ACL Policy Round Up: Extension of Public Health Emergency, Booster Guidance, Surprise Medical Billing, Paid Leave, and More

You probably know that the CDC is recommending COVID-19 vaccine boosters for many older adults and people with disabilities, but the recent guidance includes an important provision – and an opportunity – that you might have missed. This ACL Policy Round Up recaps the highlights of that guidance and:

• Extension of Public Health Emergency
• HHS Study: COVID-19 Vaccine Linked to Saving Lives for Older Americans
• Comments Needed: CMS’ Second “Surprise Medical Billing” Rule
• New Guidance: HIPAA and COVID-19 Vaccinations
• Return to School Roadmap: Development and Implementation of Individualized Education Programs
• Office of Disability Employment Policy Brief: Access to Paid Family and Medical Leave for People with Disabilities
• Request for Public Comments: 2021-2022 Interagency Autism Coordinating Committee Strategic Plan

Extension of Public Health Emergency

On Oct. 15, HHS Secretary Xavier Becerra renewed the determination that a public health emergency exists. This extends the public health emergency, and the associated authorities/flexibilities, for 90 days.

CDC Guidance for COVID-19 Boosters

On September 24, the CDC recommended booster shots for people who are at highest risk for COVID-19, if they received their second Pfizer shot at least six months ago. (FDA and CDC are evaluating data for Moderna and J&J boosters – we’ll keep you posted). CDC says that people 65 and older, people 50-64 with underlying medical conditions, and adults in long-term care settings should receive a booster, and younger people with medical conditions or jobs that put them at increased risk may receive one.

Here are the important pieces that you might have missed:

• “Long-term care settings” now include far more than nursing homes and assisted living facilities. Group homes, senior housing, ICFs and more – virtually all congregate residential settings – are included.
• “Adults in long-care settings” includes more than people who live in long-term care settings. It also includes people who receive services and participate in programs in congregate settings, such as senior centers and adult day programs. 

See this page on our COVID-19 site for more examples of places that are considered long-term care settings. 

Another important note: The CDC’s pharmacy partners program is available to our networks to support your work to help older adults and people with disabilities (and the service-provider workforce) get vaccinated. Through this page on CDC's website, providers of home or community-based long-term care services can connect to a pharmacy partner to access COVID-19 vaccines for their clients, residents, and staff. The page also includes a downloadable PDF with information on long-term care pharmacies that are enrolled with the federal government to provide COVID-19 vaccines.

And, of course, the Eldercare Locator and Disability Information and Access Line are available for older and adults and people with disabilities who need help getting their vaccines and boosters.

HHS Study Finds COVID-19 Vaccine Linked to Saving Lives for Older Americans

In case you missed it, a study by the HHS Office of the Assistant Secretary for Planning and Evaluation found that COVID-19 vaccinations may have helped prevent hundreds of thousands of new infections and tens of thousands of deaths among older adults. COVID-19 vaccinations were linked to a reduction of approximately 265,000 COVID-19 infections, 107,000 hospitalizations, and 39,000 deaths among Medicare beneficiaries between January and May 2021. Learn more about the study or read the report on these findings.

Input Needed: New Interim Final Rule – "Requirements Related to Surprise Billing: Part II"

Input is needed on a new interim final rule (with comment period), “Requirements Related to Surprise Billing; Part II.” The third in a series released by the Departments of Health and Human Services, Labor, and Treasury and the Office of Personnel Management, the rule establishes new consumer protections from surprise billing and excessive cost sharing for health care. Specifically, it implements provisions of the No Surprises Act related to the independent dispute resolution process, good faith estimates for uninsured (or self-pay) individuals, the patient-provider dispute resolution process, and expanded rights to external review.

The rule reminds providers that they must follow effective communications requirements and provide appropriate auxiliary aids and services at no cost and ensure that information conveyed through information and communications technology is accessible to people with disabilities and includes a number of provisions that seek to ensure the accessibility of the specific processes described in the rule.

Input from the aging and disability networks, and the older adults and people with disabilities that we serve, is critical. HHS is particularly looking for comments on:

• Additional barriers to understanding and exercising rights related to good faith estimates, patient-provider dispute resolution, and how and when to initiate the dispute resolution process.
• Whether the provisions and protections related to communication, language, and literacy sufficiently address barriers to understanding and exercising these rights.
• Additional or alternate policies HHS may consider to help address and remove such barriers.
• Ways to ensure accessibility of the dispute resolution process.
• Additional supports that may be needed to meet the needs of underserved communities, including people with low-English proficiency, people with disabilities who require information in alternate and accessible formats, and stakeholders serving such communities.

Comments must be received no later than 5 p.m. on Dec. 6. Instructions for submitting comments can be found in the Federal Register notice published on Oct. 7.  

This fact sheet from the Centers for Medicare & Medicaid Services has more information about the three rules, the No Surprises Act, and surprise medical billing.

New Guidance: HIPAA and COVID-19 Vaccinations

On September 30, the HHS Office for Civil Rights issued guidance clarifying when the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule applies to requests for information about whether someone has received a COVID-19 vaccine and when that information can be provided. The Rule is meant to protect sensitive health information and covers the use and disclosure of individuals’ health information by health plans, health care clearinghouses, health care providers that conduct standard electronic transactions, and, in some cases, their business associates.

Key takeaways:

• The Rule does not prevent anyone from asking whether someone has received any type of vaccine, including the COVID-19 vaccine.
• The Rule generally does not limit what an employer can request from employees as part of the terms and conditions of their employment, even if that employer is an entity covered by the Rule.

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• An employer can ask or require employees to:
  • Provide documentation or other confirmation of their COVID-19 vaccination.
  • Sign a HIPAA authorization for a covered health care provider to disclose their COVID-19 vaccination record to their employer.
  • Wear a mask – while in the employer’s facility, on the employer’s property, or in the normal course of performing their duties at another location.
  • Disclose whether they have received a COVID-19 vaccine in response to questions from clients or patients.
  • Documentation or other confirmation of vaccination; however, it must be kept confidential and stored separately from the employee's personnel files under Title I of the Americans with Disabilities Act (ADA).
• Organizations, providers, and other individuals covered by the Rule cannot disclose whether an individual has received a COVID-19 vaccine unless the individual has authorized it or the Rule expressly permits or requires disclosure.
• The Rule does not prevent anyone from disclosing their own vaccination status to anyone else.

Return to School Roadmap: Development and Implementation of Individualized Education Programs

In response to requests from stakeholders, the Department of Education's Office of Special Education and Rehabilitative Services (OSERS) developed the Return to School Roadmap to support full implementation of requirements of the Individuals with Disabilities Education Act (IDEA) as schools and programs are returning to in-person services. The Roadmap answers questions about IDEA requirements related to the development and implementation of IEPs, including meeting timelines, ensuring implementation of initial evaluation and reevaluation procedures, determining eligibility for special education and related services, and providing the full array of special education and related services that children with disabilities need in order to receive free and appropriate public education, and more. It also provides other information that state and local education agencies, teachers, providers, and parents should consider.

Read more key takeaways

• Students have been impacted by the pandemic in a variety of ways. The IEP team must consider any new or changed needs to ensure that the student is still receiving a free and appropriate public education (FAPE) as required under the Individuals with Disabilities Education Act (IDEA).
• When considering the needs of students with underlying medical conditions, IEP teams must work to identify an appropriate educational placement in the least restrictive environment that meets the child’s school-related health needs.
• During the COVID‑19 pandemic, students with disabilities may not have received appropriate services to allow them to meet the goals outlined in their IEPs. IEP teams will need to determine whether, and to what extent, compensatory services may be necessary to lessen the impact of the COVID-19 pandemic on the student.
• As students return to school, states and local educational agencies must consider options for delivering quality transition services. Students with disabilities are entitled to receive the appropriate services, supports, and opportunities to achieve their desired post-school education and career goals.

Office of Disability Employment Policy Brief: Access to Paid Family and Medical Leave for People with Disabilities

Access to Paid Family and Medical Leave for People with Disabilities, a policy brief from the Department of Labor’s Office of Disability Employment Policy, discusses the current landscape of paid family and medical leave (PFML) in the United States and examines access to PFML for people with disabilities. Using data from the Bureau of Labor Statistics’ Current Population Survey and American Time Use Survey Leave Module, ODEP found that workers with disabilities have significantly lower access to PFML than workers without disabilities.

Request for Public Comments – 2021-2022 Interagency Autism Coordinating Committee Strategic Plan

The Interagency Autism Coordinating Committee (IACC) is requesting public comments to inform development of its 2021- 2022 Strategic Plan. IACC is requesting comment on what YOU believe to be the most vital issues, needs and gaps that could be addressed by federal programs, activities, and/or partnerships with community organizations. Comments can be submitted through the IACC webpage through November 30, 2021.

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The current IACC Strategic Plan was issued in 2017 after an extensive process engaging diverse stakeholders including federal agencies and the public, and a progress update was issued in 2019. IACC is seeking input in the following areas of focus. (The first seven are each represented with a chapter in the current plan; the last two are new.)

IACC RFI Questions: 

1. Question 1: How Can I Recognize the Signs of ASD, and Why is Early Detection So Important? (Topic: Screening and Diagnosis)
2. Question 2: What is the Biology Underlying ASD? (Topic: Biology)
3. Question 3: What Causes ASD, and Can Disabling Aspects of ASD be Prevented or Preempted? (Topic: Risk Factors)
4. Question 4: Which Treatments and Interventions Will Help? (Topic: Treatments and Interventions)
5. Question 5: What Kinds of Services and Supports are Needed to Maximize Quality of Life for People on the Autism Spectrum? (Topic: Services)
6. Question 6: How Can We Meet the Needs of People with ASD as They Progress into and through Adulthood? (Topic: Lifespan Issues)
7. Question 7: How Do We Continue to Build, Expand, and Enhance the Infrastructure System to Meet the Needs of the ASD Community? (Topic: Infrastructure and Surveillance)
8. Supplemental Question 1: What are important issues for the IACC to consider with regard to the impact of the COVID-19 pandemic on the autism community?
9. Supplemental Question 2: What are important issues for the IACC to consider with regard to the needs of underserved populations within the autism community, including racial and ethnic minorities, economically disadvantaged communities, and rural populations?