On October 14, CMS expanded the list of telehealth services that Medicare Fee-for-Service will pay for during the COVID-19 Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care.

“Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. “Medicaid patients should not be forgotten, and today’s announcement promotes telehealth for them as well. This revolutionary method of improving access to care is transforming health care delivery in America. President Trump will not let the genie go back into the bottle.”

Expanding Medicare Telehealth Services:

For the first time using a new expedited process, CMS added 11 new services to the Medicare telehealth services list since the publication of the May 1 COVID-19 Interim Final Rule with comment period (IFC). Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately and for the duration of the PHE. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available on the List of Telehealth Services webpage.

In the May 1 COVID-19 IFC, CMS modified the process for adding or deleting services from the Medicare telehealth services list to allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare telehealth services list builds on the efforts CMS has already taken to increase Medicare beneficiaries’ access to telehealth services during the COVID-19 PHE.

Since the beginning of the PHE, CMS added over 135 services to the Medicare telehealth services list – such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services. With this action, Medicare will pay for 144 services performed via telehealth. Between mid-March and mid-August, over 12.1 million Medicare beneficiaries – over 36% – of people with Medicare Fee-for-Service received a telemedicine service.

Preliminary Medicaid and CHIP Data Snapshot on Telehealth Utilization and Medicaid & CHIP Telehealth Toolkit Supplement:

In an effort to provide greater transparency on telehealth access in Medicaid and CHIP, CMS released, for the first time, a preliminary Medicaid and CHIP data snapshot on telehealth utilization during the PHE. This snapshot shows, among other things, that there have been more than 34.5 million services delivered via telehealth to Medicaid and CHIP beneficiaries between March and June of this year, representing an increase of more than 2,600% when compared to the same period from the prior year. The data also shows that adults ages 19-64 received the most services delivered via telehealth, although there was substantial variance across both age groups and states.

To further drive telehealth, CMS released a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned from states that implemented telehealth changes. The updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires.

The toolkit includes approaches and tools states can use to communicate with providers on utilizing telehealth for patient care. It updates and consolidates in one place the FAQs and resources for states to consider as they begin planning beyond the temporary flexibilities provided in response to the pandemic.

View the Medicaid and CHIP data snapshot on telehealth utilization during the PHE.

Some of the country’s least populous states are facing major COVID-19 surges in what North Dakota Gov. Doug Burgum called “a regional COVID storm,” according to The New York Times. North Dakota, South Dakota and Montana are among the states with the highest number of cases per capita, while other rural states like Wyoming, Idaho and Nebraska have recently seen their highest seven-day case average of the pandemic.

In this 47-minute video, experts discuss telehealth policy changes made by the Centers for Medicare and Medicaid Services (CMS).   These address common issues related to provider type and location, billing and reimbursement, and guidance specific to Federally Qualified Health Centers and Rural Health Clinics.  The video is sponsored by the FORHP-supported Center for Connected Health Policy, a nonprofit working to improve health outcomes through telehealth.

The Centers for Medicare & Medicaid Services (CMS) updated the repayment terms for providers and suppliers who received accelerated and advance Medicare payment(s) during the COVID-19 emergency to reflect that repayment does not begin for one year after payment was issued.  Providers experiencing financial hardship should contact their Medicare Administrative Contractor to request an Extended Repayment Schedule.

This factsheet reports COVID-19 cases, hospitalizations, and services used by Medicare beneficiaries between January 1 and August 15.  In rural areas, there were 959 cases per 100,000 Medicare beneficiaries during this time and 252 hospitalizations per 100,000 beneficiaries.

By Tim Murphy and Tim Marema
Six out of every 10 rural counties are on the red-zone list. In the Upper Midwest, all but a handful of rural counties are seeing rapid spread of the virus.
Read more

Now more than ever, everyone needs to do their part to prevent the spread of illnesses like the flu. Because of the COVID-19 pandemic, fewer people are getting vaccines which puts their communities at greater risk for other preventable diseases.  When people get the flu shot, it helps protect them and keep them from spreading the flu to others.

Medicare and most health plans cover the cost of the flu shot, which is available at most health care provider offices, local pharmacies, senior centers, health centers, and other places in the community.

This year, we’re developing many new flu vaccination resources for people with Medicare, partners, providers, and others who can share our message.  Please use our resources to encourage your patients and partners to get their flu shot so they and their communities can stay healthy.

Racial and ethnic minority groups are disproportionately affected when it comes to receiving recommended vaccines. Many factors can contribute to lower vaccination rates, including concerns about vaccine safety and limited access to care and health coverage. The CMS Office of Minority Health created a website of Federal resources to help our partners find resources for minority populations and in additional languages.

Visit go.cms.gov/omhflu.

CMS.gov Partner and Provider Resources

• Visit cms.gov/flu for a one-stop shop to help you find CMS’s flu vaccination information and resources.
• Find vaccination resources for racial and ethnic minority patients, as well as resources for providers and partners that serve these populations at cms.gov/omhflu.
• Looking for additional languages? Find Medicare postcards in 18 languages.
• Visit our Outreach & Media Materials page for flu vaccination materials you can share within your partner networks and use to reach people with Medicare, plus other audiences across our health care programs. We will continue to update this page with additional resources.
• Use this social media toolkit with posts and graphics to spread the word about the importance of getting a flu shot this year (in English & Spanish).
• For partners, we launched a Flu Vaccine Partner Toolkit with flu and other immunization resources.
• For health care providers, we launched a new website, cms.gov/flu-provider, with flu coverage and billing information.

Medicare.gov Consumer Resources

• Medicare Blog
• Flu Shot Coverage
• Preventive & Screening Services

Your Medicare Coverage

Pennsylvania Governor Tom Wolf announced today the Pennsylvania Housing Finance Agency is improving the COVID Relief Mortgage and Rental Assistance Grant Program to help more renters and homeowners remain in their homes. Effective Oct. 17, landlords and mortgagees will have a new option to reach agreements with renters and homeowners for repayment of rent and mortgage payments above the program’s $750 monthly cap. The program previously required them to forgive the balance of the payment.

Earlier this week the governor signed an executive order extending the application deadline to Nov. 4.

“We cannot allow thousands of families to become homeless because of the pandemic,” said Gov. Wolf.  “Improving the program and giving people more time to apply will help families to stay in their homes. That will reduce the strain on social services and help landlords to pay their mortgages.

“These are positive steps, but we still need a larger solution. I continue to urge the legislature to fix the program’s other flaws so more struggling families have a place to live.”

The program has been helping fewer renters and homeowners than intended. Under the new guidance, landlords can still forgive the balance of rent and mortgage payment above $750, but creating the option to enter into repayment agreements with tenants and homeowners, and therefore recoup balance of payments, should encourage more participation in the relief program.

The federal Coronavirus Aid, Relief and Economic Security (CARES) Act, passed by Congress in March, provided $3.9 billion for Pennsylvania. As part of Pennsylvanian’s response to the pandemic, the governor signed legislation in May directing $175 million of the CARES funds to PHFA to provide $150 million for rental assistance and $25 million for mortgage assistance.

Governor Tom Wolf has repeatedly urged the General Assembly to remove the barriers so more Pennsylvanians can qualify.

The governor’s proposal would:

• Raise the $750 monthly cap on rent relief to at least 130% of HUD limits – In some parts of the state rent payments exceed $750 a month, therefore landlords decline to participate, leaving tenants without payment assistance.
• Eliminate the requirement that households be 30 days behind on rent to be eligible for assistance – The requirement creates an unfair burden on applicants who prioritize rent and mortgage payments over paying for food, medicine or other bills.
• Eliminate verification that applicants applied for unemployment compensation – The added administrative step creates unnecessary processing delays of applications and availability of assistance.

“Program changes are still needed to keep people in their homes, but in the meantime, these changes will let more people get rental assistance and avoid eviction,” said Gov. Wolf. “I continue to urge the General Assembly to make changes to allow more affected residents to qualify because, now more than ever, all Pennsylvanians need and deserve an affordable and safe place to live.”

The Centers for Disease Control and Prevention halted some rental evictions nationwide until Dec. 31; however, some tenants and all homeowners are still at risk.

Pennsylvania First Lady Frances Wolf is proud to recognize the U.S. Department of Agriculture (USDA)’s announcement that allows schools to provide free meals to all students for the rest of the school year. These flexibilities, for which First Lady Wolf recently advocated alongside 17 other first partners and spouses, ensure that schools can continue to provide the meals despite the uncertainty and hardship caused by the pandemic.

“I am so glad that the USDA has taken this important step in guaranteeing that no child has to wonder where they might find their next meal,” said First Lady Wolf. “This forward-thinking provides much-needed certainty to families, school nutrition professionals, agricultural entities and community partners working to ensure that all children have access to nutritious meals as we continue to navigate a global health crisis and its subsequent economic effects. This is one piece of the puzzle for ensuring food security, and we look forward to continuing to work with USDA on the implementation of this and related efforts.”

These flexibilities, which have been extended through June 30, 2021, allow school feeding programs to avoid unnecessary barriers as they navigate health and safety concerns, staff limitations, technical restrictions, time constraints and more. From March through August of this year, Pennsylvania schools provided more than 25 million meals to children in need.

“With the USDA’s extension of the school feeding program waivers, students are promised access to nutritious food for the rest of the school year,” said Pennsylvania Agriculture Secretary Russell Redding. “Throughout the COVID-19 mitigation response, these waivers have worked well for schools navigating many changes. Whether students are learning from home, at the school or a mix of both, these flexibilities will keep kids fed. Hungry kids can’t learn. Because of programs like this, no Pennsylvania student should go hungry.”

According to recent projections from Feeding America, more than 54 million people, including 18 million children, may experience food insecurity this year, marking a 45 percent increase in general food security rates and a 65 percent increase in child food insecurity rates compared to pre-COVID-19 statistics.

In Pennsylvania, 2.04 million Pennsylvanians, including nearly 630,000 children, face food insecurity. This marks an increase of 45.2 percent to the general food security rate and a 57.6 percent increase to the child food insecurity rate when compared to 2018 statistics.

In letters sent to USDA Secretary Sonny Perdue and Congressional leadership on September 18, 2020, First Lady Wolf and the first spouses and partners of California, Colorado, Delaware, Hawaii, Illinois, Kansas, Kentucky, Massachusetts, Minnesota, Montana, New Jersey, North Carolina, Rhode Island, Virginia, Washington, Wisconsin and Wyoming encouraged both parties to work together to extend and fully fund the necessary school feeding program waivers throughout the remainder of the 2020-21 academic year.

Yesterday’s action by the USDA comes at the heels of the passage of continuing resolution HR 8337 by the United States House and Senate and its signing by President Trump on October 1, 2020. HR 8337, in addition to maintaining federal government funding through December 11, 2020, further extends the USDA’s necessary nutrition authority and funding through September 20, 2021, for child nutrition programs, Pandemic EBT, Summer EBT for Children, Special Supplemental Program for Women, Infants, and Children (WIC), Supplemental Nutrition Assistance Program (SNAP), Commodity Supplemental Food Program (CSFP) and more. Further USDA action is needed to implement the extensions of these other programs. 

Half of all states are reporting increases in new COVID-19 cases, and several are setting new records for new daily cases reported, including rural states such as Montana and South Dakota. Unfortunately, many of these increases are being driven by small towns in rural America, where there is limited access to health care resources. According to an NPR analysis, one fifth of the first 100,000 COVID-19 deaths were outside of large metro areas, whereas rural deaths accounted for nearly half of the second 100,000 COVID-19 deaths. On a per-capita basis, the most rural counties are facing their worst spikes of the pandemic to date; based on a rolling seven-day average, there are around 19.5 daily cases per 100,000 residents in America’s most rural counties. From Bloomberg Government (subscription required):

Rural providers are on the frontline of the pandemic facing new spikes in COVID-19 cases, and they need relief and support. NRHA understands that negotiations on further COVID-19 relief have halted abruptly, but it is important that Congress recognize that rural America’s fight against COVID-19 is currently at its height. Record high numbers of new COVID-19 cases and deaths in rural America coupled with a lack of facilities and supplies is a recipe for disaster. Rural America needs Congress’s help today, and NRHA is continuing to ask Congress to act on behalf of rural America to help patients and providers survive the pandemic.