In this policy round up:
- Evusheld authorization paused and ways people who are immunocompromised can protect themselves
- New CDC website helps locate free COVID testing
- Public input opportunity: HUD Affirmatively Furthering Fair Housing proposed rule
- HUD announces new funding for affordable housing for people with disabilities
- CMS bulletin offers additional information on continuous enrollment wind down
- Letter to states on CHIP and Medicaid coverage for interpersonal consultations
- Correction to Medicare Special Enrollment Periods guidance clarifies enrollment timelines
- Public input opportunity: National Coverage Determination Analysis for injectable PrEP
- Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System
Evusheld authorization paused and ways people who are immunocompromised can protect themselves
FDA has announced that Evusheld is not currently authorized for use because it is unlikely to offer protection against the COVID-19 variants that are common today. Since December 2021, Evusheld has been an option for people who are moderately or severely immunocompromised and people with a history of severe adverse reaction to a COVID-19 vaccine or its components.
If you’ve already received Evusheld, it’s important to know that you may now have less protection from developing COVID-19 if exposed to the variants circulating today. However, there are many things you can do to increase your protection against COVID-19 including staying updated on vaccines, masking in public spaces, and improving indoor ventilation. In addition, several treatments, including Paxlovid and Veklury are available for COVID-19. Timely treatment can reduce your risk of getting very sick, being hospitalized, or dying as a result of an infection.
This resource from the Administration for Strategic Preparedness and Response addresses questions about the change in authorization for Evusheld, and how people who are immunocompromised can protect themselves including staying updated with vaccines, developing
In light of the FDA’s announcement, CDC’s Morbidity and Mortality Weekly Report details a variety of strategies that people who are immunocompromised can use to protect themselves from the variants of COVID-19 currently circulating in the United States.
New CDC website helps locate free COVID testing
CDC has launched the COVID-19 Testing Locator website, which allows consumers to search for free COVID-19 testing sites near them. The locator is part of the CDC Increasing Community Access to Testing (ICATT) program, which provides access to COVID-19 testing, focusing on communities at a greater risk of being impacted by the pandemic, people who do not have health insurance, and surge testing in state and local jurisdictions.
Public input opportunity: HUD Affirmatively Furthering Fair Housing proposed rule
The U.S. Department of Housing and Urban Development (HUD) took a major step towards rooting out longstanding inequities in housing and fostering inclusive communities by announcing the Affirmatively Furthering Fair Housing (AFFH)" proposed rule. This proposed rule would implement the Fair Housing Act's affirmatively furthering fair housing mandate, which directs the government to promote fair housing choice, eliminate disparities in housing, and foster inclusive communities.
This proposed rule seeks to simplify the required fair housing analysis, emphasize goal-setting, increase transparency for public review and comment, foster local commitment to addressing fair housing issues, enhance HUD technical assistance to local communities, and provide mechanisms for regular program evaluation and greater accountability, among other changes.
The proposed rule contains a number of changes of particular note to the aging and disability community, including:
- incorporating the housing needs of people with disabilities into the definition of “affordable opportunities;”
- defining “fair housing choice” for persons with disabilities as providing “a realistic opportunity to obtain and maintain housing with accessibility features meeting the individual’s disability-related needs, housing provided in the most integrated setting appropriate to an individual’s needs, and housing where community assets are accessible to individuals with disabilities, including voluntary disability-related services that an individual needs to live in such housing;”
- requiring consultation with organizations that advocate on behalf of individuals with disabilities such as centers for independent living, protection & advocacy agencies, aging and disability resource centers, and councils on developmental disabilities as a part of the community engagement process jurisdictions must take as they develop their Equity Plans; and
- restores previous references to the Olmstead decision and the integration mandate of Section 504 of the Rehabilitation Act.
HUD seeks public comments on this proposed rule. The 60-day comment period will open once the proposed rule is published in the Federal Register. HUD has created a guide to submitting comments. ACL networks and stakeholders are encouraged to submit their views, comments, and recommendations.
Additional fair housing resources: review the Affirmatively Furthering Fair Housing (AFFH) Fact Sheet and Engaging the Disability Community in Fair Housing Planning Webinar Series.
HUD announces new funding for affordable housing for people with disabilities
On January 4, HUD announced that it would provide $24.7 million for permanent affordable housing to people with disabilities. This award allows local public housing authorities to house up to 2,210 additional families, and further support community integration for persons with disabilities.
The assistance is provided through the HUD Section 811 Mainstream Housing Choice Voucher Program, which offers funding to housing agencies to assist non-elderly people with disabilities who are transitioning out of institutional or other isolated settings, at serious risk of institutionalization, homeless, or at risk of becoming homeless.
CMS bulletin offers additional information on continuous enrollment wind down
As we discussed in our last policy round up, the Consolidated Appropriations Act (CAA) was signed into law last month. On January 5, the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin on changes the CAA made to Medicaid and Children’s Health Insurance Program (CHIP) requirements. Under this new law, states can end coverage for people who no longer meet the requirements for Medicaid, CHIP, and the Basic Health Program.
Stakeholders may want to work with their State Medicaid agencies to ensure that older people and people with disabilities who receive Medicaid are aware of the resumption of Medicaid renewal reviews. They may also want to work with individuals who may need assistance with the renewal process. For more on how to prepare for these changes, check out ACL’s April 2022 fact sheet.
Letter to states on CHIP and Medicaid coverage for interpersonal consultations
Earlier this month, CMS released a State Health Official (SHO) letter that clarifies that states may choose to cover interprofessional consultation under Medicaid and the Children’s Health Insurance Program (CHIP).
This change allows one provider to discuss a Medicaid or CHIP beneficiary’s case with a specialist, with or without the beneficiary present, and to pay the specialist for their services directly.
The previous policy only allowed payment in these cases if the provider seeking the consultation was paid for the consulted provider’s services and then paid the consulted provider directly. This change more directly “links” routine care with specialty care, allowing more people to benefit from providers with specialized knowledge. This is especially important for improving access to providers who specialize in child and adolescent behavioral health.
Correction to Medicare Special Enrollment Periods guidance clarifies enrollment timelines
On December 30, CMS issued a notice of correction to an important Medicare rule that establishes special enrollment periods for Medicare for people in certain circumstances, including after the loss of Medicaid coverage. The establishment of these special enrollment periods will help close some of the coverage gaps in Medicare enrollment. The correction notice includes an updated chart listing the Medicare effective dates for people who enroll during certain time periods.
Public input opportunity: National Coverage Determination Analysis for injectable PrEP
Pre-exposure Prophylaxis (PrEP) is a medication that is 99 percent effective at stopping HIV transmission when taken correctly. Medicare currently covers PrEP pills and is considering covering the injectable form of the drug. It just released a National Coverage Determination Analysis for injectable PrEP- a review to determine if the medication has sufficient research support to warrant Medicare coverage.
Access to PrEP is particularly important for LGBTQ+ Medicare beneficiaries and people of color who are disproportionately impacted by HIV. Currently, in addition to medication, people on PrEP must be tested for HIV every 3 months. Medicare only covers one HIV screening per year for people 15-65 and those at increased risk of HIV transmission, even if they are taking oral PrEP. It is unclear whether that standard will change if Medicare chooses to cover injectable PrEP.
You can read the National Coverage Determination Analysis tracking sheet and comment here. The comment period is open through February 11, 2023.
Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System
On January 18, CMS released a memo outlining updates to the Nursing Home Care Compare Website and Five Star Quality Rating System to bring greater transparency about nursing home citations to families and to address concerns that some nursing homes have inappropriately diagnosed residents with schizophrenia, which can mask the facilities’ true rate of antipsychotic medication use.
As part of these changes, CMS will conduct offsite audits of schizophrenia coding and adjust the quality measure star ratings for facilities whose audit reveals inaccurate coding. This change will help improve the accuracy of the quality information that is publicly reported and the nursing home Five-Star Rating System. The use of antipsychotic medications among nursing home residents is an indicator of nursing home quality and used in a nursing home’s Five-Star rating, however it excludes residents with schizophrenia. If an audit identifies a facility with a pattern of inaccurately coding residents as having schizophrenia, the facility’s Five-Star Quality Measure Rating on the Care Compare site will be negatively impacted.
CMS will also publicly display survey citations that facilities are disputing. Currently, disputed citations are not posted to Care Compare until the dispute process is complete. While these disputes are usually resolved within 60 days, they sometimes take longer and having that information can help people make more informed choices when it comes to evaluating a nursing home. While the citations will be publicly displayed, they will not be included in the Five-Star Quality Rating calculation until the dispute is complete.