In this Policy Round-Up, you’ll find:
- New CDC Recommendations: COVID-19 Community Levels
- Department of Education: What CDC’s new guidance means for schools and students with disabilities Updated list: People at highest risk from COVID-19
- CDC’s updated guidance on intervals for mRNA vaccine (does NOT apply to everyone!)
- Access to Coverage and Care in Medicaid and CHIP (Comments due 4/18)
- CDC’s Draft Clinical Practice Guideline for Prescribing Opioids (Comments due 4/11)
- Senior Community Service Employment Program rule (Comments due 3/16)
- ICYMI: DHS’ Proposed Public Charge Rule (Comments due 4/25)
- White House Fact Sheet: Improving Safety and Quality of Care in Nursing Homes
- UPDATE: CDC’s Developmental Milestones for Children
New CDC Recommendations: COVID-19 Community Levels
The Centers for Disease Control and Prevention (CDC) released an updated framework for community response to COVID-19. Based on current data and science, the framework recommends that community measures should focus on minimizing the impact of severe COVID-19, rather than on eliminating transmission of the virus that causes COVID-19. Specifically, CDC recommends:
- Protecting those at greatest risk, through vaccines, medicines, and prevention strategies
- Preventing serious illness
- Minimizing strain on the healthcare system
Within that framework, CDC has updated its recommendations for the factors public health officials – and all people -- should consider to make decisions about which COVID-19 prevention strategies to use. (These recommendations do NOT apply to healthcare settings.)
- CDC now recommends that communities and individuals consider local “COVID-19 Community Levels,” which measure the current impact of COVID-19 on the local community. Previously, CDC had recommended considering local levels of transmission of the virus that causes COVID-19.
- COVID-19 Community Levels can be low, medium, or high. They are determined by looking at how many hospital beds are being used by COVID-19 patients, new hospital admissions due to COVID-19, and the total number of new COVID-19 cases in an area. (Together, those factors indicate the potential for strain on the health system due to COVID-19.)
- You can find your local COVID-19 Community Level on CDC’s website.
- CDC also provided recommendations for COVID-19 prevention strategies at each of the COVID-19 Community Levels. The recommendations align precautions for educational settings with those for other community settings. They also include specific recommendations for people who are immunocompromised or at high risk for severe disease include:
- Having a plan for rapid testing if needed, even when the level of COVID-19 in the community is low. (ACL has information on how to access COVID tests here including information on ordering your second round of four free COVID-19 rapid tests.).
- Talking to your healthcare provider about whether you are a candidate for medicines that treat or help prevent COVID-19, such as:
- Evusheld – A combination of two monoclonal antibodies that has been shown to reduce the risk of infection with the virus that causes COVID-19, if it is taken before being exposed to the virus.
- Monoclonal antibodies that are taken if you are infected – these may help your immune system recognize and respond more effectively to the virus.
- Oral antiviral medications, which help prevent the virus from multiplying and spreading through the body.
Why the guidance changed: High levels of vaccination and high levels of population immunity (from both vaccination and prior infections) have decreased the risk of severe illness, hospitalization, and death from COVID-19 for most people.
What has NOT changed:
- There are multiple factors to consider: CDC continues to recommend that communities and individuals make decisions about the appropriate prevention measures based on a combination of factors. In addition to the local COVID-19 Community Level, the following also should be considered:
- Individual risk of severe illness: Older adults and people with disabilities, as well as people with many chronic health conditions are at increased risk for serious illness and may need to take extra precautions.
- Specific risk factors of settings: CDC also notes that additional layers of prevention, like physical distancing and contact tracing, may be appropriate in settings such as schools, correctional facilities and homeless shelters.
- Other local data: Community vaccination coverage and other local information, like early alerts from wastewater surveillance, or the number of emergency department visits for COVID-19, can also inform decision making for health officials and individuals.
- Health care settings have different guidance: These recommendations do NOT apply to healthcare settings, such as hospitals and long-term care facilities. These settings should continue to use community transmission rates and follow CDC’s infection prevention and control recommendations for healthcare workers.
- Vaccination is crucial: Regardless of your local COVID-19 Community Level, getting vaccinated (and boosted) is the best way to slow the spread of COVID-19 and to prevent infection. Vaccination prevents most infections, and even when fully vaccinated people get COVID-19, their symptoms tend to be less severe, and they are much less likely than unvaccinated people to be hospitalized or die.
Department of Education: What CDC’s new guidance means for schools and students with disabilities
On February 25, the Department of Education released a letter that outlines how the CDC’s updated masking guidelines apply to schools and early care settings and highlights guidance available for schools and parents on the rights of students with disabilities. The letter notes that CDC guidance now recommends universal masking for the following in areas where the COVID-19 Community Level is high:
- Early care and education centers
- School buses and vans for schools and early care and education centers
The guidance reinforces that students with disabilities have a right to access schools without taking on a far greater risk to their health than other students face. That means that school districts may need to make reasonable modifications, including requiring some degree of masking to ensure students with disabilities can learn in person. The guidance also provides additional resources for students with disabilities and their families.
(3/25/22 update: See also this letter, issued 3/24/22, which provides more extensive guidance.)
Updated list: People at highest risk from COVID-19
CDC has added disabilities, primary immunodeficiencies, and physical inactivity to its list of conditions that have been conclusively shown to put people at higher risk of severe illness from COVID-19. CDC notes that people with disabilities are more likely to have chronic health conditions, live in congregate settings, and face more barriers to health care, all of which increase risk. Age remains the strongest risk factor for severe illness, and living in congregate settings also significantly increases risk. For people with underlying medical conditions, risk increases as the number of conditions increase. This science brief explains CDC's systematic review process.
CDC’s updated guidance on intervals for mRNA vaccine (does NOT apply to everyone!)
CDC now recommends consideration of an eight-week interval between the first and second mRNA COVID-19 shots for some people ages 12 years and older, particularly males who are between 12 and 39 years old. (Some studies have shown that the longer interval may make the vaccines more effective and further reduce the small risk of heart inflammation associated with the vaccines.)
It’s important to note that this new recommendation does not apply to everyone. For people who are moderately or severely immunocompromised, adults age, 65 and older, and others who need rapid protection due to increased concern about community transmission or risk of severe disease, the CDC still recommends a shorter interval between the first and second dose (three weeks for the Pfizer vaccine and four weeks for Moderna).
White House Fact Sheet: New Actions to Address the Needs of People with Disabilities & Older Adults in Response to & Recovery from COVID-19
On February 24, the Biden-Harris Administration announced that it would be taking additional steps to meet the needs of people with disabilities and older adults during the COVID-19 pandemic.
These actions taken by the Administration seek to ensure that all people with disabilities, regardless of where they live or the level of community transmission of the virus, have equitable access to COVID-19 testing, masks, and other critical mitigation strategies.
The new actions announced by the Administration include:
- Providing schools with the guidance and support needed to keep students with disabilities safe and learning in-person.
- Expansion of the Disability Information and Access Line (DIAL) to provide support to people with disabilities who need assistance to use at-home COVID-19 tests or need help finding alternatives to at-home testing.
- Working to develop full accessible at-home tests and incentivizing all at-home test manufacturers to prioritize accessibility of at-home tests.
- Releasing new COVID-19 testing guidance in American Sign Language and reviewing all existing COVID-19 guidance to confirm accessibility and provide information in Braille, ASL translation, simplified text, and other alternative formats.
- Requesting that all test developers that have received an emergency use authorization (EUA) provide instructions that are accessible and compliant with the Americans with Disabilities Act, including alternative text for all images as well as html versions.
- Distributing masks to individuals with disabilities through community-based organizations and jurisdictions and calling on states to do so as well.
Partnership Opportunity: Masks and At-Home Test Kits for Older Adults and People with Disabilities
ACL and the Health Resources and Services Administration (HRSA) have partnered to ensure older adults and people with disabilities have the resources they need to prevent the spread of COVID-19. In a recently released joint letter, ACL and HRSA announced an opportunity for the aging and disability networks to partner with HRSA-supported health centers and Medicare-certified rural health clinics to distribute at-home tests and N95 masks to people with disabilities and older adults.
HRSA’s COVID-19 Testing Supply Program began in late December, and its Health Center COVID-19 N95 Mask Program launched in January. Both programs are now available to all community health centers and rural health clinics. It is crucial that the health centers and rural clinics hear from our networks about the needs of the people we serve and our networks’ interest in partnering. This will help them accurately assess the needs in their communities and place orders to meet them.
To find a potential community health center partner, visit Find A Health Center. You can also see a list of health centers currently participating in the mask program here. (While there is not an online list of participants in the testing program, all health centers are eligible to participate.)
Input needed: Access to Coverage and Care in Medicaid and CHIP (Comments due 4/18)
The Centers for Medicare & Medicaid Services (CMS) are seeking input from stakeholders to inform the development of a comprehensive access strategy for Medicaid and the Children’s Health Insurance Program (CHIP). Your input will help CMS address barriers to enrollment and access to care. It also will help CMS ensure timely access to critical services, such as behavioral health care and home and community-based services. CMS is interested in hearing from a wide range of stakeholders, including people using Medicaid services. Comments can be submitted online until April 18.
CMS seeks information on five key objectives:
- Medicaid and CHIP reaches people who are eligible and who can benefit from such coverage
- Medicaid and CHIP beneficiaries experience consistent coverage.
- Whether care is delivered through fee-for-service or managed care, Medicaid and CHIP beneficiaries have access to timely, high-quality, and appropriate care in all payment systems, and this care will be aligned with the beneficiary’s needs as a whole person.
- CMS has data available to measure, monitor, and support improvement efforts related to access to services (i.e., potential access; realized access; and beneficiary experience with care across states, delivery systems, and populations).
- Payment rates in Medicaid and CHIP are sufficient to enlist and retain enough providers so that services are accessible.
Commenters are encouraged to preview CMS’ questions related to each objective before submitting feedback.
Input needed: CDC’s Draft Clinical Practice Guideline for Prescribing Opioids (Comments due 4/11)
The updated guideline includes several changes that were strongly advocated for by the disability community. It is intended to be flexible, and to support, not replace, clinical judgment and individualized, person-centered care. It underscores that pain management should include consideration of a person’s physical health, behavioral health, long-term services and supports, and expected health outcomes and well-being needs. It also includes content on management of subacute painful conditions, as well as to clarify recommendations that apply to patients who are being considered for initial treatment with prescription opioids and those who have already been receiving opioids as part of their ongoing pain management treatment.
Input needed: Senior Community Service Employment Program rule (Comments due 3/16)
In March of 2020, the Older Americans Act, which funds many important social and nutrition services for older adults and their caregivers, was reauthorized by the Supporting Older Americans Act of 2020. To conform to changes that were made to better support formerly incarcerated individuals, the Department of Labor (DOL) recently published a direct final rule revising its Senior Community Service Employment Program (SCSEP) regulations.
Under the new rule, grantees may choose to make formerly incarcerated individuals eligible for an increased period of participation in the program. The rule defines formerly incarcerated individuals as people who were incarcerated at any point within the last five years, or those who were under supervision following a release from jail or prison during the previous five years. It also recognizes formerly incarcerated individuals among the program’s priority groups.
Comments can be submitted online until March 16. If significant comments against the rule are submitted, the rule will be withdrawn and those comments will be considered in response to a corresponding proposed rule DOL has published. Otherwise, the rule will go into effect on April 15.
ICYMI: Input needed on DHS’ proposed “Public Charge” rule
The Department of Homeland Security (DHS) is seeking comments on a proposed rule that would define the criteria used to determine whether a person likely to become a “public charge,” or primarily dependent on the government for subsistence, for purposes of determining eligibility for a visa and/or legal residency. The proposed rule contains several provisions that directly affect older adults and people with disabilities, so input from ACL’s networks is critical. Comments may be submitted until April 25, 2022. Our blog post from March 7 has the details.
White House Fact Sheet: Improving Safety and Quality of Care in Nursing Homes
In his State of the Union address on Feb. 28, President Biden reiterated his commitment to building a long-term care infrastructure, calling out the need to expand home and community-based services and hold nursing homes accountable for providing quality care. Earlier that day, the White House released a fact sheet that outlined the details of the President’s plan for nursing home reform. Highlights include:
- Setting minimum staffing requirements
- Increasing accountability through inspection and enforcement changes and focus on the poorest nursing homes
- Improving quality through payment changes
- Improving data for consumer decision-making
- Increasing transparency of who owns nursing homes and who is accountable for care
- Improving quality of life by promoting single-occupancy rooms and otherwise reducing crowding
- Reinforcing requirements against unnecessary drugs
- Providing assistance to help nursing homes improve
The initiative will include a focus on workforce, with goals of increasing the number of people entering the caring workforce and the availability of high-quality training. The Centers for Medicare & Medicaid Services and Department of Labor will launch a National Nursing Career Pathways Campaign.
CDC’s Updated Developmental Milestones for Children
CDC has revised its developmental milestones to help parents, healthcare providers, and early childhood professionals identify children with developmental disabilities at younger ages, and connect them earlier to the interventions that have been shown to improve outcomes.
Prior to the update, the checklists indicated when 50% of children were expected to reach certain developmental milestones That made identifying children with developmental disabilities early difficult, because it didn’t provide clarity around when additional screening may be helpful. The checklists now indicate when 75% of children are expected to reach certain milestones, to make it easier to determine when a child might benefit from further evaluation. The new update also includes checklists for ages 15 and 30 months, so that a checklist is available for each recommended well-child visit.