$25.5 Billion in New COVID-19 Provider Funding Available

The U.S. Department of Health and Human Services (HHS), through the (HRSA) is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic.

Providers, defined as any provider or supplier of health care, services, and support in a medical setting, at home, or in the community, will apply for both programs in a single application. HRSA will use existing Medicaid, CHIP and Medicare claims data in calculating payments. The application portal will open on September 29, 2021.

PRF Phase 4

75% of the Phase 4 payments will be based on lost revenues and expenditures between July 1, 2020, and March 31, 2021. The remaining 25% of payments will be utilized for bonus payments for providers who serve Medicaid, CHIP, and/or Medicare patients.

Medium and small providers will receive a base payment plus a supplement, with smaller providers receiving the highest supplement. Large providers will receive a minimum payment amount based on a percentage of lost revenues and COVID-related expenses. HHS will determine the exact amount of the base payments and supplements after analyzing data from all the applications received to ensure available funds are distributed equitably.

Rural

HRSA will make $8.5B in rural payments to providers who serve patients who receive Medicaid, CHIP, and/or Medicare services in a rural area as defined by the HHS Federal Office of Rural Health Policy. Search the Rural Health Grants Eligibility Analyzer  to see what areas qualify as "rural" for the rural payments. 

Phase 3 Reconsiderations
Providers who believe their Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration. Further details on this Phase 3 reconsideration process are forthcoming.

Grace Period for Reporting Period 1

In order to help providers come into compliance with PRF Reporting requirements if they miss the September 30, 2021 deadline for the first PRF Reporting Time Period, HHS announced a final 60-day grace period for those who received a PRF payment between April 10, 2020 and June 30, 2020.

It’s important to note that the deadlines to use funds and the Reporting Time Period are not changing. However, HHS will not enforce actions for noncompliant providers during the grace period. More information on reporting is available on the HRSA website. 

Additional Information:

Visit the HRSA website for more information about eligibility requirements, documents, and information providers will need to complete their application.

Agency-Level Hospice Quality Measure (QM) Reports Now Include Claims-Based Measures

QM Reports now include two measures based on Fiscal Year 2018 and 2019 Medicare claims data: the Hospice Care Index (HCI) and Hospice Visits in the Last Days of Life (HVLDL). Hospices can use the QM Report to learn about HCI and HVLDL and begin efforts to improve quality of care. Find the QM Reports in your CASPER folders in QIES, and find information about HCI and HVLDL measure specifications in the FY 2022 Hospice Wage Index and Payment Rate Update Final Rule on the Hospice Regulations and Notices page.

CMS Issues Additional Home Health Claim Processing Instructions (From NAHC)

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12424 that provides additional instructions related claims processing for the notice of admission (NOA) for claims that span calendar years 2021 and 2022, and special circumstances for discharges when no visits are made in a subsequent 30 day period.

HHAC Members Read Full Article

Misdirected antibodies linked to severe COVID-19

National Institutes of Health (NIH) / By Sharon Reynolds

The severity of COVID-19 can differ drastically between individuals. Some people never know they’ve been infected, while others may end up needing intensive care or dying from the disease.

Several factors have been associated with severe COVID-19, including preexisting health conditions like obesity, diabetes, and high blood pressure. Men are more likely to die of the disease than women. And the risk of dying from COVID-19 increases with age.

Researchers around the world have been looking for other risk factors for severe or fatal infection with SARS-CoV-2, the virus that causes COVID-19. An international project called the COVID Human Genetic Effort has been searching for genetic and molecular differences that may increase the risk of severe COVID-19. The project is co-directed by Dr. Helen Su from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and Dr. Jean-Laurent Casanova from Rockefeller University.

Two recent studies from the project, led by Casanova, found that some severe cases of COVID-19 could be linked to problems with immune-system proteins called type I interferons (IFNs). These IFNs are needed to fight off viral infections. In rare cases, genetic conditions blocked the production of these proteins. But more commonly, antibodies that mistakenly targeted the IFNs were found in the blood of people with severe or fatal COVID-19.

To better understand how common these autoantibodies are, Casanova and his colleagues screened for them in blood samples taken from more than 3,500 people with severe or fatal COVID-19 and more than 34,000 uninfected volunteers from 38 different countries. The new study was funded in part by several NIH components, primarily NIAID. Results were published on August 19, 2021, in Science Immunology.

The team found that 20% of people hospitalized with severe COVID-19 had high or intermediate levels of autoantibodies to type I IFNs. Autoantibodies were also found in at least 18% of people who died from the disease. In contrast, people with no or mild symptoms had very low levels of these autoantibodies. The researchers estimate that the autoantibodies may account for about 20% of total fatal COVID-19 cases.

The risk of having such autoantibodies increased with age. For example, while fewer than 10% of people under the age of 40 with severe COVID-19 had active levels of these autoantibodies, more than 21% of those over the age of 80 had them.

The researchers also found evidence of autoantibody production in uninfected volunteers. They were found in less than 1% of people between 18 and 69 years; in 2.3% of those between 70 and 79 years; and in 6.3% of those 80 years and older. This suggests that type I IFN autoantibodies existed before infection and become more common past age 70.

In a related paper published in the same issue of Science Immunology, the researchers identified another rare genetic defect that occurs only in men and results in disruption of IFN production. They estimated that this genetic risk factor accounts for at least 1% of cases of life-threatening COVID-19 in men under the age of 60.

“We can neatly explain much of severe COVID-19 as a net defect in type I IFN,” Casanova says. “To an extent never seen for any other acute infectious disease, these… studies collectively provide a molecular and immunological explanation for about 20% of critical cases.”

Autoantibodies against IFNs—at even very low levels—can be screened for in the clinic. Testing for these autoantibodies could help identify uninfected people who need aggressive preventive measures or infected people who need early aggressive treatment.