Organ
Transplantation RFI, Vaccine Counseling, Supplemental
Security Income (SSI) & Spousal Impoverishment
Standards, and More
Public
Comment on Organ Transplantation
On December 3, the Centers
for Medicare and Medicaid Services (CMS) published a Request For Information (RFI)
soliciting feedback to inform potential changes to
transplant requirements. The RFI identified transplant
programs, organ procurement organizations, and end-stage
renal disease facilities to potentially receive these
changes. It outlined the changes they must meet in order to
participate in Medicare and Medicaid programs.
The RFI asks for input on several issues important to the
aging and disability communities, including:
- How to ensure people in underserved
communities receive appropriate information and
education on organ transplantation and organ donation.
- How current requirements can be
changed to ensure transplant programs
provide equal access to transplants for people
with disabilities.
- How current requirements can be
changed to address discrimination, such as decisions
made based on faulty assumptions about quality of life
and the ability to perform post-operative care.
Comments
can be submitted online until 5:00 PM on
February 1, 2022.
CMS
Vaccine Counseling Guidance
On December 2, CMS announced that states
are now required to cover COVID-19 vaccine counseling
visits where healthcare providers talk to families about
the importance of vaccinating children, when those visits
are provided as part of the Medicaid Early and Periodic
Screening, Diagnostic and Treatment (EPSDT) benefit.
These visits will now be considered part of COVID-19
vaccine administration. This change means that state
expenditures for those visits will be 100% federally
matched. The timeline for this change is the last day of
the first quarter that begins one year after the end of the
COVID-19 public health emergency (PHE).
States will also be required to cover vaccine counseling
visits for other pediatric vaccines under the EPSDT benefit,
matched at the state’s regular federal medical assistance
percentage (FMAP).
CMCS
Informational Bulletin on 2022 SSI and Spousal
Impoverishment Standards
On November 23, the Center
for Medicaid and CHIP Services (CMCS) released an informational bulletin
detailing the 2022 Supplemental Security Income (SSI)
increase, and the increase in Spousal Impoverishment
Standards. Both increases are based on inflation and will
go into effect on January 1, 2022.
The SSI increase is important to help determine Medicaid
eligibility. In many states people who are not
receiving SSI, but who meet the financial eligibility
requirements of the program are categorically, or
automatically, eligible for Medicaid. Eligibility for
other categories of Medicaid, including certain eligibility
standards relating to coverage of long-term services and
supports, is tied to an amount up to 300% of the SSI
benefit.
Someone who receives Medicaid to pay for nursing home care
is generally required to pay all but a small portion of
their income towards the cost of their care. Before the
spousal impoverishment provisions were enacted in 1988, the
spouse who was still living in the community would be left
with little or no resources, because the couple’s entire
resources and income were considered in determining how
much the individual had to pay towards their care. The
Spousal Impoverishment Standards allow the community spouse
to keep a certain amount of the couple’s combined income
and resources to avoid impoverishment.
The Spousal Impoverishment Standards have been extended to
beneficiaries of home and community-based services through
September 2023. This information is available at https://www.medicaid.gov/federal-policy-guidance/downloads/cib050421.pdf.
CMS
Financial Flexibilities Guidance
On December 7, CMS released guidance allowing
states to adopt higher effective income and resource
eligibility standards for people who need home and
community-based services (HCBS). This guidance will help
states “rebalance” their Medicaid long-term services and
supports (LTSS). This new option provides states with a
tool to expand access to community-based care.
The option can be provided to all people who need HCBS, or
tailored to those who receive HCBS under a certain waiver,
who receive a particular HCBS, or who meet certain other
criteria, like age. The guidance also extends to spousal
impoverishment standards.
Someone who receives Medicaid to pay for nursing home care
is generally required to pay all but a small portion of
their income towards the cost of their care. However, the
Spousal Impoverishment Standards (See section above) allow
the community spouse to keep a certain amount of the
couple’s combined income and resources to avoid
impoverishment. Under this guidance, states can allow such
couples to retain more or all of their resources. States
interested in this new flexibility should submit a state
plan amendment to CMS.
FAQ
on Updated Vaccine Mandates
ACL has previously highlighted an interim final rule (with
comment period) requiring COVID-19 vaccination of staff who
work in all Medicare and Medicaid-certified facilities. The
rule was released by CMS on November 4. This rule includes
hospitals, nursing homes, Intermediate Care Facilities for
People with Intellectual Disabilities (ICF-IIDs), Psychiatric
Residential Treatment Facilities (PRTFs), home health
agencies, and Programs for All-Inclusive Care for the
Elderly (PACE) programs. It does not include
Medicaid-funded home and community-based settings.
Implementation and enforcement of that rule has been
temporarily suspended due to litigation, and CMS has
updated its frequently asked questions
on the rule as a result. Although implementation and
enforcement of the rule is suspended, the comment period on
the rule is ongoing. Comments can be submitted online or
by mail until 5:00 PM on January 4, 2022.
Health
Equity Workgroup
The Core
Quality Measures Collaborative (CQMC) is seeking
nominations for its new Health Equity Workgroup. The
workgroup will be tasked with developing a report that
identifies and prioritizes health equity and disparities.
It will provide details on sensitive measures relevant to
CQMC’s core sets to assess healthcare quality, and will
present implementation strategies, recommendations, and
priority areas related to health equity measurement.
CQMC is seeking experts in
quality measurement and how it intersects with factors that
impact quality of care and health disparities, including
age and disability. Up to 25 people representing a diverse
variety of stakeholder perspectives will be selected for
the workgroup, including:
- Patients/consumers
- Purchasers/employers
- Public and private payers
- Medical associations
- Hospital/health systems
- Quality collaboratives
- Measure developers
- Solutions providers
- Other health care quality experts
Nominations for the
workgroup can be submitted until 6:00 PM ET on Thursday,
January 6, 2022. Full instructions for submitting
nominations and more information on the workgroup are
available in the call
for nominations.
SSA
Emergency Message
The Social Security
Administration (SSA) published an emergency message on
December 9, reopening cases where applications for
Supplemental Security Income (SSI) may have been denied because
of pandemic-related financial assistance. That assistance
was initially counted as income for the purposes of
deciding eligibility for SSI, but was later determined to
be excludable
disaster assistance.
People identified by SSA in this category will receive
notices that they may now qualify for SSI, including
retroactive payments. There is no deadline to respond to
these outreach notices.
Other people who were denied SSI, but did not receive an
outreach notice, may also now be eligible for SSI. People
who believe that determination was reached because they
received pandemic-related assistance can contact SSA to request
that their case be reevaluated. Those requests may be made
within one year for any reason, or within two years for
good cause.
Guidance
to Boost Accessibility and Equity in COVID-19 Vaccine
Programs
On December 22, the Office
for Civil Rights (OCR) at the Department for Health and
Human Services (HHS) issued guidance to improve
access to COVID-19 vaccine programs, and ensure
nondiscrimination on the basis of race, color, and national
origin.
The guidance outlines the civil rights obligations of
federally assisted health care providers and systems,
including include state and local agencies, hospitals, and
health care providers. Under Title VI of the Civil Rights
Act of 1964 and Section 1557 of the Affordable Care Act,
they are required to ensure fair and equitable access to
COVID-19 vaccines, including booster shots. The guidance
also provides best practices for vaccine providers. These
best practices can be implemented to advance and improve
equitable vaccine administration, including ways to
eliminate barriers to information, improve outreach, and
overcome transportation barriers.
DOL
Final Rule
On November 24, the
Department of Labor (DOL) published a final rule raising the
minimum wage for certain federal contractors, including
people with disabilities, beginning on January 30, 2022.
The rule implements an executive order signed by
President Biden in April. It raises the minimum wage for
certain federal contractors from its current rate of $10.95
per hour to $15 per hour. That rate will increase annually
based on inflation.
The rule also maintains provisions in the 2014 final rule, which
effectively ended the practice of using special
certificates issued under section
14(c) of the Fair Labor Standards Act to pay
people with disabilities less than the minimum wage for the
majority of federal contracts. This means that, in most
cases, federal contractors with disabilities receive the
same minimum wage as other federal contractors.
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