In The News

Updated Materials Available – Visiting Nursing Homes During Omicron Surge

The Centers for Medicare & Medicaid Services (CMS) has updated [their] Nursing Home Resource Center with two new informational products.

As of January 6, 2022, the Nursing Home Visitation FAQs have been updated to provide additional guidance about visitation during the Omicron surge. CMS has also created an infographic to graphically represent how to safely conduct visits to nursing homes during this time of spiking COVID cases around the country. These two new resources are available for nursing home providers, patients, caregivers, and CMS partners to stay informed about CMS’ latest thinking for keeping nursing homes safe in the current COVID climate.

 

Supreme Court Blocks Biden's Covid Requirements for Businesses, Upholds Health Care Workers Mandate

By NBC News By Pete Williams

WASHINGTON — The Supreme Court on Thursday blocked the Biden administration's rule requiring larger businesses to ensure that workers receive the Covid vaccine or wear masks and get tested on a weekly basis.

But the court said a separate mandate requiring vaccinations for an estimated 20 million health care workers can be enforced.

The workplace rule, announced last fall by the Occupational Safety and Health Administration, required companies with 100 or more employees to ensure that their workers either get vaccinated or wear masks and show negative Covid test results at least once a week.

The rule would have covered nearly 80 million American workers, and OSHA estimated it would save over 6,500 lives and prevent 250,000 hospitalizations in the next six months.

"Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly," the court's conservative majority said. "Requiring the vaccination of 84 million Americans, selected simply because they work for employers with more than 100 employees, certainly falls in the latter category."

In their dissent, the three liberal justices on the court said OSHA was well within its authority and expertise to impose the mandates, unlike the court, which they said was "lacking any knowledge of how to safeguard workplaces, and insulated from responsibility for any damage it causes."

"In the face of a still-raging pandemic, this court tells the agency charged with protecting worker safety that it may not do so in all the workplaces needed," the liberal justices wrote. "As disease and death continue to mount, this court tells the agency that it cannot respond in the most effective way possible. Without legal basis, the court usurps a decision that rightfully belongs to others. It undercuts the capacity of the responsible federal officials, acting well within the scope of their authority, to protect American workers from grave danger."

In a statement released later Thursday, President Joe Biden celebrated the verdict in the health care worker case as one that would "save lives," but said he was "disappointed" that the broader workplace mandate was struck down.

"I am disappointed that the Supreme Court has chosen to block common-sense life-saving requirements for employees at large businesses that were grounded squarely in both science and the law," he said, calling on individual businesses to institute their own vaccination requirements.

"We have to keep working together if we want to save lives, keep people working, and put this pandemic behind us," he added.

The Biden administration's workplace rule, announced in November, was immediately challenged by a group of businesses and Republican states that said the government lacked the power to issue such a sweeping mandate. Lower courts initially blocked the requirement, but a later ruling allowed it to go into effect.

In lifting the earlier stay, a three-judge panel of the U.S. Court of Appeals for the Sixth Circuit called the OSHA rule "an important step in curtailing the transmission of a deadly virus that has killed over 800,000 people in the United States, brought our health care system to its knees, and cost hundreds of thousands of workers their jobs."

The National Federation for Independent Businesses called the appeals court ruling "a gut punch to America's small businesses who are struggling to stay in business as they come out of the pandemic."

Karen Harned, executive director of the group's small business legal center, called the Supreme Court ruling a "welcome relief" to businesses struggling to keep afloat during the pandemic. She expressed optimism that with the OSHA rule now halted, the lower courts will proceed to find the regulation illegal.

"As small businesses try to recover after almost two years of significant business disruptions, the last thing they need is a mandate that would cause more business challenges," Harned said.

Health Care Workers Mandate

The Supreme Court on Thursday said a separate regulation that requires vaccinations for health care workers who treat Medicare and Medicaid patients could be enforced. Two federal appeals courts had blocked enforcement in 24 states, but the requirement went into effect in the remaining 26.

States opposed to the requirement said the federal law gave the government the authority to impose general health and safety rules for facilities like hospitals, but did not confer the power to require vaccines. The agency that administers Medicare and Medicaid has never before required vaccinations, they said.

Four conservative justices — Clarence Thomas, Neil Gorsuch, Samuel Alito, and Amy Coney Barrett — disagreed with the majority and said they would have struck down the mandate for health care workers. The two justices who opposed the broad worker mandate but supported the health care worker requirement were Brett Kavanaugh and the chief justice, John Roberts.

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HHS Kicks Off New Year with New Protections from Surprise Medical Bills

Dear all,

January 1, 2022, new federal protections championed by the Biden-Harris Administration will shield millions of consumers from surprise medical bills—unexpected bills from an out-of-network provider, out-of-network facility or out-of-network air ambulance provider. The protections, implemented under the No Surprises Act, ban surprise billing in private insurance for most emergency care and many instances of non-emergency care. They also require that uninsured and self-pay patients receive key information, including overviews of anticipated costs and details about their rights.

In addition to shielding millions of consumers from surprise medical bills, these protections will further President Joe Biden’s work to promote competition in health care and other sectors of the American economy.

“The No Surprises Act is the most critical consumer protection law since the Affordable Care Act,” said Health and Human Services (HHS) Secretary Xavier Becerra. “After years of bipartisan effort, we are finally providing hardworking Americans with the federal guardrails needed to shield them from surprise medical bills. We are taking patients out of the middle of the food fight between insurers and providers and ensuring they aren’t met with eye-popping, bankruptcy-inducing medical bills. This is the right thing to do, and it supports President Biden’s vision of creating a more transparent, competitive and fair health care system.”

Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.

Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.

For more information, please see the following:

Lily Griego, Regional Director, U.S. Department of Human Services 

 

CGS:  NOA Processing Issue – Reason Code 32114

Home Health NOAs submitted via EMC are returning to the provider (RTP) with reason code 32114 in error. To prevent any late NOAs, please use the following workaround:

  • Access the NOA in the DDE Claims Correction screen.
  • Enter the nine-digit ZIP code.
  • F9/resubmit the claim.

To avoid this edit, you may choose to submit NOAs via DDE (rather than EMC) until a system fix can be implemented.

If an NOA is late due to this issue, indicate the following in the Remarks field of the final claim: Jan 2022 Issue RE 32114.

 

CDC Backs FDA's Decision to Reduce Time Between Primary Series and Booster Dose of Pfizer's Covid-19 Vaccine

CNN

The US Food and Drug Administration on Monday expanded the emergency use authorization for Pfizer's Covid-19 vaccine boosters to children ages 12 to 15.

The agency also shortened the time needed before receiving a booster shot from at least six months after completion of the initial series to at least five months, for everyone 12 and older.

"Throughout the pandemic, as the virus that causes Covid-19 has continuously evolved, the need for the FDA to quickly adapt has meant using the best available science to make informed decisions with the health and safety of the American public in mind," FDA Acting Commissioner Dr. Janet Woodcock said in a statement. "With the current wave of the omicron variant, it's critical that we continue to take effective, life-saving preventative measures such as primary vaccination and boosters, mask wearing and social distancing in order to effectively fight Covid-19."

The US Centers for Disease Control and Prevention on Tuesday backed the FDA's decision to shorten the interval between an initial series of Pfizer's vaccine and a booster shot, but plans to meet with their vaccine advisory board on Wednesday to discuss the issue of expanding booster eligibility to adolescents.

The FDA updated the emergency use authorization after review of real-world data from Israel that showed there were "no new safety concerns" in expanding boosters to adolescents or shortening the timeframe between the initial series and a booster dose.

Specifically, the data showed there were no new cases of myocarditis or pericarditis reported among adolescents who received a booster, according to a statement from the FDA.

The rapid rise in cases across the country made it clear that the benefits of expanding booster eligibility clearly outweighed the risks, FDA leaders said on a call with reporters Monday...

...The FDA on Monday also authorized a third dose as part of the primary series for certain immunocompromised children ages 5 to 11, including those who have received an organ transplant

The CDC agreed with the FDA on this, consistent with their recommendation for adults who are moderately or severely immunocompromised...

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