Omicron-Specific Covid Booster Shots Are Just Weeks Away. Here’s Who Will—and Won’t—Be Eligible

CNBC | By Annika Kim Constantino

Newly updated Covid booster shots designed to target omicron’s BA.5 subvariant should be available within in the next three weeks. That begs an important question: Who’s going to be eligible to get them?

The short answer: anyone ages 12 and up who has completed a primary vaccination series, a Centers for Disease Control and Prevention spokesperson tells CNBC Make It. It’s unlikely to matter whether you’ve received any other booster doses or not before, the spokesperson says — but if you’re unvaccinated, you won’t be eligible for the updated formula until you complete a primary series with the existing Covid vaccines.

The longer answer is somewhat more complex, because it depends on which booster shots get approved and when.

Pfizer’s “bivalent” shot, which targets both the original Covid strain and omicron’s BA.5 subvariant, is expected to be authorized first. The CDC says it’ll likely come with a wide eligibility swath: the full group of vaccinated Americans ages 12 and up.

Moderna’s bivalent shot is expected to follow suit later, most likely in October. It’ll come with a somewhat narrower range of eligibility, at least at first: vaccinated people ages 18 and older. For both shots, younger pediatric age groups could become eligible later, the CDC says.

Those projections are tentative, at least for now. A person familiar with the matter told NBC News on Wednesday that it’ll hinge on how much supply Pfizer and Moderna are able to manufacture and roll out by next month. If that supply is limited, the shots could first be available to those most at risk, such as the elderly and immunocompromised.

Federal health officials believe the shots will provide the best level of protection against the highly transmissible BA.5 subvariant to date, especially in the fall and winter when a large wave of Covid infections is projected to hit the U.S.

“It’s going to be really important that people this fall and winter get the new shot. It’s designed for the virus that’s out there,” Dr. Ashish Jha, the White House’s Covid response coordinator, said at a virtual event hosted by the U.S. Chamber of Commerce Foundation on Tuesday.

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APTA Members Receive Discount to New Home Care Tech Conference 

Dear Members,

There is a new conference focused exclusively on innovative caregiving technologies for home care that I wanted to make sure is on your calendar.

It is called HCT (Home Care Tech) and it’s happening September 7 & 8 at the Gaylord National Harbor, MD. The group is extending reduced pricing of $100 to APTA members. 

This is a fantastic opportunity and I recommend you consider attending.

HCT will give you an immersive overview of the most innovative caregiving technology on the market - what's on the horizon, who's leading the charge, and how this tech can help you deliver care more efficiently.

Attendees span the entire home care universe (home health, personal care, hospice, palliative, infusion), plus the full spectrum of caregiving technology (telehealth, remote patient monitoring, diagnostic tools, etc.).

Keynoter is Dr. Joseph Kvedar, digital health pioneer and Chair of American Telemedicine Association. Here’s more on their education program: https://hctexpo.com/schedule/sessions

You can expect a high-energy couple of days, with important and helpful opportunities to connect with - and learn from - innovators, payers and peers.

More information, including registration, is available at https://hctexpo.com/. Enter code APTA for your special pricing.

I hope to see you there.

Phil Goldsmith
President
APTA Home Health

Your Assistance Needed to Combat Medicare Payment Reductions for Home Health

The Health Group 

The National Association for Home Care & Hospice (“NAHC”) needs the industry to be vocal regarding the CY 2023 Medicare home health services Proposed Rule, which includes 2023 payment rates and a variety of other changes.

NAHC has submitted comments on the proposed rule which include:

• More than 300,000 Medicare beneficiaries have lost access to home health services in recent years, with over 1,000 HHAs having closed, and Medicare spending in 2020-2021 at its lowest point since 2010.
• Congress required that CMS institute a budget neutral payment model in 2020. That model underpaid home health agencies by 2.5 to 3.2 percent in contrast to the 6.9 percent overpayment alleged by CMS.
• CMS’s evaluation as to whether the new payment model was “budget neutral” is fatally flawed in its methodological approach and is inconsistent with comparable evaluations that CMS applied in other sectors.
• CMS’s evaluation methodology is at odds with the clear mandates established by Congress in 2018 in all respects.
• CMS compounds the risks to patient care by adding new, unnecessary costs while failing to adequately recognize the significant labor and transportation cost inflation that has hit home health services.
• CMS is pulling resources from home health care at a time it is depending on that care to reduce Medicare spending on hospitalizations and other care.

You can go to Ask Congress to Prevent Home Health Cuts that Will Devastate Access to Care. Support S.4605/H. R. 8581 (p2a.co) to show your support for the Preserving Access to Home Health Care Act and help to avoid home health payment cuts.  NAHC has also scheduled September 14, 2022 for a Capitol Hill Day of Advocacy. You can register for this event at NAHC Advocacy Day • RSVPify.

The proposed payment rate cut of 7.69 percent will place many home health agencies at financial risk.

Here are 4 key Health Policy Items in the Inflation Reduction Act

Fierce Healthcare | By Robert King

The House passed on late Friday a sweeping healthcare, climate and taxes package that includes major reforms on drug prices and extends boosted Affordable Care Act subsidies through 2025.

But the sweeping Inflation Reduction Act, which now heads to President Joe Biden for his signature, could reshape many other aspects of the healthcare industry. It would give Medicare the power for the first time to negotiate a small subset of Part D and Part B drugs.

Here are four other health policy changes to look for in the bill:

• Expands eligibility for low-income Part D subsidies. The bill expands who can qualify under the Low-Income Subsidy Program that helps meet Part D cost-sharing burdens like deductibles. Currently, a beneficiary qualifies for the program if they earn up to 135% of the federal poverty level and get partial benefits for 135% to 150% of the level. The law would expand full benefits to those who earn between 135% and 150%, according to an analysis from the Kaiser Family Foundation.

• Gets rid of the cost sharing for adult vaccines for Medicare Part D. It also requires states to cover all vaccines for Medicaid and Children’s Health Insurance Program beneficiaries. The benefit though only applies to any vaccines that get cleared by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

• Delays the controversial Part D rebate rule, again. The Trump-era rule would get rid of the safe harbor for Part D rebates, leaving them open to prosecution under federal anti-kickback laws. The rule passed at the tail end of Trump’s term but has never gone into effect. The law would delay the rule from going into effect again into 2032.

• Limits the premium growth on Medicare Part D to no more than six percent a year from 2024 through 2029. The cap on premium growth is intended to mitigate the impact of other changes to Part D, said Ryan Urgo, managing director of the policy practice at consulting firm Avalere Health. The legislation includes a $2,000 out-of-pocket cost cap on Part D drugs, spread out in installments for the beneficiary over a calendar year. Part D plans will also have to pick up more of the costs for spending in the catastrophic coverage phase, which a beneficiary reaches when their drug costs reach a certain level.

Experts say regulating the bill will have a big impact on providers, including those that rely heavily on reimbursements for Medicare Part B drugs. 

Some providers purchase their own products under a buy and bill model and then get reimbursed by Medicare for the average sales price of the Part B drug plus 4% for storage and handling costs. The problem is that model doesn’t work if Medicare will reimburse for a smaller negotiated rate, experts say.

“If you are buying high and getting paid low you are, in essence, underwater,” Urgo told Fierce Healthcare. “If you are buying a drug at $1,000 and the reimbursement under Medicare with [the negotiated price] is only $800 you are $200 in the red. To address that there is going to be a need for providers to purchase products at the [negotiated rate] as opposed to market prices.”

The Community Oncology Alliance has raised concerns about this potential change. 

“History has clearly documented that bluntly cutting Medicare payments like proposed in the reconciliation bill, will lead to cancer practice closures and consolidations,” said COA Executive Director Ted Okon in a statement back in July when the drug price reform text was introduced. 

Sen. John Barrasso, R-Wyoming, proposed an amendment to the bill that would have required drugmakers to rebate the government any excess costs above the negotiated prices. The amendment was not agreed to before the final passage earlier this month.