Updates to Coverage for COVID-19 Tests

May 3, 2023

Update to Coverage for COVID-19 Tests

The COVID-19 Public Health Emergency is to end on May 11, 2023. The ending of the Public Health Emergency may impact an individual’s coverage of COVID-19 tests. The Centers for Medicare and Medicaid Services (CMS) has provided a New Consumer Fact Sheet in both English and Spanish.

Consumer Fact Sheets:

English

Spanish

What to tell consumers:

Before May 11, 2023

If you have any type of health insurance, you can get up to eight over-the-counter tests per month with no out-of-pocket costs. Over-the-counter tests are available in most pharmacies and may also be available online for delivery.

After May 11, 2023

Laboratory tests for COVID-19 that are ordered by your provider will still be covered with no out-of-pocket costs for people with Medicare. Over-the-counter tests will still be available, but there may be out-of-pocket costs. Coverage of over-the-counter tests may vary by your insurance type, as described below.

What does this mean for Medicare Beneficiaries?

Generally, Medicare doesn’t cover or pay for over-the-counter products. The demonstration that has allowed us to offer coverage for COVID-19 tests at no cost ends on May 11, 2023.

However, if you are enrolled in Medicare Part B, you will continue to have coverage with no out-of-pocket costs for appropriate laboratory-based COVID-19 PCR and antigen tests, when a provider orders them (such as drive-through PCR and antigen testing or testing in a provider’s office).

If you are enrolled in a Medicare Advantage plan, you may have more access to tests depending on your benefits. Check with your plan.

What does this mean for people with Medicaid or Children’s Health Insurance Program?

If you have coverage through Medicaid or the Children’s Health Insurance Program, you will have access to COVID-19 over-the-counter and laboratory-based COVID-19 tests after May 11, 2023.

If your insurance chooses to cover COVID-19 testing, they may require cost sharing, prior authorization, or other forms of medical management.

Public Health Emergency Ends May 11th – Implications for Rural Health Clinics

April 28, 2023

Public Health Emergency Ends May 11th – Implications for Rural Health Clinics

The COVID-19 Public Health Emergency (PHE) initially declared on January 27, 2020, will conclude on May 11, 2023. Please note: this is a separate emergency declaration from the COVID-19 National Emergency declared by the President that can be ended via a joint resolution from Congress. For a full explanation of these provisions please review the recent NARHC webinar.

RHC Specific Waivers

The conclusion of the PHE will end the below waivers:

Certain Staffing Requirements. 42 CFR 491.8(a)(6)

  • During the PHE, CMS waived the requirement that a NP, PA, or CNM be available to furnish patient care services at least 50% of the time the RHC is operating.

Temporary Expansion Locations. 42 CFR §491.5(a)(3)(iii)

  • During the PHE, CMS waived the requirement that RHCs be separately considered for Medicare survey and certification if services were expanded into more than one permanent location, including areas that would not typically meet RHC location requirements. Upon termination of the PHE, these expanded locations will be subject to location requirements and separate survey and certification.

Bed Count for Provider-Based RHCs

  • During the PHE, CMS permitted provider-based RHCs subject to their clinic-specific, grandfathered upper payment limit to increase their hospital bed count to 50+ without losing their grandfathered status. At the conclusion of the PHE, grandfathered RHCs must lower their bed count or lose their grandfathered payment status.

Nursing Home Visits

  • During the PHE, CMS removed the requirement that RHCs in an area without a current home health area shortage needed a written request and justification in order to provide home nursing services.

Virtual Communication Services

  • During the PHE, CMS allowed for online digital evaluation and management services (99421, 99422, and 99423) to be reimbursed under G0071. After the PHE, G0071 should only be used for G2012 and G2010. This was one of the first telecommunications flexibilities granted to RHCs during COVID, but the passing of the CARES Act allowed many more services to be done via telehealth during the PHE and beyond.

Read More

RHC COVID-19 Program Reminders and Updates

April 28, 2023

RHC COVID-19 Program Reminders and Updates

The Rural Health Clinic (RHC) COVID-19 Testing & Mitigation (RHCCTM) program final reporting requirements are open for RHCs or their parent TIN organizations to complete on RHCcovidreporting.com. As a reminder, this program allocated $100,000 per eligible RHC in 2021 for COVID-19 testing-related and mitigation-related expenses and could be spent between January 1, 2021 and December 31, 2022.

The RHCCTM program closeout reporting requires RHCs to attest whether they fully spent, partially spent, or did not spend the funding. It is a simple one question attestation that does not require any submission of cost documentation.

Click Here for More Information

Health Quality Innovation Network Webinar: COVID-19 Plan of Care and General Care Planning April 11

March 29, 2023

COVID-19 Plan of Care and General Care Planning April 11, 2023 at 1:00 PM Central

Register for the April 11 Simple Strategies Stand-Up webinar covering “COVID-19 Plan of Care and General Care Planning. 

These interactive sessions feature a 20-minute briefing on the featured topic before launching into an open forum for presenters and attendees to share what is working, along with questions and comments.

Register here

Missouri Immunization Coalition Survey

March 3, 2023

Missouri Immunization Coalition Survey

The Missouri Immunization Coalition (MIC) is a 501(c)(3) nonprofit existing to reduce the spread of vaccine-preventable diseases through education, advocacy, promotion, and collaborative partnerships. We also coordinate with partners across the state that share our vision of better health and well-being for all, including our public health and healthcare workforce.

This is the fourth survey MIC has created to learn about the experiences and needs of our partners. Focusing on staffing challenges during the COVID-19 pandemic, the goal of this survey is learning how MIC can advocate for solutions on local, state, and federal levels with policy and funding decision-makers.

The purpose of this 5–7-minute survey is to understand how providing care for COVID-19 patients, coordinating access to COVID-19 vaccines, and promoting education about COVID-19 disease transmission and prevention has exacerbated pre-pandemic staffing shortages and how agencies are addressing the shortages.

Complete Survey Here

Please respond by Wednesday, March 15, 2023.  

 

Resources Available as Public Health Emergency Declaration Ends

March 3, 2023

 

Resources Available as Public Health Emergency Declaration Ends

The Biden Administration announced the COVID-19 Public Health Emergency (PHE) Declaration is anticipated to end on May 11, 2023. This will significantly impact CMS Certified Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Please see this linked CMS publication to learn moreClick here to learn more about how the end of the PHE Declaration will affect other provider types.

The National Association of Rural Health Clinics (NARHC) is the nation’s top resource for all things related to RHCs. NOSORH recommends reviewing their article The Approaching End of the COVID-19 Public Health Emergency and Its Implications for RHCs and keeping an eye on the Resources tab for any upcoming TA webinars.

Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers

February 24, 2023

Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers

On February 9, the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 will end on May, 11, 2023. COVID-19 remains a significant priority for the Biden-Harris Administration and over the next several months, the Centers for Medicare & Medicaid Services (CMS) will work to ensure a smooth transition.  During the PHE, CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care during the PHE for health care providers and their beneficiaries.

Some of the flexibilities that were created during the pandemic were recently expanded by the Consolidated Appropriations Act, 2023.  Others, while critical during our initial responses to COVID-19, are no longer needed. CMS has made further updates to our CMS Emergencies Page with useful information for providers – specifically around major telehealth and individual waivers – that were initiated during the Public Health Emergency (PHE).

Please reference the following guidance in response to the PHE ending May 11, 2023:

Provider-specific fact sheets about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers

CMS COVID-19 Waivers and Flexibilities for Providers include:

  • Physicians and Other Clinicians
  • Hospitals and CAHs (including Swing Beds, DPUs), ASCs and CMHCs
  • Teaching Hospitals, Teaching Physicians and Medical Residents
  • Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)
  • Home Health Agencies
  • Hospice
  • Inpatient Rehabilitation Facilities
  • Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals
  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
  • Laboratories
  • Medicare Shared Savings Program
  • Durable Medical Equipment, Prosthetics, Orthotics and Supplies
  • Medicare Advantage and Part D Plans
  • Ambulances
  • End Stage Renal Disease (ESRD) Facilities
  • Participants in the Medicare Diabetes Prevention Program
  • Intermediate Care Facility for Individuals with Intellectual Disabilities

Department of Health & Human Services Fact Sheet

New Policy Brief: CAH Workforce During COVID-19: Barriers and Facilitators for Recruiting and Retaining Staff

February 14, 2023

New Policy Brief: CAH Workforce During COVID-19: Barriers and Facilitators for Recruiting and Retaining Staff

A new policy brief is available on the Flex Monitoring Team website: Critical Access Hospital Workforce During COVID-19: Barriers and Facilitators for Recruiting and Retaining Staff. A survey of Critical Access Hospital CEOs revealed difficulty recruiting and retaining a variety of staff positions, but primarily nurses and respiratory therapists. Barriers and facilitators to these challenges are discussed, as described by survey participants.

View Policy Brief

COVID-19 Single-Dose Vial (SDV) Vaccines Available for Rural Health Clinics

February 1, 2023

COVID-19 Single-Dose Vial (SDV) Vaccines Available for Rural Health Clinics

In November 2022, the Pfizer-BioNTech COVID-19 bivalent vaccine for people 12 years of age and older became available to order through the Rural Health Clinic COVID-19

Vaccine Distribution Program (RHCVD) program as a single dose vial (SDV).

While the vaccine is still available in multi-dose vials, the single-dose option responds to widespread requests to allow greater flexibility for RHCs that may not have the demand or capacity to store multi-dose vials.

RHCs enrolled in the RHCVD Program can order SDV through the Health Partner Order Portal (HPOP).

If an RHC is not enrolled in the RHCVD Program and wants more information, they can email  RHCVaxDistribution@hrsa.gov.

HHS Announces New $350 Million Initiative to Increase COVID-19 Vaccinations

November 30, 2022

COVID-19 Vaccine Update

HHS Announces New $350 Million Initiative to Increase COVID-19 Vaccinations: The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced a new $350 million initiative for HRSA-supported health centers to increase COVID-19 vaccines in their communities, with a specific focus on underserved populations. This funding supports health centers administering updated COVID-19 vaccines through mobile, drive-up, walk-up, or community-based vaccination events, including working with community-based organizations, and other efforts to increase the administration of COVID-19 vaccines.