On June 2, the Department of Health and Human Services released an FAQ that defines the types of expenses that are considered “attributable to the coronavirus,” and therefore an allowable use of Provider Relief Fund (PRF) funding. In addition to standard types of expenses (e.g., supplies, equipment, training, payroll), PRF funds may be used for: rent or mortgage payments; lease payments on equipment and “acquiring additional resources, including facilities, equipment, supplies, healthcare practices, staffing and technology to expand or preserve care delivery.” Allowable expenses must have been incurred after January 1, 2020, but there is currently no end date on such expenses. Read the PRF FAQs.

The 2020 Uniform Data System (UDS) Manual provides health centers with detailed instructions to complete all of the required data tables related to patients, operations and clinical performance. The 2020 UDS data reporting period for Health Center Program awardees and look-alikes will be open from Jan. 1 through Feb. 15, 2021. Key reporting changes include:

• Addition of HIV screening measure (CMS349v2)
• Addition of prescription for Pre-Exposure Prophylaxis (PrEP) International Classification of Diseases (ICD) 10 codes and Current Procedural Terminology (CPT) codes
• Revision of Appendix D to capture information on prescription drug monitoring programs (PDMPs) and social determinants of health
• Inclusion of COVID-19 ICD-10 and CPT clinical codes, as well as codes for acute respiratory illness due to COVID-19

See Program Assistance Letter (PAL) 2020-04 for a complete overview of approved CY 2020 UDS changes. Also available is the 2020 Uniform Data System (UDS) Reporting Changes TA Webinar Presentation and On Demand Recording.

The Coronavirus Aid, Relief and Economic Security Act (CARES Act), signed into law on March 27, provided for payments of up to $1,200 for every adult and $500 per dependent child. This stimulus payment does not count as income for Medicaid/CHIP or Advance Premium Tax Credit (APTC) determinations. It should also not be reported on any application for assistance. Some other points to keep in mind:

• Regular unemployment is always counted as income.
• The extension of unemployment of up to 39 weeks and the expansion of unemployment to new populations is counted as income.
• The additional $600/week supplemental unemployment benefit ends July 31, 2020; this benefit does not count toward Medicaid/CHIP but DOES COUNT toward income for Marketplace Coverage and APTC eligibility.

While the Federal government has not issued a special enrollment period or opened the Marketplace due to the pandemic, consumers who have lost coverage may qualify for a special enrollment period. See the Special Enrollment Period Reference Guide for more information.

Secretary of Health Dr. Rachel Levine announced a partnership with General Healthcare Resources to assist with the COVID-19 response. General Healthcare Resources will be deploying onsite assessment teams to assist with infection control practices, staffing and PPE training needs. The team will also assist with specimen collection and urgent staffing needs. The Department of Health (DOH) will be funding the 41 individuals who will be deployed for one year. In addition to General Healthcare Resource’s support, DOH has also been working with the U.S. Department of Health and Human Services (HHS). Since May 20, HHS assessment and action teams have been providing onsite support and training to long-term care facilities in the commonwealth.

Under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) is calling for a renewed national commitment to value-based care based on Medicare claims data that provides an early snapshot of the impact of the coronavirus disease 2019 (COVID-19) pandemic on the Medicare population.  The data shows that older Americans and those with chronic health conditions are at the highest risk for COVID-19 and confirms long-understood disparities in health outcomes for racial and ethnic minority groups and among low-income populations.

“The disparities in the data reflect longstanding challenges facing minority communities and low income older adults, many of whom face structural challenges to their health that go far beyond what is traditionally considered ‘medical’,” said CMS Administrator Seema Verma. “Now more than ever, it is clear that our fee-for-service system is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office. The transition to a value-based system has never been so urgent. When implemented effectively, it encourages clinicians to care for the whole person and address the social risk factors that are so critical for our beneficiaries’ quality of life.”

The data released today includes the total number of reported COVID-19 cases and hospitalizations among Medicare beneficiaries between January 1 and May 16, 2020. The snapshot breaks down COVID-19 cases and hospitalizations for Medicare beneficiaries by state, race/ethnicity, age, gender, dual eligibility for Medicare and Medicaid, and urban/rural locations. The new data show that more than 325,000 Medicare beneficiaries had a diagnosis of COVID-19 between January 1 and May 16, 2020. This translates to 518 COVID-19 cases per 100,000 Medicare beneficiaries. The data also indicate that nearly 110,000 Medicare beneficiaries were hospitalized for COVID-19-related treatment, which equals 175 COVID-19 hospitalizations per 100,000 Medicare beneficiaries.

Blacks were hospitalized with COVID-19 at a rate nearly four times higher than whites. The disparities presented in the snapshot go beyond race/ethnicity and suggest the impact of social determinants of health, particularly socio-economic status.

Other key data points:

• End-stage renal disease (ESRD) patients (individuals with chronic kidney disease undergoing dialysis) had the highest rate of hospitalization among all Medicare beneficiaries, with 1,341 hospitalizations per 100,000 beneficiaries. Patients with ESRD are also more likely to have chronic comorbidities associated with increased COVID-19 complications and hospitalization, such as diabetes and heart failure.
• The second highest rate was among beneficiaries enrolled in both Medicare and Medicaid (also known as “dual eligible”), with 473 hospitalizations per 100,000 beneficiaries.
• Among racial/ethnic groups, Blacks had the highest hospitalization rate, with 465 per 100,000. Hispanics had 258 hospitalizations per 100,000. Asians had 187 per 100,000 and whites had 123 per 100,000.
• Beneficiaries living in rural areas have fewer cases and were hospitalized at a lower rate than those living in urban/suburban areas (57 versus 205 hospitalizations per 100,000).

The snapshot also shows that besides higher hospitalization rates, beneficiaries enrolled in both Medicaid and Medicare have a higher infection rate of COVID-19, with 1,406 cases per 100,000 beneficiaries. By comparison, the coronavirus infection rate for beneficiaries enrolled only in Medicare is 325 cases per 100,000. The rate of COVID-19 cases for dual eligible individuals is higher across all age, sex, and race/ethnicity groups. Previous research has shown that these individuals experience high rates of chronic illness, with many having long-term care needs and social risk factors that can lead to poor health outcomes.

Given the complexity of these disparities, any solution requires a multi-sectoral approach that includes federal, state, and local governments, community based organizations, and private industry. One piece of this is the increased implementation of a value-based system that rewards providers for keeping patients healthy and gives consumers the information about disease prevention and outcomes needed to help make healthcare choices on the basis of quality. Additionally, CMS is encouraging states to double down on efforts to protect low income seniors and look at the data and determine what resources are available, both locally and federally, to improve this disparity of health outcomes. CMS has identified a range of operational opportunities for states to improve care for dually eligible individuals and a variety of models that states can participate in that focus on improving the quality and cost of care for individuals who are concurrently enrolled in Medicaid and Medicare.

The Center for Medicaid and Children’s Health Insurance Program (CHIP) Services is developing guidance for states on new opportunities to adopt innovative, value-based payment design and implement strategies to address social determinants of health for their beneficiaries, including those who are dually-eligible for Medicare and Medicaid. In addition to these ongoing efforts and programs, the CMS Office of Minority Health will be holding a series of listening sessions with key stakeholders responsible for providing care to racial and ethnic minorities. These listening sessions are intended to help refine the ongoing outreach and work by CMS to improve future efforts on this issue.

CMS typically releases Medicare claims information on an annual basis when there are more complete claims and encounter data. However, as part of the agency’s efforts to provide data transparency during the pandemic and ensure the public has this vital information as soon as it is available, CMS is releasing this preliminary data now. The data will be updated on a monthly basis as more claims and encounter records are received. CMS anticipates releasing similar information on Medicaid beneficiaries in the future.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf

For a blog by CMS Administrator Seema Verma, visit: https://www.cms.gov/blog/medicare-covid-19-data-release-blog

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press.

Calls recordings and transcripts are posted on the CMS podcast page at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts

Medicare Coverage of COVID-19 Testing for Nursing Home Residents and Patients

Today, the Centers for Medicare & Medicaid Services (CMS) has instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests for nursing home residents and patients. This instruction follows the Centers for Disease Control and Prevention’s (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19 as well as for asymptomatic residents and patients who have been exposed to COVID like in an outbreak. Original Medicare and Medicare Advantage plans will cover COVID-19 lab tests consistent with CDC guidance.

Medicare Advantage plans must continue not to charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for COVID-19 tests and testing-related services.

Read the Medicare Learning Network article: https://www.cms.gov/files/document/se20011.pdf.

Read the memo to Medicare Advantage plans: https://cms.gov/files/document/hpms-memo-diagnostic-testing-nursing-home-residents-and-patients-coronavirus-disease-2019.pdf.

More information about Medicare coverage of COVID-19 tests is available at: https://www.medicare.gov/coverage/coronavirus-disease-2019-covid-19-tests.

The Occupational Safety and Health Administration (OSHA) has issued guidance to assist employers reopening nonessential businesses and their employees returning to work during the evolving coronavirus pandemic. During each phase of the reopening process, OSHA recommends that employers should continue to focus on strategies for basic hygiene, social distancing, identification and isolation of sick employees, workplace controls and flexibilities, and employee training.

CDC has translated two quick reference guides for meat and poultry processing facilities: Key Strategies for Employers and Tips for Employees. Now available in 13 languages, these guides provide recommendations and strategies for preventing COVID-19 in meat and poultry facilities. These printable one-page flyers may be found on the Meat and Poultry Processing Facility Toolkit webpage.

CDC has published an Agricultural Employer Checklist for Creating a COVID-19 Assessment and Control Plan. To prevent and slow the spread of COVID-19, agricultural employers can use this checklist to create a COVID-19 assessment and control plan for applying specific preparation, prevention, and management measures. This checklist has been developed based on the Agriculture Workers and Employers Interim Guidance from CDC and the U.S. Department of Labor.