New, Three-Month Special Enrollment Period!

Today, President Biden took executive action to reverse several policies that have undermined the Affordable Care Act and Medicaid, and have made it harder to enroll in coverage. The President also announced a new, three-month Special Enrollment Period, allowing anyone to sign up for health coverage. Groups like YI and advocates like you have been pushing for this kind of Special Enrollment Period since the start of the Covid-19 pandemic, so this is a big win.

Here is what you need to know:

  • Sign up at Govanytime between February 15th and May 15th
  • You do NOT need to prove a loss of coverage, if you’re uninsured and want to sign up for a plan, you should
  • Coverage is more affordable than you think. In fact, a recent study found that 4 million Americans could qualify for a $0 plan – and a disproportionate amount of them are young people
  • Need help enrolling in a plan? Help is still available! Find a Navigator or assister near you with our Connector tool.

Click here to read more about this new opportunity and how to get covered.

Please help us spread the word about this exciting opportunity. It’s never a good time to go without health insurance, but now more than ever, it’s important to get covered.

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West Virginians for Affordable Health Care
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FORHP Announcements – January 28

January 28, 2021

What’s New

New National Strategy for COVID-19 Response. Last week, the White House released a plan for the pandemic that includes a campaign for vaccination, setting standards for controlling the spread of the virus, and enacting the Defense Production Act to extend emergency relief.

GAO Report on Rural Hospital Closures.  The latest report from the U.S. Government Accountability Office (GAO) addresses the effects of hospital closures on residents in rural areas. Among other objectives, the report examines how closures affected the number of health care providers, and the distance residents traveled for health care services.

NIH Assessment of COVID-19 Vaccine Hesitancy.  The National Institutes of Health (NIH) published results of a study to determine what Americans think about getting immunized with the COVID-19 vaccine.  Of a group of 1,878 participants, the greatest reluctance to get a vaccine was found among African-Americans (34%), Hispanics (29%), rural dwellers (29%), and those who had children at home (25%).

ACF Report on Child Maltreatment.  The Administration for Children and Families (ACF) reports on rates of children who are victims of neglect or abuse using data collected from the National Child Abuse and Neglect Data System.  In 2018, the National Advisory Committee on Rural Health and Human Services recommended that federal policy include a strategy for awareness, research, and programs to address the health consequences of Adverse Childhood Experiences for rural, tribal, and other at-risk populations.  See the Funding section below for several programs serving children and youth.

COVID-19 Resources

Federal Office of Rural Health Policy FAQs for COVID-19.  A set of Frequently Asked Questions (FAQs) from our grantees and stakeholders.

COVID-19 FAQs and Funding for HRSA Programs. Find all funding and frequently asked questions for programs administered by the Health Resources and Services Administration (HRSA).

CARES Act Provider Relief Fund Frequently Asked Questions.  Includes information on terms and conditions, attestation, reporting and auditing requirements, general and targeted distributions, and how to report capital equipment purchases.

CDC COVID-19 Updates.  The Centers for Disease Control and Prevention (CDC) provides daily updates and guidance, including a section specific to rural health care, a Toolkit for Tribal Communities, and a tracker of cases, deaths, and tests by countyNew: COVID-19 Vaccine Locator.

CMS Coronavirus Stakeholder Calls.  The Centers for Medicare & Medicaid Services (CMS) hosts recurring online sessions to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS.

HHS Coronavirus Data Hub.  The U.S. Department of Health & Human Services (HHS) website includes estimated and reported hospital capacity by state, with numbers updated daily.

COVID-19 Data from the U.S. Census Bureau. The site provides access to demographic and economic data, including state and local data on at-risk populations, poverty, health insurance coverage, and employment.

ATTC Network COVID-19 Resources for Addictions Treatment. The Addiction Technology Transfer Center (ATTC) Network was established in 1993 by the Substance Abuse and Mental Health Services Administration.  The online catalog of COVID-related resources includes regularly-updated guidance and trainings for professionals in the field.

GHPC’s Collection of Rural Health Strategies for COVID-19.  The FORHP-supported Georgia Health Policy Center (GHPC) provides reports, guidance, and innovative strategies gleaned from their technical assistance and peer learning sessions with FORHP grantees.

Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties.  The RUPRI Center for Rural Health Policy Analysis provides up-to-date data on rural and urban confirmed cases throughout the United States.  An animated map shows the progression of cases beginning January 21 to the present.

Rural Response to Coronavirus Disease 2019.  The Rural Health Information Hub has a compendium of rural-specific activities and guidelines, including Rural Healthcare Surge Readiness, a tool with resources for responding to a local surge in cases.

SAMHSA Training and Technical Assistance Related to COVID-19.  The Substance Abuse and Mental Health Services Administration (SAMHSA) created this list of resources, tools, and trainings for behavioral health and recovery providers.

Mobilizing Health Care Workforce via Telehealth.  ProviderBridge.org was created by the Federation of State Medical Boards through the CARES Act and the FORHP-supported Licensure Portability Program. The site provides up-to-date information on emergency regulation and licensing by state as well as a provider portal to connect volunteer health care professionals to state agencies and health care entities.

Online Resource for Licensure of Health Professionals.  Created by the Association of State and Provincial Psychology Boards, the site provides up-to-date information on emergency regulation and licensing in each state for psychologists, occupational therapists, physical therapists assistants, and social workers.

Funding and Opportunities

RWJF Summer Health Professions Education Program – February 5.  The Robert Wood Johnson Foundation (RWJF) provides a free summer enrichment program for college students interested in the health professions. Eligible students include, but are not limited to, individuals who identify as African American/Black, American Indian and Alaska Native and Hispanic/Latino, and those who are from communities of socioeconomic and educational disadvantage.

SAMHSA National Child Traumatic Stress Initiative – Category III – February 12.  The Substance Abuse and Mental Health Services Administration (SAMHSA) will make 70 awards with a total investment of $30 million for community-level treatment and services for children, adolescents, and their families who experience or witness traumatic events.  Categories I and II of this initiative are for a single national center and for service centers for specific types of events or population groups, respectively.  SAMHSA intends an even distribution of awards among rural and urban populations for eligible applicants that include state, local, and tribal governments, public or private universities and colleges, and community- or faith-based organizations.

HRSA Loan Programs for Health Professions Schools –February 25. The Health Resources and Services Administration (HRSA) offers four loan programs for colleges and universities.  Schools can then offer low, fixed-rate loans to students pursuing a wide range of health care careers.

DOJ Culturally-Specific Services for Sexual Assault Victims – March 1.  The U.S. Department of Justice (DOJ) will make 12 awards of up to $300,000 each to support services for sexual assault victims.  Eligible applicants are nonprofit organizations that provide community-based, culturally specific services in the following racial and ethnic communities:  American Indian, Alaska Native, Native Hawaiian/Pacific Islanders, Asian American, African American, and Hispanic.

DOJ Mentoring for Youth Affected by the Opioid Crisis – March 2.  The U.S. Department of Justice (DOJ) will make 17 awards of up to $1.25 million each to provide services to children and youth impacted by drug use.  Eligible applicants are nonprofit and for-profit organizations that have a mentoring program that has been operating for at least one year.

DOJ Services for Victims of Human Trafficking – March 2.  The U.S. Department of Justice (DOJ) will make 27 awards of up to $800,000 each, for direct services to victims of human trafficking.  Eligible applicants include state, local, and tribal governments, public housing authorities, and nonprofit organizations, with priority given to rural areas. A separate but related funding notice, DOJ Housing Assistance Grants for Victims of Human Trafficking – March 1, will invest $15 million in 25 awards for programs that provide transitional housing and financial assistance.

DOJ Tribal Sexual Assault Services Program – March 4.  The U.S. Department of Justice (DOJ) will invest $3.8 million for 12 awards to create or expand sustainable sexual assault services provided by Tribes, tribal organizations, and nonprofit tribal organizations within Indian country and Alaska Native villages.

ARC Workforce/Economic Revitalization in Appalachia – Letters of Intent March 5.  The Federal Appalachian Regional Commission (ARC) will make awards of up to $2.5 million each for projects that promote job creation and re-employment opportunities for displaced coal-economy workers. Projects should be a collaboration of state, local, and regional stakeholders and address priorities that include substance abuse response, enhancing broadband services, and strengthening the health care sector.  Eligible applicants, including state, local, and tribal governments and organizations within the 420 counties of the ARC service area are required to submit a Letter of Intent by March 5.

DOJ Strategies to Support Children Exposed to Violence – March 8.  The U.S. Department of Justice (DOJ) will make eight awards from a total investment of $7.5 million to support services for children.  Priority will be given to applications addressing rural-specific challenges.  Eligible applicants include state, local, and tribal governments, independent school districts, institutions of higher education, and nonprofit organizations.

DOJ Grants for Domestic Violence and Sexual Assault Against Children – March 9.  The U.S. Department of Justice (DOJ) will invest $4.8 million in 11 awards to support community-based efforts to address the needs of children and youth impacted by domestic violence, dating violence, sexual assault, and stalking.  A separate program, DOJ Grants for Domestic Violence and Sexual Assault – March 29, invests  $30 million in 45 grants to improve the criminal justice response to violence with adult victims.  Eligible applicants include state, local, and tribal governments and courts.

NEA Citizens’ Institute on Rural Design – March 12.  The National Endowment for the Arts (NEA) seeks communities to participate in its initiative involving residents and local leaders in community design.  Design challenges may include downtown revitalization, heritage preservation of land or buildings, and creating public or civic spaces for local identity and active recreation.  Up to four rural communities will be selected for an on-site rural design workshop to develop solutions to a specific design challenge.  Up to 15 communities will participate in a learning cohort of government, nonprofits, local business, and civic organizations training in design, planning, community engagement, and facilitation techniques.

HRSA P4 Challenge: Primary Care to Improve Child Health – March 15.  The Health Resources and Services Administration (HRSA) seeks innovative approaches to increase access to pediatric primary care, including well-child visits and immunization services.  Eligibility for the Promoting Pediatric Primary Prevention (P4) includes health providers, health educators, community-based organizations, public school and housing entities.

Rural Health Research

Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway.  Sign up to receive alerts when new publications become available. 

Barriers to Health Care Access for Rural Medicare Beneficiaries.  This policy brief from the University of Minnesota Rural Health Research Center presents findings from an online survey of rural health clinics describing barriers for Medicare patients in accessing healthcare services, and recommendations for how to improve access to care.

Policy Updates

Visit the FORHP Policy page to see all recent updates and send questions to ruralpolicy@hrsa.gov.

HHS COVID-19 Update

Vaccine FAQs: CDC updated their FAQs page about the vaccines. This page answers commonly asked questions about COVID-19 vaccination.

 

Vaccine Resources: CDC updated their resource page on COVID-19 vaccines. On this page, you can find when and where you can receive the vaccine, receive accurate vaccine information, and much more.

Resources on Approved Vaccines: CDC updated their resource page on the different types of vaccines. This web page explains how the body fights infection and how COVID-19 vaccines protect people by producing immunity. It also describes the different types of COVID-19 vaccines that currently are available or are undergoing large-scale (Phase 3) clinical trials in the United States.

Vaccine Facts and Unknowns for Healthcare Providers: NIH officials highlight COVID-19 vaccine facts, unknowns for healthcare providers. Healthcare providers must be able to explain the latest data supporting the safety and efficacy of vaccines for coronavirus disease 2019 (COVID-19) so they can strongly encourage vaccination when appropriate while acknowledging that uncertainty and unknowns remain.

Ensuring the Safety of Vaccines: CDC updated their page on ensuring vaccine safety. The U.S. vaccine safety system ensures that all vaccines are as safe as possible. Safety is a top priority while federal partners work to make this and other COVID-19 vaccines available.

Toolkits: CDC updated their toolkits, which include audience-specific information for healthcare teams and community administrators. CDC has toolkits for:

Testing

Lessons Learned from COVID-19 Testing: Last week, Secretary Azar delivered remarks at FREOPP on lessons from COVID-19 testing. Azar noted, “What we have done over this past year to develop the world’s largest testing system is not just unprecedented, but a uniquely American achievement—something that we could do because we believed in enlisting every creative corner of society and bringing the public and private sectors together.”

COVID-19 Contact Tracer Tools: CDC released their COVIDTracer and COVIDTracer Advanced which are spreadsheet-based tools that allow the state- and local-level public health officials and policymakers to compare the effectiveness, and the resources needed, of three user-defined contact tracing and monitoring strategies. Both tools allow you to estimate the potential effectiveness of each of the three strategies, the average number of contacts per case, and the time needed for case interviews and contact tracing follow-up activities.

Healthcare Facilities: CDC has updated their database for healthcare facilities that have implemented COVID-19 electronic case reporting.

The requirement for Proof of Negative COVID-19 Test or Recovery from COVID-19 for All Air Passengers Arriving in the United States: CDC updated their guidance for all people traveling to the US. If you plan to travel internationally, get tested before you travel by air into the United States (US), or be prepared to show proof of a recent positive viral test and a letter from your healthcare provider or a public health official stating that you were cleared to travel. On January 12, 2021, CDC issued an Order requiring all air passengers arriving in the US from a foreign country to get tested no more than 3 days before their flight departs and to present the negative result or documentation of having recovered from COVID-19 to the airline before boarding the flight. This Order will go into effect at 12:01 am EST on January 26, 2021.

Proof of Negative COVID-19 Test Required for Passengers Arriving from the UK: CDC updated their guidance for people traveling from the UK to the US. If you travel from the United Kingdom to the United States, make plans to get tested before travel. This Order applies to all air passengers, 2 years of age or older, traveling from the UK to the US, including US citizens and legal permanent residents.

Treatment

Monoclonal Antibody Treatment for High-Risk Covid-19 Positive Patients: HHS developed this fact sheet to help providers better understand monoclonal antibody treatment. Monoclonal antibody treatment has been shown to reduce hospitalization and symptom days in high-risk COVID-19 patients with mild to moderate symptoms.

Potency Assay Considerations for Monoclonal Antibodies and Other Therapeutic Proteins Targeting SARS-CoV-2 Infectivity:  FDA is issuing this guidance to assist sponsors in the development of monoclonal antibodies (mAbs) and other therapeutic proteins for use as COVID-19 therapeutics. A critical quality control measure for these products is the development and implementation of a potency assay(s) adequate to ensure that each lot is consistently produced with the potency necessary to achieve clinical efficacy and that such potency is maintained over the shelf life of the product.

Understanding Your COVID-19 Treatment Options: HHS developed this fact sheet to help patients better understand their treatment options.

Reopening Guidance

Deciding How to Go Back to School: Many parents, caregivers, and guardians face new and difficult choices about how their child will return to school in the fall, such as deciding between in-person and virtual learning. This tool is designed to help parents, caregivers, and guardians weigh the risks and benefits of available educational options to help them make decisions about sending their child back to school. It is organized to provide parents and caregivers with information on COVID-19 and why safely reopening schools is so critical.

Information for Specific Populations

Global COVID-19: CDC updated their resource page for the COVID-19 global pandemic. CDC is working closely with the World Health Organization (WHO) and other partners to assist countries to prepare for and respond to COVID-19. CDC routinely provides technical assistance to ministries of health and subnational and international partners to improve our collective response to infectious disease threats like COVID-19.

Strategy for Global Response to COVID-19: CDC updated their strategy for a global response to the COVID-19 pandemic. This strategy provides an overarching framework for the U.S. Centers for Disease Control and Prevention’s global response to the coronavirus (COVID-19) pandemic. The CDC strategy aligns with the U.S. Government (USG) strategy and the U.S. National Security Strategic goals to protect the American people and ensure U.S. health security by mitigating the spread of infectious disease threats abroad.

COVID-19 At-Risk Medicare Population Dashboard, Related Online Tools to Support Pandemic Response: To aid state, territorial, and local health departments in community-level pandemic response efforts such as implementing COVID-19 vaccination plans that meet the needs of Americans ages 65 and older, today we unveiled a suite of online tools built from existing programs and information technology platforms. Read the press release about this dashboard here.

Travel Associated Exposures: CDC updated their public health guidance on travel associated exposures. Individuals who travel may be at risk for exposure to SARS-CoV-2, the virus that causes COVID-19, before, during, or after travel. This could result in travelers’ spreading the virus to others at their destinations or upon returning home.

Cleaner Air Shelters and Cleaner Air Spaces to Protect the Public from Wildfire Smoke: CDC updated their guidance to reduce the risk of introducing and transmitting SARS-CoV-2 in cleaner air shelters and cleaner air spaces. Cleaner air shelters and cleaner air spaces are public spaces where people can seek relief from wildfire smoke.

Dialysis Facilities: CDC updated their resource page for dialysis facilities. This page includes resources on infection control, testing, training, and much more.

Animals and COVID-19: CDC updated their resource page on animals and COVID-19. Coronaviruses are a large family of viruses. Some coronaviruses cause cold-like illnesses in people, while others cause illness in certain types of animals, such as cattle, camels, and bats. Some coronaviruses, such as canine and feline coronaviruses, infect only animals and do not infect people.

Workplaces and Businesses: CDC updated their resource page for workplaces and businesses.  This page provides guidance and strategies to prevent and reduce COVID-19 transmission in workplaces.

Childcare Programs: CDC updated their toolkit for childcare programs. This toolkit includes posters, fact sheets, guidance, and FAQs.

Travel: CDC updated their resource page for travel. This page has information on domestic and international travel, mask recommendations, and more. CDC also updated their travel health notices page, which lists current travel notices and outlines COVID-19 risks in different countries.

COVID-19 Rapid Response Team (RRT) Composition: For COVID-19, RRT activation may occur prior to detection of a COVID-19 case in a particular administrative area. Examples include when there is transmission in a neighboring administrative area or when the emergency response system has already been activated (e.g. Emergency Operations Center (EOC) activation or country-equivalent). Given the high risk of COVID-19 person-to-person transmission, countries can consider prepositioning multidisciplinary RRTs prior to large-scale transmission.

Enforcement Policy During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency: FDA updated their guidance for coagulation systems for measurement of viscoelastic properties. FDA is issuing this guidance to provide a policy to help expand the availability of coagulation systems for measurement of whole blood viscoelastic properties that are used to assess hemostasis, for the duration of the COVID-19 public health emergency.

Protecting Participants in Bioequivalence Studies: FDA updated their guidance for protecting participants in bioequivalence studies during the COVID-19 public health emergency.

Funding

Provider Relief Fund Reporting Update: HHS, through HRSA, will be amending the reporting timeline for the Provider Relief Fund Program (PRF) due to the recent passage of the Coronavirus Response and Relief Supplemental Appropriations Act. HHS has been working to provide updated reporting requirements that comply with this recently passed legislation. Consequently, PRF recipients will now be required to submit their reporting requirements on their use of these funds later than previously announced. PRF recipients may begin registering for gateway access to the Reporting Portal where they will ultimately submit their information in compliance with the new reporting requirements HHS is issuing.

Funds to Expand Immunization Information Sharing Collaboration: HHS acting through the Office of the National Coordinator for Health Information Technology (ONC) announced a series of investments to help increase data sharing between health information exchanges (HIEs) and immunization information systems. ONC will award nearly $20 million in funds from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) signed by President Trump on March 27, 2020, to support the nation’s vaccination efforts to fight the COVID-19 pandemic.

CMS Updates

CMS Releases Additional Tools To Help State Medicaid and CHIP Agencies Plan For The Eventual Return To Regular Operations After The COVID-19 Public Health Emergency Ends: CMS released two tools to assist states and territories in their planning efforts to transition back to regular operations and resolve pending Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) eligibility and enrollment actions after the 2019 Novel Coronavirus (COVID-19) public health emergency (PHE) ends.  These tools were announced in the Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency State Health Official Letter that CMS released on December 22, 2020.

CMS Released Preliminary Medicaid COVID-19 Increased FMAP Expenditure Data: On a quarterly basis, states report summarized Medicaid expenditures on the Form CMS-64, which serve as the basis for the amount of FFP paid to states to fund the Medicaid program. CMS released preliminary Medicaid expenditure data that states reported to CMS through the Medicaid Budget and Expenditure System (MBES).   This information is summary level data for Medicaid service expenditures reported by states on the Form CMS-64 in MBES for the period of January 1, 2020, through March 31, 2020, and April 1, 2020, through June 30, 2020.  The data includes a breakout of expenditures associated with the Families First Coronavirus Response Act (FFCRA) section 6004 which provides a 100% Federal match to uninsured individuals eligible under the new “COVID-19 testing” optional Medicaid eligibility group and section 6008 which provides a temporary 6.2 percentage point increase to qualifying states and territory’s Federal Medical Assistance Percentage (FMAP).

Research

Evaluation of Abbott BinaxNow Rapid Antigen Test: CDC released a MMWR on evaluation of Abbott BinaxnNow rapid antigen test for sars-cov-2 infection at two community-based testing sites. Sensitivity of the BinaxNOW antigen test, compared with polymerase chain reaction testing, was lower when used to test specimens from asymptomatic (35.8%) than from symptomatic (64.2%) persons, but specificity was high. Sensitivity was higher for culture-positive specimens (92.6% and 78.6% for those from symptomatic and asymptomatic persons, respectively); however, some antigen test-negative specimens had a culturable virus. The high specificity and rapid BinaxNOW antigen test turnaround time facilitate earlier isolation of infectious persons. Antigen tests can be an important tool in an overall community testing strategy to reduce transmission.

The emergence of SARS-CoV-2 B.1.1.7 Lineage: CDC released an MMWR on the emergence of SARS-CoV-2 1.1.7 mutation lineage. Modeling data indicate that B.1.1.7 has the potential to increase the U.S. pandemic trajectory in the coming months. CDC’s system for genomic surveillance and the effort to expand sequencing will increase the availability of timely U.S. genomic surveillance data. The increased transmissibility of the B.1.1.7 variant warrants universal and increased compliance with mitigation strategies, including distancing and masking. Higher vaccination coverage might need to be achieved to protect the public. Genomic sequence analysis through the National SARS-CoV-2 Strain Surveillance program will enable a targeted approach to identifying variants of concern in the United States.

COVID-19 Variants: CDC updated their resource page on emerging SARS-CoV-2 variants and their US cases caused by variants page. There has also been a new variant detected. Multiple SARS-CoV-2 variants are circulating globally. Scientists are working to learn more about these variants to better understand how easily they might be transmitted and the effectiveness of currently authorized vaccines against them. At this time, there is no evidence that these variants cause more severe illness or increased risk of death. New information about the virologic, epidemiologic, and clinical characteristics of these variants is rapidly emerging.

 

New Publications on Rural vs. Urban Hospitalizations for COVID-19

New Publications on Rural vs. Urban Hospitalizations for COVID-19

The North Carolina Rural Health Research Program looked at rural versus urban hospitalizations for COVID-19.

Contact Information:

Mark Holmes, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.966.7100
mark_holmes@unc.edu

Additional Resources of Interest:

For Immediate Release on: December 22, 2020
This email and research alert are a service of the Rural Health Research Gateway. The Rural Health Research Gateway does not assume any legal liability for the accuracy, completeness, or usefulness of the information provided in this message. Website links included in the message are for your convenience. The Rural Health Research Gateway is not responsible for the availability or content of these websites. For additional services and information, see the Rural Health Research Gateway website at https://www.ruralhealthresearch.org.

Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients

Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients  

On December 1, CMS released the annual Physician Fee Schedule (PFS) final rule, prioritizing CMS’ investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions. The rule allows non-physician practitioners to provide the care they were trained and licensed to give, cutting red tape so health care professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. This final rule takes steps to further implement President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors including prioritizing the expansion of proven alternatives like telehealth.

“During the COVID-19 pandemic, actions by the Trump Administration have unleashed an explosion in telehealth innovation, and we’re now moving to make many of these changes permanent,” said HHS Secretary Alex Azar. “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to health care in the setting that they and their doctor decide makes sense for them.”

“Telehealth has long been a priority for the Trump Administration, which is why we started paying for short virtual visits in rural areas long before the pandemic struck,” said CMS Administrator Seema Verma. “But the pandemic accentuated just how transformative it could be, and several months in, it’s clear that the health care system has adapted seamlessly to a historic telehealth expansion that inaugurates a new era in health care delivery.”

Finalizing Telehealth Expansion and Improving Rural Health

Before the COVID-19 Public Health Emergency (PHE), only 15,000 Fee-for-Service beneficiaries each week received a Medicare telemedicine service. Since the beginning of the PHE, CMS has added 144 telehealth services, such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that are covered by Medicare through the end of the PHE. These services were added to allow for safe access to important health care services during the PHE. As a result, preliminary data show that between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees have received a Medicare telemedicine service during the PHE.

This final rule delivers on the President’s recent Executive Order on Improving Rural Health and Telehealth Access by adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the PHE, and we will continue to gather more data and evaluate whether more services should be added in the future. These additions allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home. However, this is an important step, and as a result, Medicare beneficiaries in rural areas will have more convenient access to health care.

Additionally, CMS is announcing a commissioned study of its telehealth flexibilities provided during the COVID-19 PHE. The study will explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.

Payment for Office/Outpatient Evaluation and Management (E/M) and Comparable Visits

Last year, CMS finalized a historic increase in payment rates for office/outpatient face-to-face E/M visits that goes into effect in 2021. The Medicare population is increasing, with over 10,000 beneficiaries joining the program every day. Along with this growth in enrollment is increasing complexity of beneficiary health care needs, with more than two-thirds of Medicare beneficiaries having two or more chronic conditions. Increasing the payment rate of E/M office visits recognizes this demand and ensures clinicians are paid appropriately for the time they spend on coordinating care for patients, especially those with chronic conditions. These payment increases, informed by recommendations from the American Medical Association (AMA), support clinicians who provide crucial care for patients with dementia or manage transitions between the hospital, nursing facilities, and home.

Under this final rule, CMS continues to prioritize this investment in primary care and chronic disease management by similarly increasing the value of many services that are similar to E/M office visits, such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, and physical and occupational therapy evaluation services. These adjustments ensure CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients.

“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,” Administrator Verma added. “In the past, the system has rewarded interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses.”

In addition to the increase in payment for E/M office visits, simplified coding and documentation changes for Medicare billing for these visits will go into effect beginning January 1, 2021. The changes modernize documentation and coding guidelines developed in the 1990s, and come after extensive stakeholder collaboration with the AMA and others. These changes will significantly reduce the burden of documentation for all clinicians, giving them greater discretion to choose the visit level based on either guidelines for medical decision-making (the process by which a clinician formulates a course of treatment based on a patient’s information, i.e., through performing a physical exam, reviewing history, conducting tests, etc.) or time dedicated with patients. These changes are expected to save clinicians 2.3 million hours per year in administrative burden so that clinicians can spend more time with their patients.

Professional Scope of Practice and Supervision

As part of the Patients Over Paperwork Initiative, the Trump Administration is cutting red tape so that health care professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. The PFS final rule makes permanent several workforce flexibilities provided during the COVID-19 PHE that allow non-physician practitioners to provide the care they were trained and licensed to give, without imposing additional restrictions by the Medicare program.

Specifically, CMS is finalizing the following changes:

  • Certain non-physician practitioners, such as nurse practitioners and physician assistants, can supervise the performance of diagnostic tests within their scope of practice and state law, as they maintain required statutory relationships with supervising or collaborating physicians.
  • Physical and occupational therapists will be able to delegate “maintenance therapy” – the ongoing care after a therapy program is established – to a therapy assistant.
  • Physical and occupational therapists, speech-language pathologists, and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient’s medical record. As a result, practitioners have the flexibility to delegate certain types of care, reduce duplicative documentation, and supervise certain services they could not before, increasing access to care for Medicare beneficiaries.

For More Information: