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Medicaid

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Mandatory Vaccination Update
Medicare and Medicaid Programs: Omnibus COVID-19 Health Care Staff Vaccination
OSHA Emergency Temporary Standard (ETS)  

RCPA continues to work for clarification with our State stakeholders from the Department of Human Services (DHS) and the Governor’s office as well as for guidance at the federal end through our National Councils.

The National Council on Mental Wellbeing has received several questions around the recent vaccine mandates released by the Biden Administration. The following links and summaries from the Council’s federal consultant group may answer some of your questions.

On November 4, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment (IFC), entitled “Medicare and Medicaid Programs: Omnibus COVID-19 Health Care Staff Vaccination” (Rule and Press Release).The FAQ provides excellent scenario-based guidance that may be applicable to your agency.

The IFC stipulates that all staff members of certain providers and suppliers participating in the Medicare and Medicaid programs, including those who perform their duties outside of a formal clinical setting, must be fully vaccinated against COVID-19 unless exempt. The definition of applicable facilities under the Medicare-certified providers and suppliers is listed under federal statute (for example, the current Medicare definition of CMHCs (there are 129 Medicare-certified CMHCs throughout the country), which is Section 4162 of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101–508, enacted November 5, 1990) (OBRA 1990), which added sections 1861(ff) and 1832(a)(2)(J) to the Act, includes CMHCs as entities that are authorized to provide partial hospitalization services under Part B of the Medicare program).

However, the definition of Medicaid-certified providers and suppliers will vary by state. To that end RCPA, as part of its efforts, is seeking this clarification and to confirm determinations on which providers and suppliers are subject to the IFC. 

As noted in the summary below, the IFC does not allow for weekly testing in lieu of vaccination and maintains the employer’s right to require full vaccination of employees regardless of exemptions listed in the IFC. The final rule is expected to be published in The Federal Register on November 5, 2021, with an expected effective date of January 4, 2022. There will be the opportunity to comment on the IFC. Comments must be received no later than 60 days after the publication of the IFC in The Federal Register.

Also released was the Occupational Safety and Health Administration (OSHA) Emergency Temporary Standard (ETS) for COVID-19 Vaccination and Testing in the Workplace (Rule; Fact Sheet; Press Release). The ETS requires employees who are employed by private-sector employers with 100 or more employees to get vaccinated or test negative for the virus once per week and wear a mask indoors. It also requires employers to provide paid time off for employees to get vaccinated and recovery time from vaccination. The 28 states with OHSA-approved state plans must also adhere to the ETS.

The ETS mandates that employers determine the vaccination status of each employee, obtain acceptable proof of vaccination status from vaccinated employees, and maintain records and a roster of each employee’s vaccination status.

The testing requirement for unvaccinated workers is slated to begin on January 4, 2022, and employers must comply with all other requirements (i.e. providing paid time off for employees to get vaccinated and masking for unvaccinated workers) by December 5, 2021. Employees falling under the ETS rules will need to have their final vaccination dose by January 4, 2022.

OSHA has published a series of resources with respect to this ETS, including frequently asked questions, guidance materials, and reporting requirements.

RCPA will continue to update members on the status and any changes to the current information that has been published.

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As required by the Biden-Harris Administration, the Centers for Medicare and Medicaid Services (CMS) issued an emergency regulation that requires the COVID-19 vaccination of eligible staff at heath care facilities that participate in Medicare and Medicaid programs.

The regulation will create a consistent standard within Medicare and Medicaid while giving patients assurance of the vaccination status of those delivering care. These requirements will apply to approximately 76,000 providers and cover over 17 million health care workers across the country.

Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 5, 2021. All eligible staff must have received the necessary shots to be fully vaccinated (either two doses of Pfizer or Moderna or one dose of Johnson & Johnson) by January 4, 2022.

The regulation also provides for exemptions based on recognized medical conditions or religious beliefs, observances, or practices. Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law.

CMS will ensure compliance with these requirements through established survey and enforcement processes. If a provider or supplier does not meet the requirements, it will be cited by a surveyor as being non-compliant and have an opportunity to return to compliance before additional actions occur. CMS’s goal is to bring health care providers into compliance. However, the Agency will not hesitate to use its full enforcement authority to protect the health and safety of patients.

The requirements apply to: Ambulatory Surgical Centers, Hospices, Programs of All-Inclusive Care for the Elderly, Hospitals, Long Term Care facilities, Psychiatric Residential Treatment Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Home Health Agencies, Comprehensive Outpatient Rehabilitation Facilities, Critical Access Hospitals, Clinics (rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), Community Mental Health Centers, Home Infusion Therapy suppliers, Rural Health Clinics/Federally Qualified Health Centers, and End-Stage Renal Disease Facilities.

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Over the weekend, RCPA staff was contacted by a state representative informing us that a proposal was discussed during the current budget negotiations that would have a negative impact on children with disabilities, who currently qualify for Medical Assistance, often referred to as loophole kids. Loophole kids often come from homes with one or two working parents, and these families generally have private health care insurance coverage and are paying health insurance premiums. The proposals being discussed would add additional cost sharing and/or mandated premiums to already stretched and limited household budgets, and force people who live in poverty to choose between paying the state, and covering other monthly expenses such as food, prescriptions or rent. The proposals being discussed would impose new administrative costs for the Commonwealth, wasting state and federal Medicaid dollars on unnecessary administrative burdens. On Sunday, July 9, RCPA staff sent emails and hand delivered letters to the entire General Assembly and legislative leaders opposing any proposal that would harm Pennsylvania families by making it harder for them to qualify for and keep their health coverage.

Additionally, in its correspondences, RCPA requested that the legislature table this proposal because an important issue such as this should not be entered into during the waning days of budget negotiations. RCPA argued that these types of decisions that affect thousands of disabled Pennsylvania children should be discussed in a public hearing or in stakeholder group meetings before endangering health care benefits for the Commonwealth’s most vulnerable population.

RCPA implores providers to contact their legislators and tell them to oppose this last minute budget negotiating item, and alternatively, if they are serious about discussing this issue then hold a public hearing or stakeholder group meetings, so those who rely upon this funding can have their voices heard. Questions, contact Jack Phillips, RCPA Director of Government Affairs.

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Early this week, Richard Edley, RCPA President/CEO, met with staffers from Congressmen Costello, Dent, Fitzpatrick, and Meehan’s offices, as well as Senators Toomey and Casey to discuss the current negotiations taking place on health care. RCPA highlighted the financial impacts that the “American Health Care Act” would have on Pennsylvanians and urged the Congressmen and Senators to oppose any proposal that results in cuts or rollbacks of Medicaid. RCPA stressed that Medicaid is the single largest payer of mental health and addiction treatment services in the country. Any proposals that rollback Medicaid coverage or restrict people’s access to treatment will have a significant impact on this vulnerable population.

Additionally, RCPA staff had a productive meeting with Charlotte Pineda in Congressman Fitzpatrick’s office. In that meeting, RCPA gave its support to Congressman Fitzpatrick’s “Road to Recovery Act.” This bipartisan bill addresses the antiquated and problematic IMD Final Rule and will enable Pennsylvania to expand access to residential treatment for substance use disorders, while not intruding on a state’s flexibility to implement care. Jack Phillips, RCPA Director of Government Affairs, will be scheduling additional follow-up meetings with the Congressman and his staff on the “Road to Recovery Act” and other health care issues.

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