The Centers for Medicare & Medicaid Service (CMS) is taking action to drive value-based, person-centered care, and promote sustainability and readiness to respond to future public health emergencies in our nation’s hospitals through the Hospital Inpatient Prospective Payment System (IPPS)/ Long Term Care Hospital (LTCH) Prospective Payment System final rule released today.

The final rule, effective October 1, 2021, authorizes additional payments for diagnostics and therapies to treat COVID-19 during the current public health emergency (PHE), and beyond. The rule revises payment policies, as well as policies under certain quality and value-based purchasing programs for hospitals, to lessen the adverse impacts of the pandemic. Some of these changes will incentivize the meaningful use of certified electronic health record (EHR) technology that will help public health officials monitor for future unplanned events.

“How Medicare pays for hospital care and evaluates quality, are integral pieces of achieving and addressing gaps in health equity and strengthening our health care system for a more sustainable future. CMS is moving forward to incorporate what we have learned from the COVID-19 pandemic in order to improve quality and increase transparency so that patients are positioned to make informed decisions about their care,” said CMS Administrator Chiquita Brooks-LaSure. “With this final rule, we are further improving how we measure and evaluate data while investing in quality care for people that rely on Medicare for coverage.”

Last week, CMS also finalized a number of other Medicare payment rules including for Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, Inpatient Psychiatric Facilities, and Hospice providers. Using lessons learned from the COVID-19 pandemic, these final rules will enact policies that will further protect and deliver better care to Medicare beneficiaries. These payment rules finalized new quality measures to give beneficiaries and their families better insights into the quality of care rendered at hospice facilities and vaccination reporting of facility staff.

Improving Health Equity
In an effort to advance equity through the quality reporting measurement, CMS solicited feedback on opportunities to leverage diverse data sets such as race, ethnicity, Medicare/Medicaid dual eligible status, disability status, LGBTQ+, and socioeconomic status. The agency received more than 200 comments, reflecting the importance stakeholders place on this Biden-Harris Administration priority. CMS will consider the feedback it received to inform future actions.

“Standardization of equity data to improve hospital data collection is just one more way CMS will lead the national conversation on improving health equity,” said Brooks-LaSure. “CMS will use these comments and innovate on quality measures to help identify health equity data. We’re also measuring hospital initiatives to improve maternal health outcomes as we work to reduce disparities in maternal morbidity.”

Addressing the maternal health crisis and improving maternal health is a priority to advance health equity, and a quality improvement goal for CMS. To that end, CMS is adding a Maternal Morbidity measure to the hospital quality reporting program that would require hospitals to report whether they participate in statewide or national efforts to improve perinatal health, known as Quality Improvement (QI) initiatives. Many of the factors contributing to maternal morbidity are preventable, and differentially impact women of color. This measure is an important initial step toward implementation of patient safety practices to reduce maternal morbidity, and in turn, maternal mortality.

CMS is also adopting a measure that requires hospitals and long-term care hospitals to report COVID-19 vaccination rates of workers in their facilities. Having access to information about COVID-19 vaccination rates among health care personnel will help patients, caregivers, and their communities, make informed decisions when seeking care from hospitals, cancer centers and long-term care hospitals.

Ensuring Access to Life-Saving Diagnostics and Therapeutics
In November 2020, CMS established the New COVID-19 Treatments Add-on Payment (NCTAP) to encourage hospitals to provide new COVID-19 treatments during the PHE. CMS is finalizing its proposal to extend the NCTAP for certain eligible technologies through the end of the fiscal year in which the PHE ends to continue to encourage these new treatments, and to minimize any potential payment disruption immediately following the end of the PHE. These products include currently approved hospital treatments. Providing these therapies to COVID-19 patients early can help reduce hospital stays and deaths.

Sustaining Hospital Readiness to Respond to Future Public Health Threats
Strengthening public health functions through methods such as early warning surveillance, case surveillance, and vaccine uptake, increases information available to the public and helps hospitals better serve their patients. CMS continues its ongoing response to the PHE and future health threats by promoting the meaningful use of certified EHR IT to report data that supports public health efforts. Specifically, CMS is modifying the Promoting Interoperability Program for eligible hospitals and critical access hospitals to expand required reporting within the Public Health and Clinical Data Exchange Objective.

The final rule requires hospitals to attest they are in active engagement with public health agency to submit data for measures related to nationwide surveillance for early warning of emerging outbreaks and threats; automated case and laboratory reporting for rapid public health response; and visibility on immunization coverage so public health agencies can tailor vaccine distribution strategies. Hospital reporting of the measures will support public health agencies as they prepare to respond to both future health threats and long-term COVID-19 recovery.

For a link to the FY2022 IPPS/LTCH PPS Final Rule fact sheet, please visit: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-0 .

For a link to the FY2022 IPPS/LTCH PPS Final Rule on the Federal Register, please visit: https://www.federalregister.gov/public-inspection/current.

This August, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) is recognizing National Immunization Awareness Month and encouraging you to get vaccinated to protect yourself and your loved ones.

As a result of the COVID-19 pandemic, vaccination rates for preventable diseases like pnemococcal pneumonia, flu, and hepatitis B have declined, putting communities at an increased risk. Minority communities and underserved populations are in particular disproportionately affected when it comes to receiving recommended vaccines like those that protect against pnemococcal pneumonia, flu, and hepatitis B. Many factors can contribute to lower vaccination rates, including access to care and coverage; the likelihood that providers recommend vaccinations; and concerns about vaccinations, including vaccine safety.

During National Immunization Awareness Month, CMS OMH is encouraging minority and underserved people to stay up-to-date on routine vaccines and get vaccinated. With the flu season getting closer and the country continuing to combat COVID-19, we’re calling on providers and communities to help us share resources that may help high-risk individuals learn about the benefits of vaccines and talk to their providers about necessary vaccinations.

Resources

Below are resources you can share with your community to help them learn more about the vaccinations that are available at no or low cost under most health coverage:

• Visit our Immunization and Vaccine Resources webpage to find resources that you can share with your community.
• Check out the COVID-19 Vaccine Resources webpage which compiles federal resources on the COVID-19 vaccine for healthcare professionals, partners, and patients.
• Review the below resources from the Centers for Disease Control and Prevention (CDC), which you can use to promote the importance of vaccination:
  • Get Back on Track with Routine Vaccines
  • Planning for Vaccination During the COVID-19 Pandemic
  • Educating Adults with Chronic Health Conditions: Vaccination Resources
  • Educating Spanish-Speaking Patients: Vaccination Resources
• Share the latest Coverage to Care resources, including our prevention materials (available in English and Spanish), to help patients understand preventive services that may be available to them at no or low cost.
• Learn about Medicare coverage for vaccinations (like those for flu, hepatitis B, and pneumococcal pneumonia).
• Share our Hepatitis Disparities in Medicare Fee-for-Service Beneficiaries to help your patients learn more about how hepatitis disproportionately affects certain racial and ethnic groups.
• Review our Rural-Urban Disparities in Health Care in Medicare report, which describes rural-urban differences in health care experiences and clinical care, including vaccination rates.
• For resources on childhood vaccination, refer to:
  • Resources for Encouraging Routine Childhood Vaccinations
  • Help Kids’ Safe Return to School – Get Caught Up on Recommended Vaccines
  • Catch Up on Well-Child Visits and Recommended Vaccinations
  • Childhood Vaccination Toolkit for Clinicians
  • Provider Resources for Vaccine Conversations with Parents

Connecting Kids to Coverage National Campaign

What scientists have found so far is concerning. For example, PET scans taken before and after a person develops COVID-19 suggest that the infection can cause changes that overlap those seen in Alzheimer’s. And genetic studies are finding that some of the same genes that increase a person’s risk for getting severe COVID-19 also increase the risk of developing Alzheimer’s. Alzheimer’s diagnoses also appear to be more common in patients in their 60s and 70s who’ve had severe COVID-19.

Read more.

Medical groups representing millions of doctors, nurses, pharmacists and other health workers called for mandatory vaccinations of all U.S. health personnel against the coronavirus, framing the move as a moral imperative as new infections mount sharply. “We call for all health care and long-term care employers to require their employees to be vaccinated against COVID-19,” the American Medical Association, the American Nurses Association and 55 other groups wrote in a joint statement. “The health and safety of U.S. workers, families, communities and the nation depends on it.”

Read more.

Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network Health Advisory to notify public health practitioners and clinicians about the urgent need to increase COVID-19 vaccination coverage (i.e., the percentage of the population fully vaccinated) across the United States to prevent surges in new infections that could increase COVID-19 related morbidity and mortality, overwhelm healthcare capacity, and widen existing COVID-19-related health disparities. Increasing vaccination coverage is especially urgent in areas where current coverage is low. Unvaccinated persons account for the majority of new COVID-19 infections, hospitalizations, and deaths. Currently circulating SARS-CoV-2 variants of concern, especially the highly infectious Delta variant (B.1.617.2), are accelerating spread of infection. Unvaccinated and partially vaccinated people need to practice all recommended prevention measures until fully vaccinated. In areas with substantial and high transmission, CDC recommends that fully vaccinated individuals wear a mask in public indoor settings to help prevent the spread of Delta and protect others.

Background
COVID-19 case rates are rising again after a period of decline: COVID-19 cases have increased over 300% nationally from June 19 to July 23, 2021, along with parallel increases in hospitalizations and deaths driven by the highly transmissible B.1.617.2 (Delta) variant. While significant progress has been made to make COVID-19 vaccine widely available, disparities in vaccination coverage persist across population groups and geographic areas. As of July 23, 2021, 1,856 (63.0%) of the 2,945 counties with available vaccination data have particularly low vaccination coverage, defined here as <40% of the population being fully vaccinated. As of July 23, 2021, among the counties with vaccine coverage <40%, 36.0% (N = 668) have COVID-19 incidence rates in the high burden level (≥100 cases/100,000 over the last seven days) (see figure below, and further data at COVID Tracker).

Overall, the majority (81.4%) of counties with high COVID-19 incidence rates are found in communities with low vaccination coverage. As COVID-19 case counts continue to rise nationally, areas with lower vaccination coverage are at especially high risk for a surge in cases.

Most cases of COVID-19 and hospitalizations are in unvaccinated individuals:  While COVID-19 vaccines authorized in the United States remain effective against SARS-CoV-2 infection and severe disease, some infections among vaccinated persons (i.e., breakthrough infections) are anticipated and have been reported. However, the majority of COVID-19 cases and hospitalizations are occurring among individuals who are not fully vaccinated.  From January through May 2021, of the more than 32,000 laboratory-confirmed COVID-19-associated hospitalizations in adults ≥18 years of age for whom vaccination status is known, <3% of hospitalizations occurred in fully vaccinated persons.

The COVID-19 Delta variant is widely prevalent and more infectious than prior strains: The COVID-19 Delta variant currently accounts for more than 80% of all COVID-19 cases in the United States. This variant is significantly more infectious than prior SARS-CoV-2 variants and has led to a rapid rise in COVID-19 cases in other countries, including the United Kingdom and Israel. Emerging evidence suggests that fully vaccinated people who do become infected with the Delta variant are at risk for transmitting it to others.

COVID-19 vaccination is our most effective strategy to prevent infection and severe disease: Vaccination is a priority national strategy to interrupt SARS-CoV-2 transmission, protect personal and public health, and preserve healthcare system capacity. COVID-19 vaccines are safe and recommended for all persons aged 12 years of age and older, even for those with prior SARS-CoV-2 infection.  Immunologic data support the role of Food and Drug Administration (FDA)-authorized COVID-19 vaccines in offering protection against the known currently circulating variants. By limiting viral spread, vaccination also minimizes opportunities for the introduction of more infectious variants through random mutation. Mutations could produce future variants that are more virulent and capable of evading diagnostic and therapeutic tools or overcoming vaccine-induced immunity.

COVID-19 vaccination coverage at skilled nursing facilities (SNF) helps prevent infection: Nursing home residents have been severely impacted by COVID-19 and are disproportionately represented in overall burden of COVID-19-related morbidity and mortality in the United States. While there has been significant progress in vaccinating SNF residents, vaccination coverage of staff at many facilities remains low. Preliminary data from CDC’s National Healthcare Safety Network (NHSN) indicate residents of SNFs in which vaccination coverage of staff is 75% or lower experience higher crude rates of preventable COVID infection.

CDC recommends urgent action by all: CDC recommends continued efforts to accelerate primary vaccination efforts, especially in areas with lower vaccination coverage. Individuals who are not fully vaccinated need to maintain all recommended prevention measures. People who are immunocompromised should be counseled about the potential for reduced immune responses to COVID-19 vaccines and to follow current prevention measures to protect themselves against COVID-19 until advised otherwise by their healthcare provider.  CDC recommends ensuring tailored, culturally responsive, and linguistically appropriate communication of vaccination benefits (see vaccine equity resources below).

Recommendations for Public Health Jurisdictions

• Continue and increase efforts to reach and partner with communities to encourage and offer vaccination. Co-lead the conversation by participating in community education and outreach events.
• Leverage resources to promote vaccine equity.
• Encourage clinicians to offer and recommend COVID-19 vaccination to their patients and community members.
• Work with community partners to make vaccination easily accessible for unvaccinated populations.
• Implement additional prevention strategies when transmission is high and vaccination coverage is low (MMWR).
• Continue to monitor community transmission levels, variant, and vaccination coverage levels, and focus vaccine efforts on populations with low coverage.
• Communicate vaccination coverage, variant, and transmission levels to key partners, including the key information on risk associated with the B.1.617.2 (Delta) variant.

Recommendations for Clinicians

• If you are a clinical provider and are not fully vaccinated, get vaccinated as soon as possible to protect yourself, your family, and your patients.
• Increase patient outreach efforts to encourage, recommend, and offer COVID-19 vaccination.
• Remind patients that vaccination is recommended for all persons aged 12 years of age and older, even for those with prior SARS-CoV-2 infection. Follow trusted sources carefully for any new recommendations and changes in vaccine guidance.
• Support efforts to ensure people receiving a first dose of a COVID-19 mRNA vaccine (i.e., Pfizer-BioNTech or Moderna) return for their second dose to complete the series.
• Communicate with unvaccinated staff, patients, and other individuals to increase confidence in vaccination. CDC has many resources for providers to help increase vaccine confidence .
• Recommend that fully vaccinated patients who are immunocompromised continue to practice all recommended prevention measures for unvaccinated persons.

Recommendations for Healthcare Facilities and Systems, Nursing Homes, and Businesses

• Recommend and offer COVID-19 vaccine to your staff and employees and establish policies to encourage uptake such as time off to receive the vaccine.
• Consider offering COVID-19 vaccine at your workplace (Workplace COVID-19 Vaccine Toolkit).
• Evaluate whether your facility can implement vaccine requirements or vaccine incentives.

For More Information

• CDC Weekly Morbidity and Mortality Weekly Report (MMWR) Guidance for Implementing COVID-19 Prevention Strategies in the Context of Varying Community Transmission Levels and Vaccination Coverage
• Interim Public Health Recommendations for Fully Vaccinated People

COVID Data Tracker

United States Department of Agriculture (USDA) Deputy Under Secretary for Rural Development Justin Maxson announced that the Department is extending the COVID-19 Special Relief Measure for USDA’s Single-Family Housing Guaranteed Loan borrowers.

The USDA COVID-19 Special Relief Measure provides new alternatives for borrowers to help them achieve up to a 20 percent reduction in their monthly principal and interest payments. New options include an interest rate reduction, term extension and a mortgage recovery advance, which can help cover past due mortgage payments and related costs.

Borrowers will first be assessed for an interest rate reduction, and if additional relief is still needed, the borrowers will be considered for a combination rate reduction and term extension. In cases where a combination of rate reduction and term extension is not enough to achieve a 20 percent payment reduction, a third option combining the rate reduction and term extension with a mortgage recovery advance may be used to reach the target payment.

In addition, the Department of Treasury’s Homeowner Assistance Fund (HAF), a critical component of President Biden’s American Rescue Plan, provides $9.961 billion to states, Washington, D.C., territories and Tribes for relief to homeowners impacted by the COVID-19 economic crisis. These funds can be used for assistance with mortgage payments, homeowner’s insurance, utility payments and other specified purposes. Homeowners can access these funds in addition to the payment reduction options discussed above.

For more information, see the White House Fact Sheet: Biden Administration Announces Additional Actions to Prevent Foreclosures.

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

The American Hospital Association, American Medical Association, and American Nurses Association on Tuesday released a public service announcement in English and another one with Spanish subtitles in which leaders of each of the groups tell audiences to “ask questions, follow the science and get vaccinated.”

Read more.

As the nation’s COVID-19 vaccination campaign enters a new, more challenging phase, primary care providers will be key to reaching many of the millions of Americans who have not yet gotten their shots. In a new feature, the Commonwealth Fund offer lessons gleaned from interviews with primary care providers on how to integrate COVID-19 vaccination into their day-to-day work. Practices have faced many challenges, but many have also devised creative ways to assess and meet vaccine demand and respond to patients’ questions and concerns. A recent poll found that 53 percent of unvaccinated people prefer to be vaccinated in their personal doctor’s office. Learn how we can make that an easier option for more Americans.

Learn more.