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Authors Posts by Fady Sahhar

Fady Sahhar

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Fady is responsible for policy and regulatory matters related to Physical Disabilities and Aging, with primary focus on personal assistance, employment services, and service coordination. Emphasis is placed on engaging the Office of Long-Term Living and the Community HealthChoices Managed Care Organizations, coordination of care with Behavioral HealthChoices MCOs, and collaborations with other advocacy and provider associations. Fady is also the President / CEO of ProVantaCare, an RCPA-affiliated company focused on contracting with MCOs, and is the President of XtraGlobex, a consulting firm focused on Value-Based Payment contracting. He brings extensive experience in the advocacy and operations of human services providers in physical disabilities and aging, from his role at Liberty Resources, Inc., and his service with a number of nonprofit services providers. He earned an MBA in Marketing from The University of Tennessee and a PhD in Organizational Leadership from Capella University.

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Photo by Markus Winkler on Unsplash

The Medical Assistance (MA) Bulletin posted on 10-22-2021 applies to all providers that render personal care services (PCS) to beneficiaries in the fee-for-service (FFS) delivery system, including Agency with Choice and Vendor Fiscal/Employer Agent financial management services organizations that provide PCS to MA participants who are enrolled in an Office of Developmental Program or Office of Long-Term Living waiver, the Act 150 Program, or a Community HealthChoices managed care organization.

The purpose of the bulletin is to:

  • Advise providers of updates to certain error status codes (ESC) for PCS subject to electronic visit verification (EVV), effective for claims received on and after October 22, 2021; and
  • Advise providers of an updated Provider Assistance Center (PAC) contact e-mail for their use.

Providers rendering PCS in the managed care delivery system should address any questions regarding ESCs for PCS subject to EVV with the applicable managed care organization.

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Photo by Markus Winkler from Pexels

On September 28, 2021, AmeriHealth Caritas, which operates Medicaid managed care plans in 13 states and the District of Columbia, launched a new wholly-owned subsidiary called Social Determinants of Life, Inc. The subsidiary will invest in, support, and deploy solutions to help members build resilience, and help improve their health and create a path out of poverty. AmeriHealth Caritas is currently hiring for key leadership positions at the new company.

As the first step for Social Determinants of Life, Inc., AmeriHealth Caritas invested $29 million in Wider Circle in a $38 million funding round, becoming Wider Circle’s largest shareholder. Wider Circle is a California-based startup that builds tech-enabled, hyper-local health programs and peer-to-peer social networks. Its community care model is centered around trust, where culturally competent community engagement leaders and volunteer member ambassadors form groups with their neighbors to inform, support, and motivate one another to be more engaged and proactive about their health. Wider Circle is using the investment funds to continue developing and expanding its model. AmeriHealth Caritas has not released details about how Social Determinants of Life will leverage the Wider Circle model.

Commenting on the funding round, Darin Buxbaum, president and chief operating officer of Wider Circle said, “With the support of AmeriHealth Caritas’s new Social Determinants of Life, Inc., Blue Venture Fund and others, Wider Circle is well positioned to extend our proven hyper-local engagement model to improve health outcomes in communities nationwide.” Wider Circle offers programs to tens of thousands of members in more than 320 communities nationwide across the country

Wider Circle works with Medicare Advantage plans, Medicaid managed care organizations and capitated provider organization groups. The company seeks to align with the health plan sponsors through a per engaged member per month payment model. In this model, Wider Circle is paid for each actively engaged member as long as the member remains engaged in the Wider Circle group. The groups meet 10 or more times each year at favorite local public meeting spots, and connect on the phone every other week.

Wider Circle uses an evidence-based, data-driven approach to identify and group health plan members at the local level based on demographic and similar backgrounds. The company hires community engagement and outreach specialists from the same communities to invite health plan members to participate in the local groups. From there, neighbors help the group recruit other neighbors and open doors that would otherwise remain closed.

Trained facilitators build trusted groups of neighbors in a culturally competent manner by engaging members via weekly small-group meetings for six weeks. During this group formation period, the facilitators recruit and encourage able members to become volunteer “ambassadors” to help lead the group and ensure that members are informed about planned meetings and have access to the resources they need. To support the group leaders Wider Circle has employees in every community supported by Area Managers and state and account leadership.

After training, the group members support one another through tailored in-person and virtual interactions. The groups can meet in restaurants, parks, community centers, houses of worship, and other public gathering areas. The group members meet almost every month and chat on the phone every other week.

Wider Circle programs have helped Medicare and Medicaid plan members improve preventative care utilization and vaccine adoption rates while reducing hospital days. During the coronavirus disease 2019 (COVID-19) public health emergency, the Wider Circle groups supported participants facing isolation, delivered more than 180,000 meals, and helped participants access comprehensive social support services.

AmeriHealth Caritas serves nearly 5 million Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, and behavioral health services.

OPEN MINDS last reported on AmeriHealth Caritas in the following articles.

For more information, contact:

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Message from Centers for Medicare and Medicaid Services (CMS):

Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and Most Commercial Health Insurance Coverage.

Following the FDA’s recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the CDC, CMS will continue to provide coverage for this critical protection from the virus, including booster doses, without cost sharing.

Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance, or deductible. In addition, thanks to the American Rescue Plan Act of 2021, nearly all Medicaid and CHIP beneficiaries must receive coverage of COVID-19 vaccines and their administration, without cost-sharing. COVID-19 vaccines and their administration, including boosters, will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market. People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.

“The Biden-Harris Administration has made the safe and effective COVID-19 vaccines accessible and free to people across the country. CMS is ensuring that cost is not a barrier to access, including for boosters,” said CMS Administrator Chiquita Brooks-LaSure. “CMS will pay Medicare vaccine providers who administer approved COVID-19 boosters, enabling people to access these vaccines at no cost.”

CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations. More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available on the CDC COVID-19 Vaccination Program Provider Requirements and Support webpage and through the CMS COVID-19 Provider Toolkit.

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Message from Centers for Medicare and Medicaid Services (CMS): 

New action will protect patients of the 50,000 providers and over 17 million health care workers in Medicare and Medicaid certified facilities

The Biden-Harris Administration will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant. Facilities across the country should make efforts now to get health care staff vaccinated to make sure they are in compliance when the rule takes effect.

The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), announced that emergency regulations requiring vaccinations for nursing home workers will be expanded to include hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others, as a condition for participating in the Medicare and Medicaid programs. The decision was based on the continued and growing spread of the virus in health care settings, especially in parts of the U.S. with higher incidence of COVID-19.

“There is no higher priority for us than patient health and safety. As the Delta variant strengthens, the Biden-Harris Administration is committed to doing everything we can to keep patients, and those who care for them, safe,” said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. “There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health. Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential.”

Nursing homes with an overall staff vaccination rate of 75% or lower experience higher rates of preventable COVID infection. In CMS’s review of available data, the agency is seeing lower staff vaccination rates among hospital and End Stage Renal Disease (ESRD) facilities. To combat this issue, CMS is using its authority to establish vaccine requirements for all providers and suppliers that participate in the Medicare and Medicaid programs. Vaccinations have proven to reduce the risk of severe illness and death from COVID-19 and are effective against the Delta variant.  CMS will continue to work closely with all Medicare and Medicaid certified facilities to ensure these new requirements are met.

“We know that those working in health care want to do what is best for their patients in order to keep them safe,” said CMS Administrator Chiquita Brooks-LaSure. “As the Delta variant continues to spread, we know the best defense against it lies with the COVID-19 vaccine. Data show that the higher the level of vaccination rates among providers and staff, the lower the infection rate is among patients who are dependent upon them for care. Now is the time to act. I’m urging everyone, but especially those fighting this virus on the front lines, to get vaccinated and protect themselves, their families, and their patients from COVID-19.”

CMS is developing an Interim Final Rule with Comment Period that will be issued in October. CMS expects certified Medicare and Medicaid facilities to act in the best interest of patients and staff by complying with new COVID-19 vaccination requirements. Health care workers employed in these facilities who are not currently vaccinated are urged to begin the process immediately. Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.

Please note that RCPA is working diligently with the Department of Health, Department of Human Services, and the Governor’s Office in order to obtain clarification of the above information. In this way, we will be able to fully understand the impact of this expansion. If you have any questions, please contact your RCPA Policy Director.

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Photo by Chris Montgomery on Unsplash

The National Disability Rights Network and the American Association of People with Disabilities will be hosting the 2021 Disability Vote Summit on Tuesday, September 14, 2021, from 12:00 pm–4:00 pm EST.

At the virtual summit, they will explore:

  • The power of the disability vote
  • Lessons learned from 2020 turnout
  • How to use data to mobilize the disability vote

Confirmed presenters include representatives from the National Disability Rights Network, the National Federation of the Blind, SABE Go Voter Project, and more! Join national disability advocates, state and local organizers, policymakers, and others who are working to get out the disability vote.

If you have any questions, please contact Lilian Aluri or Jack Rosen.

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