CMS Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers

Yesterday, CMS released the interim final regulations requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. These requirements will apply to approximately 76,000 providers and cover over 17 million health care workers across the country.

Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 5, 2021All eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson – by January 4, 2022.  

At this time, CMS is not allowing for daily or weekly testing of unvaccinated individuals as an alternative to vaccination.  The regulation provides for exemptions based on recognized disability, medical conditions or religious beliefs, observances, or practices.  With regard to recognized clinical contraindications to receiving a COVID-19 vaccine, facilities should refer to the CDC informational document, Summary Document for Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, accessed at www.cdc.gov/vaccines/covid-19/downloads/….  CMS directs providers and suppliers to the Equal Employment Opportunity Commission (EEOC) Compliance Manual on Religious Discrimination160 for information on evaluating and responding to requests related to religious beliefs, observances, or practices. While employers have the flexibility to establish their own processes and procedures, including forms, CMS points to The Safer Federal Workforce Task Force’s “request for a religious exception to the COVID-19 vaccination requirement” template as an example.

Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law. CMS will ensure compliance with these requirements through established survey and enforcement processes.  If a provider or supplier does not meet the requirements, it will be cited by a surveyor as being non-compliant and have an opportunity to return to compliance before additional actions occur.

The requirements apply to: Ambulatory Surgical Centers, Hospices, Programs of All-Inclusive Care for the Elderly, Hospitals, Long Term Care facilities, Psychiatric Residential Treatment Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Home Health Agencies, Comprehensive Outpatient Rehabilitation Facilities, Critical Access Hospitals, Clinics (rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), Community Mental Health Centers, Home Infusion Therapy suppliers, Rural Health Clinics/Federally Qualified Health Centers, and End-Stage Renal Disease Facilities.

NRHA will be reviewing the regulation and submitting comments on behalf of our members expressing concern about the workforce and access implications in rural areas.  Comments on the interim final regulation must be provided within 60 days of November 5th, 2021 to be considered. 

To view the interim final rule with comment period, visit: public-inspection.federalregister.gov/…

To view a list of frequently asked questions, visit: www.cms.gov/files/document/cms-omnibus-staff-vax-requirements-2021.docx

NRHA will be sharing a more detailed summary of the regulation shortly.  In meantime, feel free to contact our government affairs team at ccochran@ruralhealth.us. Thank you.

FY 2022 Appropriations Requests & Allocations

Hello NRHA members,

This week, the Senate Appropriations Committee (SAC) released the text of their nine remaining appropriations bills, including the Labor, Health and Human Services, Education, and Related Agencies (L-HHS) bill. Below is an update on NRHA’s fiscal year (FY) 2022 appropriations requests.

Both the House Appropriations Committee (HAC) and SAC recommended increasing funding for the U.S. Department of Health and Human Services (HHS) rural health programs, which are administered by the Federal Office of Rural Health Policy (FORHP). The HAC recommended increasing funding to $70.7 million above the FY 2021 enacted level, and the SAC recommended increasing funding to $73.2 million above the FY 2021 enacted level. NRHA is extremely pleased that both Congressional appropriations committees are seeking to provide more funding for rural health programs. However, we will continue to advocate that both committees match NRHA’s requested allocations for individual programs.

The HAC and SAC matched NRHA’s requested funding allocations for the Rural Maternal and Obstetric Management Strategies (RMOMS) program ($10 million) and Rural Residency Planning and Development (RRPD) program ($12.7 million). Additionally, the HAC and SAC included report language to encourage HRSA to expand the current program to include RTTs in obstetrics and gynecology and request a report in the fiscal year 2023 Congressional Budget Justification on the progress made to date and efforts to expand RTTs in obstetrics and gynecology. 

The HAC matched NRHA’s requested funding allocations for the Medicare Rural Hospital Flexibility (Flex) program ($61.2 million) and Rural Emergency Hospital (REH) Technical Assistance (TA) program ($10 million) but did not match NRHA’s requested funding allocations for the Rural Provider Modernization Technical Assistance program ($8 million) and Rural Provider Modernization Grants ($13 million). The SAC did not match NRHA’s funding allocation for any of these programs. Neither the HAC or SAC matched NRHA’s requested funding allocations for the United States Department of Agriculture (USDA) Rural Hospital Technical Assistance (TA) program ($5 million. 

Below is a chart of FY 2022 requests and allocations:  

Links:  

President Biden’s FY 2022 budget request

FY 2022 HAC L-HHS bill report

FY 2022 SAC L-HHS explanatory statement

FY 2022 HAC Ag bill report

FY 2022 SAC Ag bill report

$25.5 billion in Provider Relief Fund & American Rescue Plan rural funding is now available

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced a new application cycle for $25.5 billion in COVID-19 provider funding. Applicants will be able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). 

What Is the Provider Relief Fund?
Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus. These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions.

What Is ARP Rural?
ARP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers; funding will be available to providers who serve patients in these communities. Eligible applicants can apply for the ARP Rural funds through the same Application and Attestation Portal that is available to apply for the Phase 4 General Distribution. Providers will apply for both programs in a single application.

In order to be considered for an ARP Rural payment, applicants must include any billing Tax Identification (TIN) owned by the applicant. ARP Rural payments will be determined based on the amount and type of Medicare, Medicaid, and CHIP services provided by billing TINs to rural beneficiaries. Applicants do not need to verify whether their beneficiaries live in an area that meets the definition of rural. HRSA will base payments on data already available to it using the Federal Office of Rural Health Policy definition of rural.

Please remember you have to APPLY for this funding. It will not be automatically allocated as with past phase funding.  In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.

The application is open now and will close on October 26, 2021 at 11:59 p.m. ET. 

Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application. 

Real time technical assistance is available by calling the Provider Support Line at (866) 569-3522, for TTY dial 711. Hours of operation are 8 a.m. to 10 p.m. CT, Monday through Friday.

Please go to the following HRSA web site to find out more information and access resources for your application: 
https://www.hrsa.gov/provider-relief/future-payments

Update on Recent Funding from HRSA

Dear Regional Partners, 

I am pleased to share with you that today, a new application cycle for $25.5 billion in COVID-19 provider funding has opened.  Applicants are able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve ruralbeneficiaries covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

See a detailed list of eligible provider types and application instructions here.

Applications must be received by October 26, 2021 at 11:59 p.m. ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application. In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.Yesterday, the U.S. Department of Health and Human Services (HHS) awarded nearly $1 billion in American Rescue Plan funding to nearly 1,300 Health Resources and Services Administration (HRSA) Health Center Program-funded health centers in all 50 states, the District of Columbia, and the U.S. territories to support major health care construction and renovation projects. These awards will strengthen our primary health care infrastructure and advance health equity and health outcomes in medically underserved communities, including through projects that support COVID-19 testing, treatment, and vaccination.  Health centers will use this funding for COVID-19-related capital needs, constructing new facilities, renovating and expanding existing facilities to enhance response to pandemics, and purchasing new state-of-the-art equipment, including telehealth technology, mobile medical vans, and freezers to store vaccines.    FY 2021 American Rescue Plan Funding for Health Center Construction and Capital Improvements award recipients in Region 6 can be found here. Recent awards of over $5 Million to Expand Services at HRSA’s Health Center Program School-Based Service Sites can be found here
Recent awards of over $48 Million to Health Centers for Ending the HIV Epidemic in the U.S. Initiative can be found here

Finally, on September 17, 2021 HRSA announced nearly $350 million in awards to every state across the nation to support safe pregnancies and healthy babies. Funding will expand home visiting services to families most in need, increase access to doulas, address health disparities in infant deaths, and improve data reporting on maternal mortality. 

FY2021 awards to strengthen maternal and child health in Region 6 can be found here: 

Our team at the HRSA Office of Intergovernmental and External Affairs (IEA) remain committed to supporting your COVID-19 response efforts.  Please do not hesitate to reach out to us with questions, concerns, or requests for support and engagement.

Best,
Jeri D. Pickett
HRSA Regional Administrator, Region 6

Change to Provider Relief Funds FAQs

NRHA wanted to notify you of a change to the Provider Relief Fund on justifying what is allowable under expenses.  Page 21 of the attached FAQ from 9.13.21 has eliminated the term “marginal” in the last sentence (see below).  Providers must still relate and document the expenses claimed (net of other reimbursements) to COVID as noted in this and other FAQs.  This clarification in policy also appears to be consistent with the feedback members are receiving when talking with the HRSA PRF hotline.  

How do I determine if expenses should be considered “expenses attributable to coronavirus not reimbursed by other sources?” (Modified 9/13/2021) 
Expenses attributable to coronavirus may include items such as supplies, equipment, information technology, facilities, personnel, and other health care-related costs/expenses for the period of availability. The classification of items into categories should align with how Provider Relief Fund payment recipients maintain their records. Providers can identify their expenses attributable to coronavirus, and then offset any amounts received through other sources, such as direct patient billing, commercial insurance, Medicare/Medicaid/Children’s Health Insurance Program (CHIP); other funds received from the federal government, including the Federal Emergency Management Agency (FEMA); the Provider Relief Fund COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured (Uninsured Program); the COVID-19 Coverage Assistance Fund (CAF); and the Small Business Administration (SBA) and Department of the Treasury’s Paycheck Protection Program (PPP). Provider Relief Fund payments may be applied to the remaining expenses or costs, after netting the other funds received or obligated to be received which offset those expenses. The Provider Relief Fund permits reimbursement of marginal increased expenses related to coronavirus provided those expenses have not been reimbursed from other sources or that other sources are not obligated to reimburse. 

NRHA recommends you speak with your financial advisors/council on what this change may mean to your PRF expenditures and reporting. 

Update of COVID-19 Therapeutics from HHS/ASPR

We wanted to share an update from the Department of US Health and Human Services around policies related to allocation, distribution, and administration efforts surrounding the current monoclonal antibody therapeutics available to combat the COVID-19 pandemic.  

Beginning Monday, September 13th HHS made a change to their distribution process to coordinate through a state/territory-coordinated system.  The intent of this change is to maintain equitable distribution, both geographically and temporally providing states and territories with consistent, fairly distributed supply over the coming weeks and while the USG works to procure additional supply.  Key to this change is that administration site (i.e. providers) will not be able to order mAbs directly from the distributor and must work with their state/territory to access the supply.  

Weekly distribution amounts will be determined based on weekly reports of new COVID 19 cases and hospitalizations in addition to data on inventories.  Weekly distribution determinations posted on phe.gov/mabs

HHS Announced 60 Day Grace Period for PRF Reporting

In addition to making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic, in light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS (Department of Health & Human Services) announced Friday a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period.  While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.

New Provider Relief Funds available – $25.5 billion

The Biden-Harris Administration announced today that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic.  This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.  View the press release for the PRF Phase 4 here.  For more information on eligibility requirements and the application process for PRF Phase 4 and ARP Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.

Covid-19 Community Vaccine Program

The Mississippi State Department of Health (MSDH) has launched a Covid-19 Community Vaccine Program, aimed at vaccinating home bound patients. MSDH is currently looking for providers in the following counties to participate in the program: Montgomery, Grenada, Jefferson, Carrol, Leflore, and Wilkinson.

If you are interested in becoming a CCVP provider, please view the following information: Covid-19 Community Vaccination Program (CCVP)

NRHA Events Going Virtual

As an organization serving and consisting of public health leaders, NRHA has a responsibility to abide by and serve as a model for proper health precautions. That is why we have made the difficult decision to shift the association’s Rural Health Clinic and Critical Access Hospital Conferences to a virtual environment.

The fourth wave of the COVID-19 pandemic is hitting harder than anyone expected. While Delta variant forecasts are difficult to project, the situation is unlikely to improve between now and this fall.

For these reasons, we ask for your patience as we transition our RHC and CAH Conferences away from our plans to host in Kansas City. As usual, you can register for these events at reduced virtual rates, and all content will be available Sept. 21-24 and on demand at your convenience for a full year.


View virtual rates here…

At NRHA, the health and well-being of our members and all rural Americans is our top priority. We do not want to risk contributing to the spread of this deadly virus, and we don’t want to place rural health care workers, hospitals, and health systems under any more pressure than they already face. 

We know it is not ideal, but virtual events allow NRHA to present – and you to experience – even more educational content than at an in-person event. NRHA will utilize the same platform as our 2021 Annual Rural Health Conference, by far our most intuitive and seamless virtual environment. 

Though this is certainly not what any of us had planned, we look forward to seeing everyone virtually this fall. Rural America is nothing if not resourceful, and together we will continue to overcome the challenges we face.