enacting fee system reforms, strengthening know-how and infrastructure, and reinforcing the workforce shifting ahead. Moreover, the Activity Drive submitted a letter to the Medicare Fee Advisory Fee requesting it replace its 2012 report entitled “Serving Rural Medicare Beneficiaries.” The requested updates embody incorporating medically underserved areas as a definite geographic class; together with dually eligible Medicare beneficiaries and beneficiaries with a number of continual circumstances; and inspecting elements and developments that will have impacted these communities because the 2012 report, reminiscent of expanded use of telemedicine and supplier consolidation. The Activity Drive is shifting towards growing bipartisan coverage proposals to deal with the problems they recognized of their report. Stakeholders are inspired to proceed to interact with the Activity Drive on priorities and potential options. Congressional committees, together with the Methods and Means Committee, have bemoaned the declining state of the agricultural well being infrastructure and promised motion, however little laws searching for to buttress rural healthcare has superior in recent times.

Administration

Administration Issued Steering Asking Hospitals to Submit COVID-19 Information On to HHS. The brand new steerage modifies earlier directions from the Administration for hospitals to submit each day information on COVID-19 instances to the Facilities for Illness Management and Prevention (CDC), requiring as a substitute that hospitals submit their information on to HHS. The sorts of data requested, together with testing information, mattress capability and provide standing, haven’t modified. In keeping with the Administration, the aim of the change is to streamline the info assortment course of. Nevertheless, the transfer comes amid issues from some public well being officers that the Administration is searching for to restrict the position of the CDC for political functions. The brand new steerage took impact on July 15, 2020. 

Courts

Arkansas and DOJ Requested Supreme Courtroom to Restore Medicaid Work Necessities. 

The state of Arkansas and the Division of Justice (DOJ) every filed petitions asking the US Supreme Courtroom to reverse a February federal appeals courtroom determination voiding Arkansas’ Medicaid work requirement. The decrease courtroom dominated {that a} requirement that beneficiaries take part in work, schooling or comparable actions to qualify for Medicaid advantages violates the intent of this system. Of their petitions, Arkansas and DOJ argue that the appeals courtroom misinterpreted the intent of the Medicaid program, that the Facilities for Medicare and Medicaid Companies (CMS) has broad authority to approve Medicaid waivers, and that these waivers promote beneficiaries’ well being and independence. The controversial coverage has confronted courtroom defeats in Kentucky, New Hampshire, Michigan and Arkansas. On account of ongoing litigation, Arizona and Indiana suspended implementation of their necessities. Ohio, Wisconsin and South Carolina have acquired approval for work requirement waivers from CMS however haven’t but carried out their packages. In April, Utah turned the final state to place its work necessities on maintain, citing the general public well being dangers associated to COVID-19 and the pandemic’s affect on the state’s economic system. At the moment, 9 states have work requirement waivers pending CMS approval. 

States

Utah Submitted Waiver to Increase Medicaid Entry for Justice-Concerned People. 

The Part 1115 waiver utility would amend Utah’s present Medicaid waiver to supply Medicaid protection for certified justice-involved people through the 30-day interval instantly following their launch from incarceration. The state intends to implement the waiver efficient July 1, 2021, by means of the top of the present waiver approval interval, which is June 30, 2022. Present statute prohibits Medicaid protection for these incarcerated in a jail or jail. CMS will settle for public feedback on the proposal by means of August 12, 2020.

Fast Hits

The Home Vitality and Commerce Committee held a markup of 30 payments centered on a spread of points from COVID-19 to IT infrastructure. All 30 payments have been reported favorably to the complete Home with bipartisan assist. 

Representatives Mike Thompson (D-CA), Peter Welch (D-VT), Invoice Johnson (R-OH), David Schweikert (R-AZ) and Doris Matsui (D-CA) launched the Defending Entry to Publish-Covid-19 Telehealth Act, which might deal with important current limitations on the everlasting enlargement of telehealth.

Senate Democrats launched a white paper outlining a course of for growing and distributing a protected, efficient and accessible COVID-19 vaccine.

Senator Elizabeth Warren (D-MA) and Consultant Ayanna Pressley (D-MA) despatched a letter requesting data from HHS on the Administration’s efforts to deal with racial well being disparities exacerbated by the COVID-19 pandemic. 

CMS Administrator Seema Verma printed a weblog submit on the affect of expanded telehealth companies throughout COVID-19.

HHS and the interior income service printed a proposed rule providing grandfathered group well being plans higher flexibility to amend cost-sharing necessities.

The Substance Abuse and Psychological Well being Companies Administration printed a ultimate rule making modifications to the company’s laws governing the confidentiality of substance use dysfunction affected person information.

CDC launched a sequence of up to date toolkits offering steerage on reopening for varied people and teams.

The Authorities Accountability Workplace printed a report that discusses supplemental funds and the sorts of financing preparations utilized by states to finance their share of the Medicaid program.

M+ Sources

Final week, HHS introduced it’s allocating extra focused funding by means of the Supplier Reduction Fund, together with roughly $three billion to “security internet” hospitals and $1 billion to specialty rural hospitals, city hospitals with sure rural Medicare designations, and hospitals in small metropolitan areas; together with a funding utility course of for dentists. Extra data on these newest funding distributions is out there right here.

The Trump Administration launched the American Kidney Initiative on July 10, 2019, when President Trump signed an Government Order pledging transformation and innovation to enhance take care of kidney sufferers and scale back healthcare prices. Our report evaluations the actions of the previous 12 months and forecasts the work nonetheless to come back.

Our consultants focus on the enlargement of telehealth companies and flexibilities that has occurred through the COVID-19 pandemic on the newest episode of the Well being Coverage Breakroom.

Subsequent Week’s Prognosis

The Senate returns from recess to proceed negotiations on annual appropriations and one other COVID-19 aid invoice. The Home Vitality and Commerce Committee will maintain a listening to on ongoing vaccine improvement efforts, and the Senate Growing old Committee will maintain a listening to on racial well being disparities amongst seniors.