In the News

Year-End Funding Package Includes Medicare and Medicaid Policies

Medicare Rights Center / By Lindsey Copeland

In late December, Congress passed an omnibus spending bill (P.L. 117-328) that funds the federal government through the current fiscal year (September 30, 2023) and makes several important changes to Medicare and Medicaid.

Medicare

Medicare Telehealth

PHE Waiver Extension—The bill extends most of the COVID-19 public health emergency (PHE) Medicare telehealth flexibilities through 2024 and directs the Department of Health & Human Services (HHS) to study telehealth utilization and assess potential fraud.

Medicare Mental Health Care

Provider Expansions—Medicare mental health coverage has known gaps, which the spending bill helps close. One long-sought change will allow Medicare Part B to cover services provided by marriage and family therapists and licensed professional counselors beginning January 1, 2024.

Intensive Outpatient Services—To further ease access, the package revises Medicare’s partial hospitalization benefit to establish coverage of intensive outpatient services beginning January 1, 2024.

Crisis Psychotherapy Services—It also increases payments for mobile crisis care (crisis psychotherapy services furnished by a mobile unit or in other non-facility settings) starting on January 1, 2024.

Workforce Development—It provides for 200 new Medicare-supported graduate medical education (GME) residency positions, half of which are allocated for psychiatry and psychiatry subspecialties.

Provider Outreach—To promote uptake, the omnibus requires HHS to educate providers on the availability of crisis psychotherapy services, behavioral health integration services, and opioid use disorder treatment services under Medicare.

COVID Treatments—The bill temporarily (through December 2024) allows Part D plans to cover oral antiviral treatments that have an emergency use authorization (EUA). This update will permit Medicare to cover COVID-19 treatments like Paxlovid once the PHE ends and those products shift to the commercial market.

Medicare Coverage Changes and Extenders

Lymphedema Compression Garments—Under the bill, compression garments for the treatment of lymphedema will be covered under Part B as durable medical equipment (DME) starting in January 2024.

In-home intravenous immune globulin services (IVIG)—It also provides permanent Medicare coverage for items and services related to the administration of IVIG, beginning on January 1, 2024.

Durable Medical Equipment—The omnibus continues the blended payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in certain non-competitive bid areas through 2023.

Hospital at Home Waiver—It extends (through December 31, 2024) the Acute Hospital Care at Home initiative.

Medicaid

Medicaid Home- and Community-based Services (HCBS)

Money Follows the Person and Spousal Impoverishment—The bill continues the Medicaid Money Follows the Person program and protections from spousal impoverishment for people receiving HCBS through September 30, 2027. These critical Medicaid policies that we have long supported help older adults and people with disabilities live with choice, dignity, and independence.

Medicaid PHE Coverage

Continuous Coverage Requirement—The omnibus sunsets the Medicaid continuous coverage requirement. Created in 2020 by the Families First Coronavirus Response Act (FFCRA), this provision has allowed states to maintain their Medicaid rolls in exchange for a 6.2% federal match rate (FMAP) bump. The FFCRA tied this coverage policy to the duration of the PHE; it will now end on April 1.

At that time, the enhanced FMAP will begin to reduce gradually, eventually reaching zero on December 31, 2023. The maintenance of effort (MOE) requirements tied to the FMAP increase—that states may not make eligibility standards, methodologies, or procedures for determining Medicaid eligibility more restrictive than they were on January 1, 2020—will continue to apply during the phase-down period.

Medicaid Eligibility and Funding

Enhanced Eligibility Postpartum and for Children—The bill also requires states to give children (under the age of 19) 12 months of continuous coverage in Medicaid and CHIP and permanently extends the American Rescue Plan policy allowing states to provide 12 months of postpartum coverage to pregnant individuals in Medicaid and CHIP.

Funding for the U.S. Territories—The omnibus extends Puerto Rico’s higher federal Medicaid match (76%) through September 30, 2027, and permanently extends a higher federal match (83%) for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands. These updates will provide much-needed consistency and fiscal stability.

 

Elimination Of Non-Competes Would Have ‘Major’ Effect On Home-Based Care World

Home Health Care News / By Andrew Donlan
 
In early January, the Federal Trade Commission (FTC) proposed a ban on non-compete agreements nationwide.
 
The rule is likely to be finalized. When and if it does, it is also likely to have a massive effect on the home health and home care industries.
 
Such a move would not just hurt companies by allowing leaders to jump ship, but it would also muddy the waters on a slew of contractual agreements between caregivers and clients.
 
“I definitely think it’s major. It’s extraordinarily significant,” Angelo Spinola, the chair of home care, home health and hospice at the law firm Polsinelli, told Home Health Care News. “If you can’t stop a key executive from leaving and competing against you, that will have a significant impact on the industry.”
 
The proposed rule can be traced back to the Biden administration’s Aug. 2021 request to the FTC to take a longer look at restricting or banning non-compete agreements. Broadly, the idea was that non-competes restricted workers’ mobility and ability to make a livable wage.
 
It seemed at the time that President Biden was referring to low-wage workers specifically. And while this would have an effect on, for instance, the caregiver-provider relationship, it would also be a major shake-up in what home-based care leadership could do when looking for new opportunities.
 
For instance, Spinola offered up the example of a home health administrator. They could be trained up by a home health organization, promoted and given access to all the patient data and pricing of an organization.
 
“Now that individual says, ‘You know what, I’ve got all the relationships. And I’ve been collecting a salary from the owner. But now I’m just going to go across the street, and I’ll open my own agency. I’ll wait for those clinicians to call me and start working with me. And the relationships I’ve developed with the facilities and those referral relationships, I’ll just bring those over,” he said.
 
Home-based care leadership has already been in disarray, to a certain extent. Big-time executives have either left their posts or been forced out in the wake of COVID-19 and other unfavorable market conditions.
 
If the FTC ruling becomes final, that could become even more so the case.
 
Read Full Article

 

US Health Officials Propose Annual COVID-19 Vaccination for Most Americans

Associated Press
 
WASHINGTON — U.S. health officials want to make COVID-19 vaccinations more like the annual flu shot.

The Food and Drug Administration on Monday proposed a simplified approach for future vaccination efforts, allowing most adults and children to get a once-a-year shot to protect against the mutating virus.
 
This means Americans would no longer have to keep track of how many shots they’ve received or how many months it’s been since their last booster.
 
The proposal comes as boosters have become a hard sell. While more than 80% of the U.S. population has had at least one vaccine dose, only 16% of those eligible have received the latest boosters authorized in August.
 
The FDA will ask its panel of outside vaccine experts to weigh in at a meeting Thursday. The agency is expected to take their advice into consideration while deciding future vaccine requirements for manufacturers.
 
In documents posted online, FDA scientists say many Americans now have “sufficient preexisting immunity” against the coronavirus because of vaccination, infection or a combination of the two. That baseline of protection should be enough to move to an annual booster against the latest strains in circulation and make COVID-19 vaccinations more like the yearly flu shot, according to the agency.
 
For adults with weakened immune systems and very small children, a two-dose combination may be needed for protection. FDA scientists and vaccine companies would study vaccination, infection rates and other data to decide who should receive a single shot versus a two-dose series.
 
FDA will also ask its panel to vote on whether all vaccines should target the same strains. That step would be needed to make the shots interchangeable, doing away with the current complicated system of primary vaccinations and boosters.
 
The initial shots from Pfizer and Moderna — called the primary series — target the strain of the virus that first emerged in 2020 and quickly swept across the world. The updated boosters launched last fall were also tweaked to target omicron relatives that had been dominant.
 
Under FDA's proposal, the agency, independent experts and manufacturers would decide annually on which strains to target by the early summer, allowing several months to produce and launch updated shots before the fall. That’s roughly the same approach long used to select the strains for the annual flu shot.
 
Ultimately, FDA officials say moving to an annual schedule would make it easier to promote future vaccination campaigns, which could ultimately boost vaccination rates nationwide.

The original two-dose COVID shots have offered strong protection against severe disease and death no matter the variant, but protection against mild infection wanes. Experts continue to debate whether the latest round of boosters significantly enhanced protection, particularly for younger, healthy Americans.

 

President's Message

Posted: January 24, 2023

It’s back! PT After Dark, that is. While the specific program is still under development, After Dark will happen at CSM 2023 in San Diego. It will be on Thursday, February 23, from 9 PM to 11 PM PST, at the Hilton Bayfront, in the Aqua Salons DEF. There will be plenty of room, so bring your friends and colleagues to talk about the hard issues in physical therapy today with no holds barred, no audiovisual, and no recording!

Of course, the rest of APTA Home Health’s CSM programming is just as amazing! We hope to see you at CSM, especially on Wednesday evening, February 22, at our meet and greet event and on Friday evening, February 24, at our annual business meeting. Both events are at the Hilton Bayfront in room Aqua 300. On tap for the business meeting are our annual award presentations, a brief update on the Academy’s goings-on, and the reveal of our new strategic plan. We look forward to seeing you at both of these events!

Sincerely, 

Phil Goldsmith
President
APTA Home Health

 

Volunteers Needed for 2023 CSM Booth

It is almost that time of year again! The annual APTA Combined Sections Meeting is back in San Diego, CA, February 23-25, 2023.

In an effort to get to know more of our members and create more opportunities for our members to get involved with the Academy, we are asking for volunteers to help run the APTA Home Health Academy booth in the exhibit hall at CSM.

For members that will be attending CSM 2023 and are interested in volunteering at the booth for a minimum of TWO HOURS, we are offering a $100 credit towards any education in our Learning Center!

Please make sure that if you sign up to volunteer at the booth, you make sure to mark it in your calendar so you don't forget, and that you are able to stay at the booth for the whole time slot. At least one member of our board will also be at the booth at all times with our volunteers. Please CLICK HERE to view available time slots and sign-up to volunteer! 

If you have questions about volunteering, please email us at [email protected]. We look forward to seeing you at CSM at booth #1734!

 
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