Tracking the Public Health Emergency - When Will it Ever End?

The Biden-Harris administration has indicated that it will not issue a 60-day notice to end the COVID-19 public health emergency (PHE) on January 11, 2023, meaning that we can now expect the PHE to be extended for another 90 days through April 11, 2023.

Energy and Commerce Republican Leader Cathy McMorris Rodgers (R-WA) and Health Subcommittee Republican Leader Brett Guthrie (R-KY) have repeatedly called on the Biden Administration to provide a detailed plan to unwind the COVID-19 emergency. Additionally, The National Association of Medicaid Directors (NAMD) sent a letter to Senate Majority Leader Chuck Schumer (D-NY), Senate Minority Leader Mitch McConnell (R-KY), Speaker Nancy Pelosi (D-CA), and House Minority Leader Kevin McCarthy (R-CA) urging Congress to provide states with certainty around the end of the Medicaid continuous enrollment requirement. Specifically, NAMD asked lawmakers to:

Provide certainty on when Medicaid coverage redeterminations will begin, with at least 120 days’ advance notice.

Provide certainty that existing federal guidance on the redetermination period will not change.

Provide certainty on available financial resources during the redetermination period, specifically by maintaining the current 6.2 percentage point FMAP enhancement through the first quarter of redeterminations and phasing the enhancement down over 12 months after this quarter.

Provide certainty that underlying Medicaid eligibility will not change during the redetermination period.

The Senate passed a resolution to end the national emergency declaration, which has been renewed annually since former President Trump issued the declaration pursuant to the National Emergencies Act and is different than the COVID-19 PHE.  The resolution was advanced by a bipartisan vote of 62-36.  In response, the White House Office of Management and Budget (OMB) issued a statement affirming that President Biden would veto efforts to end the national emergency. The current national emergency declaration is set to expire on March 1, 2023. Until it’s conclusion, the declaration allows the President to waive various federal regulatory requirements and activate a variety of statutory emergency authorities.  ‘

Insurance Companies Pocketing Millions in Overpayments Through Their Medicare Advantage Subsidiaries, Audits Find

McKnight’s Senior Living | By Kathleen Steele Gaivin
 
The Centers for Medicare & Medicaid Services released the results of 90 audits of Medicare Advantage plans. The federal audits discovered $12 million in net overpayments for the care of 18,090 patients sampled, Kaiser Health News reported Monday.
 
CMS released the audits to settle a Freedom of Information lawsuit KHN filed against the agency just over three years ago. The audits looked at billings from 2011 through 2013, which are the most recent reviews completed, according to KHN.
 
Currently 46% of Medicare-eligible older adults are enrolled in MA plans. That number is expected to exceed 50% within the next few years.
 
“It’s incredibly frustrating that it took a lawsuit and years of pushing to make this vital information public,” Thomas Burke, a San Francisco attorney who represented KHN pro bono, said in an article published on KHN’s website last month.
 
Medicare Advantage plans primarily are run by major insurance companies. As the plans have grown in popularity as an alternative to traditional  Medicare coverage, they have fallen under increased scrutiny, as previously reported by McKnight’s. Last spring, the Office of Inspector General accused MA organizations of denying or delaying services that met Medicare coverage and MA billing rules. In August, CMS published a request for information, asking the public to provide input regarding various aspects of MA plans. Several home care organizations, including the National Association for Home Care and Hospice and the Partnership for Quality Home Healthcare, urged CMS to ensure that MA plans provide the same level of care as fee-for-service plans and release patients from hospitals to home healthcare in a timely fashion.
 
According to KHN, federal regulators have said they intend to extrapolate the payment error rates from those samples across the total membership of each plan — and recoup an estimated $650 million as a result. The audits go back more than a decade, yet there has been no attempt to recover the losses. CMS was set to unveil a final extrapolation rule Nov. 1, but that didn’t happen. The agency has now pushed that action off until February. 

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New Boosters Add Limited Protection Against Covid-19 Illness, First Real-World Study Shows

By Brenda Goodman, CNN

Updated Covid-19 boosters that carry instructions to arm the body against currently circulating Omicron subvariants offer some protection against infections, according to the first study to look at how the boosters are performing in the real world. However, the protection is not as high as that provided by the original vaccine against earlier coronavirus variants, the researchers say.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, called the new data “really quite good.”

“Please, for your own safety, for that of your family, get your updated Covid-19 shot as soon as you’re eligible to protect yourself, your family and your community,” Fauci said at a White House briefing Tuesday.

Uptake of the bivalent boosters, which protect against the BA.4/5 subvariants as well as the original virus strain, has been remarkably slow. Only 11% of eligible Americans have gotten them since they became available in early September.

The new study found that the updated boosters work about like the original boosters. They protect against symptomatic infection in the range of 40% to 60%, meaning that even when vaccine protection is its most potent, about a month after getting the shot, people may still be vulnerable to breakthrough infections.

That’s in about the same range as typical efficacy for flu vaccines. Over the past 10 years, CDC data shows, the effectiveness of the seasonal flu vaccines has ranged from a low of 19% to a high of around 52% against needing to see a doctor because of the flu. The effectiveness varies depending on how similar the strains in the vaccine are to the strains that end up making people sick.

The authors of the new study say people should realize that the Covid-19 vaccines are no longer more than 90% protective against symptomatic infections, as they were when they were first introduced in 2020.

“Unfortunately, the 90% to 100% protection was what we saw during like pre-Delta time. And so with Delta, we saw it drop into the 70% range, and then for Omicron, we saw it drop even lower, to the 50% range. And so I think what we’re seeing here is that the bivalent vaccine really brings you back to that sort of effectiveness that we would have seen immediately after past boosters, which is great. That’s where we want it to get,” said Dr. Ruth Link-Gelles, an epidemiologist at the US Centers for Disease Control and Prevention.

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CMS Updates Medicare Enrollment Instructions

The Health Group

Effective December 5, 2022, certain modifications have been made to Chapter 10 of the Medicare Program Integrity Manual dealing primarily with “Ownership Disclosures”, “Electronic Funds Transfers”, and “Special Payment Addresses”. MM12880 - Provider Enrollment Instructions: Seventh General Update (cms.gov).

Ownership Disclosures:

The provider or supplier must disclose ALL persons and entities that meet the definition of “owner”.

Providers must show the applicable ownership percentage for each owner if required by the specific provider enrollment application being completed.

There cannot be indirect owners without direct owners.

The combined disclosed ownership percentages for the provider or supplier’s organizational and individual owners cannot be greater than 100%.