CMS | Increased Medicare Payment for Life-Saving COVID-19 Vaccine

From CMS on March 15

Biden-Harris Administration Increases Medicare Payment for Life-Saving COVID-19 Vaccine

On March 15, CMS increased the Medicare payment amount for administering the COVID-19 vaccine. This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff. At a time when vaccine supply is growing, CMS is supporting provider efforts to expand capacity and ensure that all Americans can be vaccinated against COVID-19 as soon as possible.

Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies, and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.

These updates to the Medicare payment rate for COVID-19 vaccine administration reflect new information about the costs involved in administering the vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately.

CMS is updating the set of toolkits for providers, states, and insurers to help the health care system swiftly administer the vaccine with these new Medicare payment rates. These resources are designed to increase the number of providers that can administer the vaccine, ensure adequate payment for administering the vaccine to Medicare beneficiaries, and make it clear that no beneficiary, whether covered by private insurance, Medicare, or Medicaid, should pay cost-sharing for the administration of the COVID-19 vaccine.

Coverage of COVID-19 Vaccines:

As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine. To ensure broad and consistent coverage across programs and payers, the toolkits have specific information for several programs, including:

Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and there is no applicable copayment, coinsurance, or deductible.

Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine (if they do not receive it for free) and its administration for beneficiaries enrolled in MA plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time. Like beneficiaries in Original Medicare, Medicare Advantage enrollees also pay no cost-sharing for COVID-19 vaccines.

Medicaid: State Medicaid and Children’s Health Insurance Program agencies must provide vaccine administration with no cost sharing for nearly all beneficiaries during the Public Health Emergency (PHE) and at least one year after it ends. Through the American Rescue Plan Act signed by President Biden on March 11, 2021, the COVID vaccine administration will be fully federally funded. The law also provides an expansion of individuals eligible for vaccine administration coverage. There will be more information provided in upcoming updates to the Medicaid toolkit.

Private Plans: CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing during the PHE. Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates.

Uninsured: For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).

More Information:

 

ET3 | Model Medical Triage Line Notice of Funding Opportunity

From CMS on March 12, 2021

Emergency Triage, Treat and Transport (ET3) Model Medical Triage Line – Notice of Funding Opportunity (NOFO) Available

 

Today, the Centers for Medicare & Medicaid (CMS) is releasing a Notice of Funding Opportunity (NOFO) for the Emergency Triage, Treat and Transport (ET3) Model. Through the NOFO, CMS will fund state and local governments, their designees, or other entities that operate or have authority over a Public Safety Answering Point (PSAP) to establish or expand Medical Triage Lines aimed at reducing inappropriate use of emergency ambulance services and increasing efficiency in Emergency Medical Services (EMS) systems.

The NOFO complements the ambulance payment component of the ET3 Model, which began implementation on January 1, 2021 and for which the final list of Participants was posted today. Applicants to the NOFO must share at least one ZIP Code with the ambulance providers and suppliers that are participants in the model. Under the ET3 Model, CMS provides greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call, by paying ambulances to transport beneficiaries to Alternative Destinations or to facilitate Treatment in Place with a Qualified Health Care Partner, either in-person or through telehealth.

The NOFO is available at grants.gov under Opportunity Number CMS-2F2-21-001.

For more information, please see the ET3 Model’s webpage. Stay up to date on the latest ET3 Model news and updates by subscribing to the ET3 Model listserv or contact us at ET3Model@cms.hhs.gov.

CMS | Updated Nursing Home Visitation Guidelines

From CMS on March 10, 2021

 CMS Updates Nursing Home Guidance with Revised Visitation Recommendations

The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance today for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE).

This latest guidance comes as more than three million doses of vaccines have been administered within nursing homes, thanks in part to the CDC’s Pharmacy Partnership for Long-Term Care Program, following the U.S. Food and Drug Administration’s (FDA) authorization for emergency use of COVID-19 vaccines.

According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation for:

  • Unvaccinated residents, if the COVID-19 county positivity rate is greater than 10 percent and less than 70 percent of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions; or
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

The updated guidance also emphasizes that “compassionate care” visits should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak. Compassionate care visits include visits for a resident whose health has sharply declined or is experiencing a significant change in circumstances.

CMS continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection control, including maintaining physical distancing and conducting visits outdoors whenever possible. This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated.

“CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families,” said Dr. Lee Fleisher, MD, CMS Chief Medical Officer and Director of CMS’ Center for Clinical Standards and Quality. “That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely. This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of COVID-19.” 

High vaccination rates among nursing home residents, and the diligence of committed nursing home staff to adhere to infection control protocols, which are enforced by CMS, have helped significantly reduce COVID-19 positivity rates and the risk of transmission in nursing homes.

Although outbreaks increase the risk of COVID-19 transmission, as long as there is evidence that the outbreak is contained to a single unit or separate area of the facility, visitation can still occur.

For additional details on the updated nursing home visitation guidance released today, visit here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19-revised

A Fact Sheet can be found here: https://www.cms.gov/newsroom/fact-sheets/cms-updates-nursing-home-guidance-revised-visitation-recommendations

EMS.gov | Rural EMS training and recruiting grants

From NHTSA’s Office of EMS

DEADLINE REMINDER: Apply now for rural EMS training and recruiting grants
Eligible applicants from rural EMS agencies are encouraged to submit applications before March 18, 2021

EMS organizations planning on applying for a Rural EMS Training Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment must submit applications by March 18. SAMHSA plans on awarding up to $5.5 million in awards to help eligible agencies recruit and train personnel. More information is available on SAMHSA’s website.

In recognition of the great need for emergency services in rural areas and the critical role EMS personnel serve across the country, SAMHSA plans on funding up to 27 projects, with a maximum of $200,000 per grant awardee. Eligible applicants include rural EMS agencies operated by a local or tribal government (fire-based and non-fire based) and non-profit EMS agencies.

Learn More or Apply Now

CMS Ambulance Open Door Forum Feb 25

From CMS on February 18, 2021

February 25 Open Door Forum

Thursday, February 25, 2021 | 14:00 ET

Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468

The next CMS Ambulance Open Door Forum is scheduled for:

Date:  Thursday, February 25, 2021

Start Time:  2:00pm-3:00pm PM Eastern Time (ET);

Please dial-in at least 15 minutes before call start time.

Conference Leaders: Jill Darling, Susanne Seagrave

Agenda

**This Agenda is Subject to Change**

  1. Opening Remarks

Acting Chair- Susanne Seagrave, Acting Director, Division of Data Analysis and Market-Based Pricing (Center for Medicare)

Moderator – Jill Darling (Office of Communications)

  1. Announcements & Updates

III. Open Q&A

**DATE IS SUBJECT TO CHANGE**

Next Ambulance Open Door Forum: TBA

ODF email: AMBULANCEODF@cms.hhs.gov

———————————————————————

This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.

Open Door Participation Instructions:

This call will be Conference Call Only.

To participate by phone:

Dial: 1-888-455-1397 & Reference Conference Passcode: 8604468

Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Instant Replay: 1-866-372-3811; Conference Passcode: No Passcode needed

Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-372-3811 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until February 27, 2021, 11:59PM ET.

For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html.

CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.

US Department of Labor issues stronger workplace guidance on coronavirus

U.S. Department of Labor | January 29, 2021

US Department of Labor issues stronger workplace guidance on coronavirus
New OSHA guidance seeks to mitigate, prevent viral spread in the workplace

WASHINGTON, DC – The U.S. Department of Labor announced today that its Occupational Safety and Health Administration has issued stronger worker safety guidance to help employers and workers implement a coronavirus protection program and better identify risks which could lead to exposure and contraction. Last week, President Biden directed OSHA to release clear guidance for employers to help keep workers safe from COVID-19 exposure.

“Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace” provides updated guidance and recommendations, and outlines existing safety and health standards. OSHA is providing the recommendations to assist employers in providing a safe and healthful workplace.

“More than 400,000 Americans have died from COVID-19 and millions of people are out of work as a result of this crisis. Employers and workers can help our nation fight and overcome this deadly pandemic by committing themselves to making their workplaces as safe as possible,” said Senior Counselor to the Secretary of Labor M. Patricia Smith. “The recommendations in OSHA’s updated guidance will help us defeat the virus, strengthen our economy and bring an end to the staggering human and economic toll that the coronavirus has taken on our nation.”

Implementing a coronavirus protection program is the most effective way to reduce the spread of the virus. The guidance announced today recommends several essential elements in a prevention program:

  • Conduct a hazard assessment.
  • Identify control measures to limit the spread of the virus.
  • Adopt policies for employee absences that don’t punish workers as a way to encourage potentially infected workers to remain home.
  • Ensure that coronavirus policies and procedures are communicated to both English and non-English speaking workers.
  • Implement protections from retaliation for workers who raise coronavirus-related concerns.

“OSHA is updating its guidance to reduce the risk of transmission of the coronavirus and improve worker protections so businesses can operate safely and employees can stay safe and working,” said Principal Deputy Assistant Secretary for Occupational Safety and Health Jim Frederick.

The guidance details key measures for limiting coronavirus’s spread, including ensuring infected or potentially infected people are not in the workplace, implementing and following physical distancing protocols and using surgical masks or cloth face coverings. It also provides guidance on use of personal protective equipment, improving ventilation, good hygiene and routine cleaning.

OSHA will update today’s guidance as developments in science, best practices and standards warrant.

This guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of existing mandatory safety and health standards. The recommendations are advisory in nature, informational in content and are intended to assist employers in recognizing and abating hazards likely to cause death or serious physical harm as part of their obligation to provide a safe and healthful workplace.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance.

CDC | Essential Workers Vaccine Communication Toolkit

CDC has designed a COVID-19 Vaccination Communication Toolkit for Essential Workers to help employers build confidence in this important new vaccine. The toolkit will help employers across various industries educate their workforce about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns.

Access Toolkit

The toolkit contains a variety of resources including:

  • key messages,
  • an educational slide deck,
  • FAQs,
  • posters/flyers,
  • newsletter content,
  • a plain language vaccine factsheet (available in several different languages),
  • a template letter for employees,
  • social media content, and
  • vaccination sticker templates.

This toolkit will help your organization educate employees about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns.
Access Toolkit

Fierce Healthcare | Agency veteran appointed as acting CMS administrator

From Fierce Healthcare on January 20

Agency veteran Liz Richter has been named the acting administrator of the Centers for Medicare & Medicaid Services (CMS).

The announcement Wednesday comes as President Joe Biden has yet to name a permanent administrator, who will require Senate confirmation.

Richter has served at CMS since 1990 and most recently served as the deputy center director for the Center for Medicare. She has also served as the director of the Hospital and Ambulatory Policy Group in the Center for Medicare Management.

Continue Reading

CMS | Updated Medicare COVID-19 Snapshot

From CMS on January 15

Today, the Centers for Medicare & Medicaid Services (CMS) released our monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 1.9 million COVID-19 cases among the Medicare population and over 493,000 COVID-19 hospitalizations.

The updated snapshot covers the period from January 1 to November 21, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by December 18, 2020.

Read on CMS.gov

CMS | Report Highlights Four Years of Accomplishments In Healthcare

From CMS on January 13

Today, the Centers for Medicare and Medicaid Services (CMS) released “Putting Patients First: The Centers for Medicare & Medicaid Services’ Record of Accomplishment from 2017-2020,” a report highlighting the agency’s transformation in ensuring all Americans have access to quality and affordable healthcare.

The report examines CMS’ accomplishments over the last four years, highlighting agency actions that responded to the coronavirus disease 2019 (COVID-19) pandemic and furthered CMS’s Four Core Goals identified in 2017: empowering patients and doctors, ushering in a new era of state flexibility and local leadership, developing innovative approaches, and improving the CMS customer service experience.

Accomplishments covered in the report include the response to the COVID-19 pandemic and efforts through 16 strategic initiatives that resulted in major regulatory actions, changes in guidance, and streamlined processes and procedures – including the reorganization of CMS. It also allows agency staff and leadership to better understand the impacts of policy decisions, while providing a resource to inform future CMS decisions. The report also covers how progress with respect to the Four Core Goals significantly contributed to the agency’s ability to respond to the unprecedented COVID-19 public health event.

Access “Putting Patients First: The Centers for Medicare & Medicaid Services’ Record of Accomplishment from 2017-2020.” 

Oregon | President Baird Joins OHA COVID-19 Vaccine Advisory Committee

From the Oregon Department of Human Services on December 31

OHA completes recruitment for COVID-19 Vaccine Advisory Committee

27-member group to create sequencing for COVID-19 immunizations

PORTLAND, Ore. — Oregon Health Authority has completed recruitment for its Vaccine Advisory Committee (VAC) that will determine the sequence in which new COVID-19 vaccines are distributed around the state.

The 27-member committee will advise OHA on vaccine sequencing for phases 1b, 1c and 2 of the state’s vaccine distribution plan, with the goal of prioritizing communities most affected by COVID-19. The COVID-19 Vaccine Advisory Committee will be grounded in OHA’s definition of health equity, which—as cited in this excerpt—is a health system where “all people can reach their full health potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances.”

To advance health equity, and counter unjust COVID-19 inequities, the COVID-19 VAC will:

  • Advise OHA on the ethical principles that should guide decisions on sequencing of COVID-19 vaccines.
  • Review data on COVID-19 and immunization inequities.
  • Advise OHA on which workers, high-risk groups or critical populations should be sequenced at what time, taking into consideration where they are located across the state.

The committee roster is as follows:

Aileen Duldulao

Oregon Pacific Islander Coalition

Cherity Bloom-Miller

Siletz Community Health Clinic

Christine Sanders

Rockwood Community Development Corp.

Daysi Bedolla Sotelo

Pineros y Campesinos Unidos del Noroeste

DeLeesa Meashintubby

Volunteers in Medicine

Debra Whitefoot

Nch’i Wana Housing

Derick Du Vivier

Oregon Health & Science University

Dolores Martinez

Euvalcree

George Conway

Deschutes County Health Services

Kalani Raphael

Oregon Pacific Islander Coalition

Kelly Gonzales

Portland State University

Kristin Milligan

Community Volunteer Network

Laurie Skokan

Providence Health & Services

Leslie Sutton

Oregon Council on Developmental Disabilities

Maleka Taylor

The Miracles Club

Maria Loredo

Virginia Garcia Memorial Health Center

Marin Arreola

Interface Network

Muriel DeLaVergne-Brown

Crook County Health Department

Musse Olol

Somali American Council of Oregon

Nannette Carter-Jafri

SEIU Local 503 Indigenous People’s Caucus

Ruth Gulyas

LeadingAge Oregon

Safina Koreishi

Columbia Pacific CCO

Sandra McDonough

Oregon Business & Industry

Shawn Baird

Metro West Ambulance Service

Sue Steward

Northwest Portland Area Indian Health Board

Tsering Sherpa

The Rosewood Initiative

Zhenya Abbruzzese

Adventist Health

“The COVID-19 Vaccine Advisory Committee brings tremendous lived and professional experience to guide OHA’s decisions about vaccine sequencing in a way that upholds OHA’s goal to eliminate health inequities by 2030,” said Cara Biddlecom, OHA deputy public health director.

“Members of this committee represent communities that have been unjustly impacted by COVID-19, including tribal communities and communities of color, and OHA is committed to involving community members in the decision-making processes that affect their lives.”

The committee’s first public meeting is Thursday, Jan. 7, from 9 a.m. to noon. The meeting can be accessed via conference line at 669-254-5252; meeting ID: 160 583 9896.

For more information about the committee, visit the Vaccine Advisory Committee information page. Comments or questions can be emailed to covid.vaccineadvisory@dhsoha.state.or.us.

Stay informed about COVID-19:

Oregon response: The Oregon Health Authority leads the state response.

United States response: The Centers for Disease Control and Prevention leads the US response.

Global response: The World Health Organization guides the global response.

CHART Model Community Transformation Track App Deadline Extended

From CMS on December 29, 2020

CHART Model Community Transformation Track Application Deadline Extension

The Centers for Medicare & Medicaid Services (CMS) will extend the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track application deadline by one month to March 16, 2021.

This extension is in response to feedback received from stakeholders, including comments about the challenges of preparing an application during the coronavirus disease 2019 (COVID-19) public health emergency. Extending the application deadline will allow interested applicants additional time to prepare their applications.

The Community Transformation Track will provide up-front funding to up to 15 rural communities across the country. The rural communities will be awarded seed money to work with health care providers and payers across the community to design systems of care that improve access to high quality care that is sustainable and value-based.

COVID-19 Healthcare Resilience Working Group Vax Videos

The Federal Pre-Hospital / EMS COVID-19 Healthcare Resilience Working Group put together two wonderful videos to encourage EMS providers to get both the COVID-19 vaccination and seasonal flu shot. Please share with your staff!

Watch Video 1: https://vimeo.com/492847212/3682909c4c

Watch Video 2: https://vimeo.com/492847424/d5a17f6b4c

 

 

Medicare | 2% Sequestration Suspended Through March

From CMS on December 28

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through March

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.