Infrastructure bill to be signed by President today. Next up, “Build Back Better”

Late Friday night, on November 5^th, the House passed the $1.2 trillion infrastructure bill that is a key piece of President Biden's agenda.

Following its passage, President Biden, who is scheduled to sign the bill today, described the legislation as a, "once-in-a-generation investment that's gonna create millions of jobs, modernize our infrastructure, our roads, our brides, our broadband, a whole range of things, to turn the climate crisis into an opportunity.” Thirteen Republicans voted to pass the infrastructure bill, while six Democrats voted against it.

The bill provides $550 billion in new spending on the nation's physical infrastructure, including roads, bridges, ports, water and rail.  It also includes $65 billion for broadband infrastructure deployment and $55 billion for clear water investments. In order to pass the bill, Democrat moderates had to assure progressives that the Party’s larger climate and social initiatives, which are found in the Build Back Better Act (BBB), would be voted on in its current form no later than this week.

If the House passes the BBB, it’s still not clear what its fate would be in the Senate, where moderates have threatened to vote against it unless they first have the opportunity to weigh its anticipated impact on the economy following scoring by the Congressional Budget Act (CBO).

• Bill text of the latest version of the BBB can be found HERE
• Bill text of the hard infrastructure package can be found HERE

Proposed spending targets for the BBB were initially around $3.5 trillion but will likely be closer to $1.75 trillion in order to secure every Senate Democrat vote, which it is anticipated will be required to pass. The legislation would impact almost every sector in the United States and contains multiple policies with direct relevance for home care and hospice.

The following is a synopsis of some of the most consequential policies included in the current version of the House BBB legislation (thank you to the National Association for Home Care & Hospice for their analysis). It should be noted that it is almost a certainty that the Senate will make additional revisions.

Medicaid Home and Community-Based Services (HCBS) found in the “Better Care Better Jobs Act”)

$150 billion to bolster Medicaid HCBS, increasing access to services and supporting direct care workers

• Provide a 6% FMAP increase for HCBS
• Require coverage of personal care services
• Require caregiver supports (e.g., respite care)
• Require payment rates that “support the recruitment and retention of the direct care workforce.”
• Require an update of payment rates at least every 3 years.
• Make spousal impoverishment protections permanent for recipients of Medicaid HCBS.
• Make the Medicaid Money Follows the Person (MFP) demonstration permanent, to  help those in institutional facilities transition back to the community.
• See the legislative language for this provision HERE

Direct Care Worker Training and Support

Billions in grant-based programs for states and territories to improve frontline caregiver access to economic and educational supports. Eligible initiatives may include wage subsidies, student loan repayment or tuition assistance, childcare, and other activities that benefit direct care workers.  Grants would also be created for use in recruiting, retaining, and advancing the direct care workforce; implementing models and strategies to make the field of direct care more attractive; and improving wages, including through training and registered apprenticeships, career pathways, or mentoring.

Hospice and Palliative Care Training Support

$90 million for investments to train, educate, and strengthen the specialty hospice and palliative care provider workforce. $25 million would go to funding for broad-based palliative care and hospice education and training, $20 million to palliative medicine physician training, $20 million to palliative care and hospice academic career awards, $20 million to hospice palliative care nursing, and $5 million to dissemination of palliative care information.

Paid Family and Medical Leave

Beginning in January 2024, all workers would be eligible for up to four weeks of paid leave as new parents, workers dealing with their own serious medical conditions, and workers who need leave to care for a loved one with a serious medical issue. Benefits would be progressive, with lower-income workers receiving higher levels of wage replacement (approximately two-thirds for the average worker).

Increases in OSHA Fine Amounts

The bill also includes provisions that would:

• Expand Medicaid coverage
• Lower prescription drug costs
• Extend ACA marketplace health plan subsidies
• Add hearing coverage to the Medicare program
• Invest tens of billions of dollars in bolstering public health infrastructure and training
• Boost funding by over $1 billion for Older Americans Act (OAA) programs that support older adults and family caregivers
• Provide $40 million in funding for programs to support family caregivers’ mental health and well-being
• Provide $500 million in new grant funding to support medical-legal partnerships (programs that integrate patient-centered legal services into health care settings to address their patient and families’ health-related social needs)

Major health and care-related provisions that were not incorporated into the House bill include:

• A separate tax credit for family caregivers
• New Medicare dental and vision benefits.

Layer Upon Layer of Regulation’: Breaking Down the CMS Vaccination Mandate

Home Health Care News  
By Andrew Donlan | November 8, 2021
 
This article is an exclusive feature available as a part of your subscription to HHCN +
 
Since the Centers for Medicare & Medicaid Services (CMS) released its interim emergency regulation relating to the federal government’s vaccine mandate last Thursday, more clarity has come to the surface.
 
Specifically, CMS has made clear what health care providers are included, what individuals can be exempt and how the mandate will be enforced.
 
What came as somewhat of a surprise was the fact that home- and community-based services (HCBS) providers were not included in the mandate. It instead only applies to providers regulated under the CMS Conditions of Participation (CoPs), which includes home health agencies, and, overall, nearly 76,000 providers and 17 million health care workers.
 
No one knows the exact thought process behind that decision for CMS, Darby Anderson, the chief strategy officer at Addus HomeCare Corporation (Nasdaq: ADUS) and vice chairman of the Partnership for Medicaid Home-Based Care (PMHC), told Home Health Care News.
 
“I assume it was a decision of where to draw the line,” Anderson said. “Using CoPs makes sense, as it is a clear way to define the service and personnel providing it consistently across states which have varied definitions on HCBS personnel types. It is helpful from the perspective of allowing waivers and testing options to keep staff employed.”
 
Because of the enormous complexity that goes into an interim emergency regulation like this one, leaving out HCBS providers allowed CMS to be more concrete with its guidelines.
 
But between the CMS mandate, the Occupational Safety and Health Administration’s (OSHA) coinciding guidelines for private businesses and state mandates, there is a lot for providers to sort through.
 
“It is layer upon layer of regulation and requirements that are not always easy to understand,” Emina Poricanin, managing attorney of Poricanin Law, told HHCN.
 
The CMS mandate doesn’t just apply to patient-facing workers, but full-time telework staff are exempt. It also does not allow for opt-outs, where an individual can instead be tested weekly in lieu of being vaccinated.
 
That could potentially squeeze some workers out of home health care and other health care settings. It could also give providers not included in the emergency regulation an edge, if they are OK with employing unvaccinated workers.
 
Along with HCBS providers, assisted living facilities, group homes and physician’s offices are not subject to the mandate.

Read Full Article

Court Halts COVID-19 Vaccination/Testing Mandate for Businesses

A Federal Court of Appeals temporarily halted the Biden administration's OSHA Emergency Temporary Standard (ETS) that required businesses with over 100 employees to mandate the COVID-19 vaccine or regular testing.

The Stay was issued by a three judge panel at the Fifth Circuit Court of Appeals, following a request by Texas, Utah, Mississippi and South Carolina, as well as businesses who claimed they would be adversely impacted.

The judges wrote: "Because the petitions give cause to believe there are grave statutory and constitutional issues with the Mandate, the Mandate is hereby STAYED pending further action by this court.”  

Read the court’s ruling here:

https://www.ca5.uscourts.gov/opinions/unpub/21/21-60845.0.pdf

CDC data shows vaccines 5x more effective than prior COVID-19 infections

Healthcare IT News / By Kat Jercich

Data released by the U.S. Centers for Disease Control and Prevention found that among hospitalized patients with symptoms similar to COVID-19, unvaccinated people with a previous novel coronavirus infection were five times more likely to test positive than fully vaccinated people.  

"These findings suggest that among hospitalized adults with COVID-19-like illness whose previous infection or vaccination occurred 90-179 days earlier, vaccine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19," said study authors.  

WHY IT MATTERS  

The agency used data from 187 hospitals in the VISION Network, which includes Columbia University Irving Medical Center, HealthPartners, Intermountain Healthcare, Kaiser Permanente Northern California and Northwest, Regenstrief Institute, and University of Colorado.   

By examining data from adults hospitalized between January and September 2021, it compared the odds of testing positive for COVID-19 among adults who had not received an mRNA vaccine, but who'd had a previous novel coronavirus infection, with individuals who had gotten two Pfizer or Moderna shots.  

The chances of testing positive for COVID-19 were 5.49 times higher among the former group.  

The benefits of vaccination in this particular study appeared to be higher for Moderna recipients and for those older than 65. The agency noted several limitations, including potential misclassification of patients and selection bias.   

The study only examined adults who had tested positive more than three months prior to their hospitalization in order to reduce the chances that their illness was related to an ongoing infection rather than a new one.

It also did not include those who had received only one mRNA vaccine dose, those who obtained their second shot less than two weeks before hospitalization or those who received the Johnson and Johnson vaccine.  

In addition, wrote researchers, "These results might not be generalizable to nonhospitalized patients who have different access to medical care or different healthcare-seeking behaviors, particularly outside of the nine states covered."  

Overall, they said, the messaging remains consistent: Everyone eligible should get the vaccine – including those who have already had COVID-19.    

THE LARGER TREND  

As the COVID-19 pandemic continues, more data has become available about the disease, and about who is particularly vulnerable to it.  

This past month, the CDC published the rates of COVID-19 cases and deaths by vaccine brand for the first time. Although efficacy differed by type, unvaccinated people had a 6.1 times greater risk of testing positive for COVID-19 in August 2021, and an 11.3 times greater risk of dying from the disease.  

But hesitancy still remains an issue. Although digital health tools can help, advocates and strategists say getting shots into arms will require a thoughtful response.  

ON THE RECORD  

"This report focused on the early protection from infection-induced and vaccine-induced immunity, though it is possible that estimates could be affected by time," wrote CDC researchers.   

"Understanding infection-induced and vaccine-induced immunity over time is important, particularly for future studies to consider," they added.