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Policy Round-Up: RSV Vaccine, HUD 504 ANPRM, Food is Medicine RFI, and More

May 30, 2023
Vicki Gottlich, Deputy Administrator for Policy and Evaluation

In this Policy Round-Up:

  • Coming this Fall: FDA-approved RSV Vaccine for Older Adults
  • Comments Needed:
    • HUD to Update Section 504 Disability Rules
    • Interagency RFI on Food is Medicine Research Opportunities
    • CMS Proposed Rule to Expand Health Coverage to DACA Recipients
    • HHS Office of the National Coordinator for Health Information Technology Proposed Rule on Health Data, Algorithm Transparency, Information Sharing, and More 
  • State Medicaid Director Letter on Demonstration Opportunity for People Transitioning Out of Incarceration

Coming this Fall: FDA-approved RSV Vaccine for Older Adults

The Food and Drug Administration (FDA) has approved the first respiratory syncytial virus (RSV) vaccine, Arexvy, for use by people 60 and older in the United States.

RSV is a highly contagious virus that causes infections of the lungs and breathing passages. While anyone can get RSV, older adults — particularly those with underlying health conditions — are at high risk for becoming severely ill from RSV.

In older adults, RSV is a common cause of lower respiratory tract disease (LRTD), which affects the lungs and can cause life-threatening pneumonia and bronchiolitis (swelling of the small airway passages in the lungs). In a clinical trial, the vaccine reduced the risk of developing RSV-associated LRTD by 82.6% and the risk of developing severe RSV-associated LRTD by 94.1%.

RSV is seasonal, typically starting during the fall and peaking in the winter. While the vaccine is not yet available, it is expected by the fall, before the start of the next RSV season.

Input Needed: HUD to Update Section 504 Disability Rules

The U.S. Department of Housing and Urban Development (HUD) is seeking public input on potential changes to its regulations implementing Section 504 of the Rehabilitation Act of 1973. Section 504 prohibits discrimination on the basis of disability by federally administered or financed programs.

View the Advanced Notice of Proposed Rulemaking (ANPRM) for Nondiscrimination on the Basis of Disability: Updates to HUD's Section 504 Regulations.

Why: An ANPRM allows a federal agency to solicit specific information and data from the public that can help in the drafting of a proposed rule. In this case, HUD intends to draft a proposed rule that would update their accessibility standard and clarify the obligations of HUD recipients in light of advances in areas including accessible design, information and communication technology, and assistive technology since HUD's current Section 504 regulations were published in 1988.

The ANPRM also recognizes the importance of accessible and affordable housing efforts to assist individuals in transitioning from institutional and other segregated settings into integrated, community-based settings — especially in light of efforts to implement the Supreme Court’s 1999 Olmstead ruling.

When: The deadline to submit comments is July 24, 2023.

How to submit comments: Comments can be submitted electronically via Regulations.gov or mailed to:


Regulations Division, Office of General Counsel
Department of Housing and Urban Development
451 7th Street SW, Room 10276
Washington, DC 20410-0500


If submitting by mail, please reference this title and docket number: Nondiscrimination on the Basis of Disability: Updates to HUD’s Section 504 Regulations; HUD-2023-0029.

What: The ANPRM includes a series of questions on which HUD seeks input. One question that may be of particular interest to the aging and disability networks is:  


To what extent are individuals with disabilities at serious risk of entering institutional settings or being unable to transition from institutional or group home settings — including skilled nursing facilities, correctional institutions, and inpatient rehabilitation for substance misuse — because they are unable to find affordable, accessible, and integrated housing opportunities in community-based settings? Please describe any challenges faced and solutions identified with locating affordable, integrated, and accessible housing, including issues such as ensuring housing is available when an individual is ready to transition from an institutional setting, coordinating housing and services, identifying available housing programs that individuals may be eligible for, the referral and/or application process, the use of preferences, the operation of waitlists, insufficient accessible and integrated housing opportunities, etc.


Other key issues on which HUD seeks input include:

  • Updates to HUD’s definition of “individual with disabilities.”
  • Auxiliary aids and services that can empower people with disabilities to participate equitably in housing and community development programs and activities.
  • The impact of a lack of accessible housing units and facilities on the willingness of eligible people with disabilities to apply for housing programs. 
  • Challenges using a Housing Choice Voucher or other tenant-based rental assistance in the private rental market to secure units that meet a household's disability-related needs.
  • The modernization of accessibility requirements and consistency in the design and construction of housing units.

Input needed: Interagency RFI on Food is Medicine Research Opportunities

Twelve federal agencies, including ACL, have released a Request for Information (RFI) that invites input on research opportunities and best practices for Food is Medicine research programs. Food is Medicine is an umbrella term for a variety of activities and services that respond to the critical link between nutrition and health. This includes services and activities such as medically tailored meals, medically tailored and healthy food packages or groceries, and prescriptions for nutritious groceries or produce.

The RFI seeks input from a wide variety of stakeholders, including:

  • People who have received, or are eligible to receive, Food is Medicine services
  • People with lived experience with hunger, food insecurity, or a chronic condition
  • Older adults
  • Community organizations
  • Patient advocacy groups

Topics the RFI seeks feedback on include research, provision of services and activities, community outreach and engagement, education and training, and coverage for services.

Comments can be submitted online until June 30, 2023.

Learn more about medically tailored meals and ACL’s Senior Nutrition Program.

Input needed: Proposed Rule to Expand Health Coverage to DACA Recipients

The Centers for Medicare & Medicaid Services (CMS) seeks comments on a proposed rule that would expand eligibility for health coverage to Deferred Action for Childhood Arrivals (DACA) recipients. The proposed change also would allow otherwise eligible DACA recipients to receive financial assistance that helps pay for premiums and reduces cost-sharing for Marketplace plans.

DACA allows undocumented people who were brought to the United States as children to remain here and to work legally. Under current rules, DACA recipients are ineligible for many federal programs, including health coverage.

This CMS fact sheet has additional details on the proposed rule. Comments can be submitted online or by mail until June 23, 2023.

Input needed: ONC Proposed Rule on Health Data, Algorithm Transparency, Information Sharing, and More

The Office of the National Coordinator for Health Information Technology (ONC) is seeking input on a proposed rule that would impact how health information for consumers, including people with disabilities and older adults, is shared and accessed. ONC developed the proposed rule to implement provisions of the 21st Century Cures Act and make several enhancements to the ONC Health IT Certification Program to advance interoperability; improve transparency; and support the access, exchange, and use of electronic health information.

The rule also would address the use of artificial intelligence in health care decision making, including through predictive decision support interventions. (These systems are an increasingly common part of health care, but biases within them can negatively affect the care people receive.)

The rule solicits comment on a variety of topics, including: 

  • A proposed technical means for patients to request a restriction on use and release of their data.
  • Risk mitigation for predictive decision support interventions.
  • Additional opportunities to improve algorithmic transparency and trustworthiness in health IT design, development, and implementation.

Comments can be submitted online or by mail until 5:00 PM ET on June 20, 2023.

State Medicaid Director Letter: Demonstration Opportunity Regarding People Transitioning Out of Incarceration

In a letter to state Medicaid directors, CMS provides guidance for designing demonstration projects to provide short-term coverage of Medicaid services to eligible individuals transitioning out of incarceration. The goal is to help ensure their health care needs are met during their reentry process.

States participating in the new Medicaid Reentry Section 1115 Demonstration Opportunity must, at a minimum, provide case management, medication-assisted treatment services, and a 30-day supply of all prescription medications. CMS also encourages states to consider providing additional services, such as peer support and behavioral health services. States can choose to cover services provided in person, through telehealth, or through a combination of both. CMS generally expects states participating in the demonstration to provide coverage for 30 days prior to release but may consider proposals for up to 90 days of coverage.

While CMS encourages states to provide coverage to a broad population of eligible individuals, states have the flexibility to limit coverage to more targeted populations. However, states must do so in a way that does not exclude people with undiagnosed health conditions.

People who are currently enrolled in, or eligible for, Medicaid and who are near release from state or local jails, prisons, or youth correctional facilities are eligible for pre-release services under this demonstration.

People in federal prisons are not eligible, as the federal Bureau of Prisons is responsible for providing, and paying for, all physical and behavioral health care in those settings. However, CMS encourages states to help individuals incarcerated in federal prisons in their state apply for Medicaid in the state where that person intends to live upon release.

In January, CMS approved a first-of-its-kind Section 1115 demonstration amendment in California that covers a range of health care services for people returning to the community from jails and prisons. Fourteen other states have submitted applications seeking approval to provide similar coverage.


Last modified on 05/30/2023


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