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On Friday, CDC announced recommendations for
boosters of the Pfizer COVID-19 vaccine for people who: are
65 and older, live in long-term care settings, are at high
risk for severe illness, or work in a high-risk job.
Today’s Policy Roundup includes those details, along with
the following:
- CMS guidance: ARP Act funding for
Medicaid and CHIP (Coverage of habilitation services,
COVID-19 testing and vaccination, and more).
- Input needed: Medicare drug pricing
rule
- Input Needed: NQF Rural Telehealth
and Healthcare System Readiness Measurement Framework
- Medicare.gov Tool to Compare
Nursing Home Vaccination Rates
CDC recommendations for
COVID-19 vaccine boosters
On Friday, the CDC recommended booster shots
of the Pfizer COVID-19 vaccine for people at highest risk
of serious illness and those in high risk occupational and
institutional settings. Specifically, CDC
guidance now states that people who received their
second shot at least six months ago:
Should receive a booster shot if they are:
May receive a booster shot, based on their
individual benefits and risks, if they are:
- 18–49 years old and have underlying
medical conditions
- 18–64 years year old, and at
increased risk for COVID-19 exposure and transmission
because of occupational or institutional setting. The
CDC website includes a complete
list, but it includes front line healthcare
workers and congregate care staff.
CDC will evaluate available data in the
coming weeks to swiftly make additional recommendations for
other populations, as well as for people who received the
Moderna or Johnson & Johnson vaccines.
CMS Guidance on Medicaid
and CHIP: COVID-19 testing, habilitation services, FMAP
increase
In two letters to state health officials,
CMS recently provided guidance on Medicaid and CHIP
requirements and flexibilities established by the American
Rescue Plan Act (ARP). These include coverage of
habilitation services for students with disabilities,
COVID-19 testing and vaccination, and more. Some
highlights:
- Remote learning has made it
challenging for children with disabilities who receive
Medicaid-covered services at school to get the
services they need. As of August 30, states
now can cover habilitation services for students
who are enrolled in a section 1915(c) waiver and/or
1915(i) program who are also learning remotely all or
part of the time, if schools are unable to provide
those services.
- COVID-19
testing must be covered for Medicaid and CHIP
beneficiaries, without any cost sharing. This applies
both to tests used to diagnose COVID-19 and tests to
screen someone for COVID-19 so they can return to
school or work or meet requirements for travel. All
types of tests approved by FDA are covered under this
requirement, including at-home tests, whether those
tests are sent to a laboratory to get results or not.
- The ARP included a temporary
increase in the federal funding provided to states for
a number
of different services for Medicaid and CHIP
participants.
Read more.
Input Needed: “Most
Favored Nation” Medicare Drug Pricing Rule
Bottom line: The Centers for Medicare and Medicaid
Services is seeking
comment on its proposal to rescind the rule
published in November 2020 to establish a Most Favored
Nation (MFN) Model for setting Medicare payment rates for
some Part B drugs.
The MFN
model proposed to lower Medicare spending on Part B
drugs by basing Medicare payments on prices paid by other
countries, several of which use Quality-Adjusted Life Years
(QALYs) to determine whether to cover medical treatments
(include medicines). Aspects of the rule itself and the
rulemaking process were challenged in lawsuits, which has prevented
the rule from being implemented.
The proposed rule to rescind the MFN --
currently open for comment --would permanently prevent the
policy from taking effect. Because of the significant
impact of this rule on older adults and people with
disabilities, we strongly encourage the aging and
disability networks to provide
comments and encourage the people you serve to do the
same. Comments are due Oct. 12, 2021.
Advocates for older adults and people with
disabilities strongly
objected to the rule for several reasons.
Read more.
Input Needed: NQF Rural
Telehealth and Healthcare System Readiness Measurement
Framework
Bottom Line: The National Quality Forum (NQF) is seeking
input on the Rural
Telehealth and Healthcare System Readiness Measurement
Framework. Comments may be submitted through the project page through Friday, October 8 at
6:00 PM ET.
Why this is important: Rural communities commonly face shortages in
healthcare professionals, lack of transportation options
and other challenges to accessing health care, and these
issues have been exacerbated by the COVID-19 pandemic.
Telehealth has the potential to increase access to care and
improve quality of care in rural communities, particularly
during emergencies.
Read more.
Medicare.gov adds
vaccination rates to nursing home details
Last week, CMS launched a new feature on
Medicare.gov to make it easier to check COVID-19
vaccination rates for nursing home staff and residents.
When users search for information about nursing homes using
Medicare.gov’s “Find
and Compare” tool, they will now find the percentage of
residents and staff who are vaccinated for COVID-19, along
with the state and national rates for each.
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