Thinking of our Members, Colleagues, Patients, Loved Ones, and First Responders Affected by the SoCal Fires

Coalition for Compassionate Care of California | By Moore Ballentine

The staff of CCCC are watching as the Palisades, Eaton, Hurst, and other fires ravage Southern California. Our hearts and thoughts are with all affected. Here are a few tangible ways you can help, even at this early stage.

Donate to:

• The California Fire Foundation: online at https://cpf.salsalabs.org/disasterrelief/index.html to provide aid and resources for both fire crews and residents.
• The American Red Cross: online at redcross.org/donate/donation.html/ to aid disaster recovery by providing emergency shelters, meals, medical care, and recovery planning services.
• Los Angeles Fire Department Foundation: online at https://supportlafd.org/donate/. The foundation is the official nonprofit of the Los Angeles City Fire Department, supporting more than 3,000 local firefighters and paramedics by providing equipment and tools to help them fight wildfires effectively. 
• The California Community Foundation: online at https://www.calfund.org/funds/wildfire-recovery-fund/ toward its Wildfire Recovery Fund to aid those affected by the fires. 

As always, in the early stages of a disaster, cash donations are more helpful than supplies or efforts to volunteer. That said, Pasadena Humane is asking for both donations (give at pasadenahumane.org/wildfirerelief) and specific supplies to help shelter animals displaced by the fire: pet food and water bowls, extra large crates, and blankets. Drop off supplies at 361 S. Raymond Avenue, Pasadena.

For information and updates, here are some helpful links, courtesy of the California Department of Aging:

• Los Angeles County Shelter Information and Locations: List of shelters in Los Angeles County.
• Sign Up to Receive Emergency Alerts
• Cal Alerts: Sends alerts about emergency situations that arise in your county.
• Alert LA County: Sends alerts from Los Angeles County about emergency situations.
• CAL FIRE Incidents Updates: Shares the latest updates on all major wildfire incidents in California.
• CAL FIRE Go! Evacuation Guide: Offers guidance for safe and efficient evacuation during wildfires. 
• LISTOS California: Provides several resources for individuals and community providers to prepare for emergencies and disasters.
• Response.ca.gov: A one-stop website for information about shelters, transportation, air quality, and more.
• Emergency Preparedness Guide: Offers guidance to help older adults and people with disabilities prepare for emergencies to ensure they stay safe before, during, and after disasters and other emergency events

Editor's note: Thank you, Coalition for Compassionate Care of California for equipping so many with this crucial information! Readers of our newsletter, please distribute and encourage your networks to support these relief efforts. Ongoing, our newsletter will be posting ways you can specifically help hospice and palliative care in these tragically impacted service areas. Please email relevant stories with URL links to [email protected]. We send support to all persons affected! 

Home Health OASIS Submission Requirements for All Patients, HHQRP Resources

Alliance Daily | Jan. 9, 2025

Effective January 1, 2025, home health agencies could voluntarily begin submitting OASIS data for all patients regardless of payer. The collection and submission of the OASIS for all patients becomes mandatory July 1, 2025.

The Centers for Medicare & Medicaid Services (CMS) removed the temporary suspension of the OASIS data collection on non-Medicare/non-Medicaid home health agency patients through the CY2023 Home Health Prospective Payment System Rate Update final rule and updated the removal in the CY2025 Home Health Prospective Payment System Rate Update final rule. With these changes, patients who have received home care services of more than one visit in a quality episode provided by all Medicare-certified home health agencies and Medicaid home health providers in states where those agencies are required to meet the Medicare Home Health Conditions of Participation, are eligible for OASIS data collection and submission. 

There are no changes to patients excluded which are those under the age of 18, those receiving only maternity services, and those receiving only chore, housekeeping or personal care services. As stated above, there is a voluntary period prior to the mandatory implementation date of July 1, 2025.

There are many questions about the revised requirement which CMS has addressed in a Q&A document. CMS has also released a Fact Sheet and provided guidance on the provision of the OASIS privacy notice. Specifically, effective January 1, 2025 HHAs should only provide patients with the CMS Privacy Act Statement and Attachment A – Statement of Patient Privacy Rights.  Attachment C – Notice About Privacy for Patients Who Don’t Have Medicare or Medicaid should not be provided to patients. These forms are available on the Home Health Agency Center webpage in the OASIS section. Both documents are available in English and Spanish.

In addition to these OASIS resources, CMS has also posted updated introductory courses to the Home Health Quality Reporting Program (HHQRP). This series of courses is helpful for those new to the HHQRP as well as those interested in a refresher.

What Covid Tried to Teach us — and Why it Will Matter in the Next Pandemic

Stat News | By Helen Branswell
 
Five years ago this week, STAT was interviewing nervous infectious disease scientists about a mysterious disease spreading in the central Chinese city of Wuhan, located roughly 500 miles west of Shanghai. On Jan. 4, 2020, we published the first of what would become a torrent of articles on the disease now known as Covid-19. 

The intervening years have both sped and crawled by, too busy at times to take stock of all that has changed, too plodding to believe we have arrived at this anniversary already. (The first case of Covid in the U.S., in a person who had traveled to Wuhan, was not confirmed by the Centers for Disease Control and Prevention until Jan. 20, 2020.)
What do we have to show for the time that has passed? Not enough.

There’s a saying attributed to all sorts of people that one shouldn’t waste a good crisis. In public health, especially, learning from disease outbreaks and environmental disasters is critical; figuring out what worked and what didn’t is fundamental to emergency response planning for the next time. Much as we all might hate the idea, the fact remains that there will be more pandemics. We cannot wish them away and we imperil ourselves if we do not prepare for them. Already, there are renewed concerns about the potential for an H5N1 flu pandemic, with the virus tearing through U.S. dairy cow herds over the past year and also infecting at least 66 people in this country, most of them workers exposed to infected cows or poultry. 

And yet there haven’t been the types of post-mortems or after-action inquiries that normally follow an event of the magnitude of the Covid pandemic. In 2021 a group of experts in public health, science, and other fields began to lay the groundwork for what they thought would be an independent commission looking into the handling of Covid. When the Biden administration decided not to appoint such a body, the group turned its work into a book that was published in the spring of 2023. “They didn’t have an agenda in mind. They could not articulate even to themselves internally as to how the system should change,” the lead author, Phillip Zelikow, said at the time of the administration’s decision to forgo an inquiry.

We appear to be trying to teach ourselves the lessons of Covid the hard way. 
So as we ruminate on the fact that a half-decade has passed since Covid entered our world, here are some thoughts about things we will likely have to deal with when the next pandemic hits — realities that can be traced back directly to the Covid experience.
Public trust in public health institutions has cratered

The CDC has long been the world’s preeminent public health agency. It’s not a coincidence the Chinese, European, and African equivalents are called China CDC, the ECDC, and the Africa CDC. But at the beginning of the Covid pandemic, when the United States was trying to identify newly infected individuals to limit transmission, a test devised by the CDC — the only one in use at the time — failed. Mistakes happen, but that was a bad mistake to make at a very bad time to make it. A successful test would not have stopped Covid. But the unsuccessful test made the CDC look inept just when the country turned to it to chart the path forward.

Later, messaging from officials at the CDC and elsewhere in the government discouraged the public from wearing masks, in part — though this was not generally acknowledged out loud — to preserve scarce supplies for health care workers who were forced to reuse disposable surgical masks for days on end because hospitals couldn’t replace them. Then the guidance shifted and people were urged to mask up even out of doors, with the CDC’s website offering instructions on how to make a mask using hair elastics and T-shirt fabric. A surreal read even back in 2020, those instructions can still be found in the agency’s online archives…

How the DOGE Agenda Could Impact Medicaid, Veterans' Healthcare

Fierce Healthcare / By Noah Tong 

Axes and chainsaws, not butter knives and chisels.

That’s how Department of Government Efficiency (DOGE) commission co-chair Vivek Ramaswamy describes the approach he and world’s richest man Elon Musk will take to reducing the size of the federal government.

Musk has said he wants $2 trillion slashed from the budget, a figure that borders on ambition and an impossibility depending on who you ask. Benefits to Medicaid could be on the chopping block.

The duo outlined their goals in a Wall Street Journal op-ed. DOGE will work with the Office of Management and Budget (OMB) to rescind regulations and cut costs, they say, on the belief that recent court cases give them authority to reverse prior executive overreach under other administrations.

They also want to reduce the head count of federal employees at agencies by skirting civil service protection norms, mandate in-person work (with support from some senators and despite union pushback) and move agencies out of Washington, D.C.

Lastly, Musk and Ramaswamy intends to “take aim” at unauthorized spending from Congress to eliminate funds to Planned Parenthood. If possible, Trump and co. are looking to sidestep the 1974 Impoundment Control Act, which ensures a president cannot refuse to release congressionally appropriated funds to programs. The strategy to fight impoundment law in the court system is endorsed by former House Speaker Newt Gingrich.

Lawmakers fluctuate on how they hope to accomplish the DOGE’s plans. Some say entitlement programs like Medicare and Medicaid won’t be touched, while others make no such promises. Outgoing Rep. Michael Burgess, R-Texas, suggested the DOGE eliminate redundant departments (PDF) within the the Centers for Medicare & Medicaid Services.

Fierce Healthcare took a closer look at the healthcare implications of the DOGE and recent comments made by Ramaswamy and other Republicans on Medicaid and veterans’ care.

Healthcare for veterans 

On Nov. 13, just over one week after the presidential election, Ramaswamy denounced expired government programs that account for $516 billion each year.

“There are 1,200+ programs that are no longer authorized but still receive appropriations,” he said on X. “This is totally nuts. We can & should save hundreds of billions each year by defunding government programs that Congress no longer authorizes. We’ll challenge any politician who disagrees to defend the other side.”

Top of the list of these programs is the Veterans’ Health Care Eligibility Reform Act of 1996, costing the government $119 billion a year. This law continues to self-authorize and receive discretionary funding each year through spending bills. The law expired in 1998 but continues to provide medical benefits to veterans today.

Does Ramaswamy actually want to de-fund this program, which has the potential to be politically devastating to his party?...

Medicaid 

If the DOGE and the Trump administration are looking for cuts wherever they can find them in the $6.75 trillion federal budget, and all of discretionary funding accounts for $1.7 trillion, they will have to look toward Social Security, Medicare or Medicaid for further action.

Ramaswamy is leaving the door open to reform Medicare and Medicaid by eliminating waste and fraud through program integrity measures, reported multiple news publications. He has also called on reducing duplicative payments for individuals enrolled in Medicare Advantage and veterans’ healthcare.

Republicans could be shy to cut benefits to Medicare and Medicaid, but lawmakers seem to be keeping an open mind. Rep. Ralph Norman, R-South Carolina, said “nothing is sacrosanct” following a closed doors DOGE meeting with Musk and Ramaswamy in early December. Other lawmakers—like Reps. Brett Guthrie of Kentucky and Mark Alford of Missouri, as well as Sens. Rand Paul of Kentucky, John Cornyn of Texas and Chuck Grassley of Iowa—say various options of federal program reforms are possible.

Cuts to Medicaid could be pushed in one or two big reconciliation packages where only a simple majority is needed, said Kristin Wikelius, chief program officer at United States of Care, a think tank advancing expanded health access. Medicaid policies will likely mirror Trump’s first term. 

There is likely to be return to work requirements for state Medicaid programs, said Eric Levine, associate principal at Avalere. Those requirements normally look different on a state-by-state basis

“You can see redder states implementing them as a way to reduce enrollment for a populations who would be deemed able to work and to not divert resources from the traditional Medicaid population,” he explained…

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