CDC Expands Updated COVID-19 Vaccines to Include Children Ages 6 Months through 5 Years

Following FDA action, [December 9, 2022] CDC expanded the use of updated (bivalent) COVID-19 vaccines for children ages 6 months through 5 years. Children ages 6 months through 5 years who previously completed a Moderna primary series are eligible to receive a Moderna bivalent booster 2 months after their final primary series dose. Children ages 6 months through 4 years who are currently completing a Pfizer primary series will receive a Pfizer bivalent vaccine as their third primary dose.

Updated COVID-19 vaccines are formulated to protect against some of the more recently circulating viruses.

Most importantly, COVID-19 vaccines are critical to providing ongoing protection as immunity wanes and the virus continues to mutate.

The vast majority of children in this age group have not received any doses of a COVID-19 vaccine. CDC is working to increase parent and provider confidence in COVID-19 vaccines and improve uptake among the 95% of children who are not vaccinated or who have not completed the COVID-19 vaccine primary series. Parents should talk to their child’s health care provider to ensure their child is up to date on their COVID-19 and other vaccines.

2023 Executive Forecast: ‘Home Health Companies Must Be Operationally Nimble’

Home Health Care News | By Joyce Famakinwa
 
In a sense, home health leaders are entering 2023 with many of the same concerns they came into 2022 with. Additional ones may have been added, but not many have been taken away.

Staffing continues to be a pain point in a competitive labor market, and both COVID-19 and inflation are still factors.

While these concerns remain top of mind for home health executives, the dynamics surrounding managed care contracting and the expiration of public health emergency (PHE) waivers are also grabbing their attention as the year comes to a close.

As part of our annual tradition, Home Health Care News heard from six industry leaders and noted their takes on the biggest thing to watch for next year and what the focus of their organization will be moving forward. Their names and predictions are below, edited for length and clarity.

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In 2023, the home health care industry will continue adapting to change. With the pending expiration of waivers from the public health emergency, new OASIS-E guidelines and increased audits, coupled with the expansion of Medicare Advantage, agency processes will be fluid and evolve as the year progresses. The number of changes will differentiate the 2023 year from others and the impact on already-strained staff will be significant. It will be essential to provide resources and structure to continue to train those staff members who are new to the industry as well as to support veteran clinicians as the demands of care delivery adjust.

Jet Health will continue to execute its mission to deliver the right care in the right setting to our patients, with a commitment to multiple service levels across all the markets we serve. We expect to be innovative by diversifying our clinical network with the addition of clinicians across areas of specialization as well as through the use of remote patient monitoring, telehealth and predictive analytics. These initiatives allow Jet Health to provide the best outcomes for its patients and to challenge clinicians to increase their knowledge and toolkits as both they and the company pursue growth opportunities.

— Stacie Bratcher, CEO of Jet Health

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The industry’s ability to recruit and retain clinical home care talent will continue to be front and center in 2023, as the structural shortages impacting the health care workforce will likely take several years to normalize. In the coming year, the need to address widening health disparities remains extremely urgent. Meeting recruitment and retention challenges in home care, and securing sustainable Medicare, Medicaid and managed care reimbursements, are critical steps to ensuring vital access and advancing health equity in the communities we serve at VNS Health.

At VNS Health, we are focused on creating solutions that simplify the health care experience for the most vulnerable people in our service area. In particular, we’re expanding our care management and palliative care solutions and investing significantly in consumer experience improvements. A top priority for us in 2023 is meeting the wide-ranging needs of people with mental health challenges. By integrating evidence-based interventions into our existing home care programs and creating new, population-based solutions, we’re actively addressing this critical and growing health care need.

— Dan Savitt, president and CEO of VNS Health

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The biggest change we see coming in 2023 are the dynamics surrounding managed care contracting. Given the pressures of inflation, fee-for-service rate reductions/stagnation and our value in reducing the total cost of care, I believe the community will push back strongly on payers to provide stability and value to us as partners who can increase quality for their members and lower total costs of care.

Internally, all hands are on deck to continue to improve the clinician experience. Streamlining documentation burden, after-hours care coordination and robust training and onboarding are all core focus areas for AccentCare as we enter the new year.

— Stephan Rodgers, CEO at AccentCare

Read Full Article 

HHS Releases Policies to Make Coverage More Accessible and Expand Behavioral Health Care Access for Millions of Americans in 2024

The Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality health care options for millions of consumers. The proposed rule would increase access to health care services, simplify choice and improve the plan selection process, and reduce consumer barriers.

“The Biden-Harris Administration has taken historic action to expand access to health care, and the Affordable Care Act Marketplace provides millions of Americans vital coverage,” said HHS Secretary Xavier Becerra. “As we make a final push now during Open Enrollment, we are encouraged that so many people are signing up for Marketplace health plans. Already we are working to build on this success.”

“We know that access to affordable health care is a concern across the nation. During the first several weeks of Affordable Care Act Marketplace Open Enrollment, we have already seen 5.5 million people select a Marketplace health plan, an 18% increase compared to last year” said CMS Administrator Chiquita Brooks-LaSure. “Continuing to propose policies that help make it easier for consumers to choose and maintain the health coverage that best fits their needs is vital. If finalized, this proposed rule does just that.”

Increasing access to health care services

The Biden-Harris Administration has made expanding access to behavioral health care a top priority. As part of that effort, the proposed rule includes two new major essential community provider (ECP) categories that are critical to delivering needed behavioral health care: Substance Use Disorder Treatment Centers and Mental Health Facilities. The rule also furthers access to providers by including a proposal to extend the current overall 35% provider participation threshold to two major ECP categories: Federally Qualified Health Centers and Family Planning Providers. These changes, in conjunction with a proposal to expand Network Adequacy requirements, would increase provider choice, advance health equity, and expand access to care for consumers who have low income, complex or chronic health care conditions, and/or who reside in underserved areas, as these consumers are often disproportionately affected by unanticipated costs associated with provider network status and limited access to providers.

Simplifying choice and improving the plan selection process

In response to public feedback, the rule includes proposals to make it easier for consumers to pick a health plan that best fits their needs and budget by updating designs for standardized plan options and limiting the number of non-standardized plan options offered by qualified health plans (QHPs) through the Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs). The average number of plans available to consumers on the Marketplace has increased from 27.1 in PY2019 to 131.4 in PY2023. Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings. Streamlining the plan selection process would make it easier for consumers to evaluate plan choices available on the Marketplaces and to select a health plan that best fits their unique health needs.

Making it easier to enroll in coverage

The proposed rule would give the Marketplaces the option to implement a special enrollment period for people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage. This option would mean that consumers would have 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select a Marketplace plan. CMS believes that this new proposed special rule would help mitigate coverage gaps when consumers lose Medicaid or CHIP while allowing for a more seamless transition into Marketplace coverage…

Read Full Press Release

For more information on the proposed rule, consult the fact sheet.

To review the Notice of Benefit and Payment Parameters for 2024 Proposed Rule, visit the CMS website. The 45-day public comment period will begin once published in the Federal Register.  

President's Message

Posted: December 13, 2022

First, thank you to VP Chris Chimenti for filling in for me in the last issue of House Calls. I appreciate his kind and thoughtful words as well as those that several other members shared upon the passing of my father.

Have you listened to Dr. Tim Dunn’s nearly hour-long interview with Cindy Krafft on “All Things OASIS” yet? It is amazing! Cindy approaches OASIS-E (and several other topics) with her usual wit and expertise, and we’ll be hearing a lot more from Dr. Dunn, our new OASIS program director, in the coming weeks as his training series rolls out. Watch for this series of online modules in January, along with more podcast interviews with industry leaders!

Finally, let’s all pause for a moment and remember Douglas Brant. Mr. Brant was a home health nurse in the Spokane, WA, area who was murdered on December 1 by a client’s family member during a visit. While the exact circumstances around this tragedy are unclear, the safety of all home health providers should be sacrosanct. Always pay attention to your surroundings, and always leave yourself a way out!