HHS is holding webinars on the new reporting requirements, for which participants will need to register.
State legislative session is off and running
Today marks day four of what promises to be a lengthy, contentious legislative session. So far, more than 400 bills have been introduced, and that number will increase rapidly as we approach the first deadline of session. After 5 p.m. today, members of the House are limited to no more than seven more bills each. Members who are prolific bill sponsors or who want to “make a statement” in advance of the November election, must introduce their bills soon. Of interest to hospitals and healthcare, there are quite a few bills related to vaccine mandates and exemptions—as predicated, this will be a strong theme of the session. AzHHA will be reviewing all bills of interest in our weekly legislative updates to members every Friday at 1:30 p.m. starting January 14. A calendar item has been shared with members. Please contact us with any questions.
Opening Day also featured Governor Ducey’s final State of the State address, his eighth one—an accomplishment that hasn’t happened in over three decades. The Governor highlighted some of his priorities for this year, which included border security and water issues, and didn’t focus on hospitals or healthcare in his remarks. On Friday, the Governor’s budget proposal will be released, giving us further insight into any proposals affecting healthcare or workforce development, which is expected to be a focus area.
DIFI publishes standardized prior authorization forms
Laws 2021, Chapter 115 (HB 2621) directed the Department of Insurance and Financial Institutions (DIFI) to approve two uniform prior authorization request forms for (1) prescription drugs, devices and durable medical equipment and (2) all other healthcare procedures, treatment and services. DIFI recently published the forms as part of Regulatory Bulletin 2021-01. Prior authorization requests that are submitted on forms other than these approved forms on or after January 1, 2023, will be invalid under HB 2621.
CMS releases additional guidance for the No Surprises Act
The Centers for Medicare & Medicaid Services (CMS) recently released several new resources to assist with the implementation of the No Surprises Act. The documents include
a series of frequently asked questions related to the federal independent dispute resolution (IDR) process and notice of consent requirements;
frequently asked questions related to the uninsured and self-pay good faith estimates;
several new guidance documents on the patient-provider dispute resolution process for providers, facilities, select dispute resolution entities and uninsured/self-pay patients. The guidance for facilities and providers may be accessed here;
a list of certified IDR entities;
letters notifying states of CMS’ understanding of the requirements that each state is enforcing either directly or through a collaborative enforcement agreement, and the provisions that CMS will enforce. These letters also communicate whether the federal IDR process and the federal patient-provider dispute resolution process apply in each state, and in what circumstances;
the qualified payment amount (QPA) calculation methodology and
guidance on states with external review processes, including a process for referring matters to the federal government in instances when states cannot accommodate No Surprises Act compliance.
HHS updates COVID-19 reporting requirements
The U.S. Department of Health and Human Services (HHS) updated its guidance last week on reporting COVID-19-related data. Specifically, HHS guidance:
- adds new data fields for the COVID-19 monoclonal antibody therapeutic Sotrovimab, effective January 19, 2022, every week.
adds new data fields for pediatric beds. Effective on a daily basis starting February 2, 2022.
converts several existing influenza hospitalization data elements from optional to mandatory reporting, starting February 2, 2022, on a daily basis.
deactivates reporting of 27 data elements, primarily focused on supply chain and therapeutics whose use has been curtailed (e.g., remdesivir).
The Arizona Department of Health Services (ADHS) is working with its vendor Juvare to ensure EMResource is updated in a timely manner to align with the new HHS data fields for those hospitals reporting federal data through EMresource. HHS is holding webinars on the new reporting requirements, for which participants will need to register.
VAPAC approves COVID-19 antiviral prioritization - ADHS updates therapeutic resources
The Arizona Vaccine and Antiviral Prioritization Committee (VAPAC) met last week and approved tiered prioritization criteria for the COVID-19 antivirals Paxlovid and Molnupiravir. ADHS has also updated its therapeutics resource page to include information in English and Spanish on antiviral therapies as well as monoclonal antibody treatment. The resource page includes a link to a therapy locator map.
U.S. Supreme Court may rule on federal vaccine mandates this month
The U.S. Supreme Court held oral arguments January 7 on whether to allow CMS’ COVID-19 vaccine mandate for healthcare workers and the Occupational Safety and Health Administration’s (OSHA) vaccine-or-test mandate applicable to employees at places of work with at least 100 employees to go into effect pending review in the courts of appeals.
While difficult to predict, experts have suggested the Court likely will allow the CMS vaccine mandate to go into effect nationwide. The federal government emphasized at oral argument that CMS will exercise its enforcement discretion so that facilities working in good faith to vaccinate their staff do not have to fear significant enforcement action. Regarding the OSHA mandate, observers indicated the Court signaled a willingness to uphold a vaccine-or-test mandate that is specifically tailored to certain high-risk workplaces. Experts predict the Supreme Court likely will rule not only on whether to uphold injunctions blocking the rules that were issued by lower courts but also on the ultimate enforceability of the vaccine mandates.
Many experts foresee a decision being issued by the Supreme Court within the month. Questions may be sent to Liz Lorenz, AzHHA director of policy.
AzHHA urges members of Arizona delegation to sign on to House ‘Dear Colleague’ letter
AzHHA has requested members of the Arizona Congressional delegation to sign on to a letter that is circulating in the House of Representatives asking the White House to enlist the support of federal agencies to investigate reports of anti-competitive behavior from nurse-staffing agencies, which has been contributing to significant workforce challenges during the pandemic.
The bipartisan letter cites reports that nurse staffing agencies are vastly inflating prices by two, three or more times pre-pandemic rates, and taking 40% or more of the amount being charged to the hospitals for themselves in profits. The letter urges the White House to ensure that the federal government takes steps to prevent conduct that is exacerbating the shortage of nurses, straining the healthcare system and ultimately negatively impacting patient care. AzHHA is grateful for Senator Kelly’s leadership in originally bringing this issue to the attention of the White House and calling for action in this November 15, 2021 letter.
Questions may be sent to Debbie Johnston, AzHHA executive vice president.
At home COVID-19 tests to be covered by insurance beginning January 15
Individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration, will pay zero out-of-pocket costs. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month starting January 15. State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. Frequently asked questions relating to free at-home over-the-counter COVID-19 test kits are available on the Centers for Medicare and Medicaid Services’ website.
ADHS announces availability of COVID-19 booster to everyone age 12+
As the Omicron variant continues to increase its prevalence across the country, getting fully vaccinated and or a booster shot is crucial to slow the spread within our communities. Following the U.S Food and Drug Administration’s approval of the COVID-19 booster vaccine for children ages 12-15, ADHS announced the availability of the booster vaccine to all Arizonans age 12+. “We’re encouraged that even more Arizonans can update their protection against COVID-19 by getting a safe, free, and highly effective booster dose,” said Don Herrington, ADHS interim director.
To find a vaccine site near you, visit azhealth.gov/FindVaccines. The bilingual ADHS COVID-19 Hotline is available from 8 a.m. - 5 p.m. seven days a week at 844.542.8201.
AzHHA releases a new model for home and community-based palliative care
Serious illness impacts an estimated 45 million Americans and their families or caregivers. The Arizona Coalition Model was designed by the Arizona Coalition to Transform Serious Illness Care, a group of more than 40 stakeholders across Arizona dedicated to improving the lives of people with serious illness. “This is the model for our vision of palliative care services, giving those living with chronic illness – and their caregivers – some options for symptom management or overall goals of care,” said Vicki Buchda, AzHHA Vice President of Care Improvement. “Our hope is for payors and providers to use this flexible model so we may ultimately provide better care and support to those suffering.”
A white paper prepared by Discern Health, part of Real Chemistry on behalf of AzHHA, describes the services, operational requirements and measures of success to support medical and social determinants of health needs of those with serious illness. To read the full report or learn more about the Arizona Coalition Model visit azhha.org/az_model.
COVID-19 supportive care
Patients with acute or chronic COVID-19 symptoms and related complications are discovering COVID-19 supportive care – at no cost to them. “This is the first medical professional who has acknowledged my long COVID symptoms,” said a patient referred to the palliative care telehealth service this year. Prior to discovering the COVID-19 supportive care program, this patient noted the challenges they faced when trying to find the right care. “I’ve had the virus for eight months and had more than 40 doctor consultations!!! So, thank you.”
The service is open to people suffering with the complexities of COVID-19 related symptoms, or those chronic conditions exacerbated by COVID-19. Patients do not need a physician’s referral to receive this specialized, palliative care. Learn more at azhha.org/telehealth.
February 7 - Developing a Telemedicine Program
This course is ideal for individuals or groups who have some telehealth experience and are interested in expanding their services. It is also a great course for those new to telehealth who are interested in gaining a deeper understanding of the growing industry. The course fee is waived for Arizona, New Mexico, Utah, Colorado and Nevada residents. Register here.
Introduction to POLST
Interested in learning how to use the Arizona POLST form with your patients? The one-hour Introduction to POLST workshop equips healthcare professionals with knowledge and resources to begin using POLST, Physician Orders for Life-Sustaining Treatment, in Arizona. The objectives are to describe what POLST is at the state and national level, explain why POLST is important, define the population for POLST, when to begin the conversation and who completes POLST, describe the process for completing, reviewing and updating POLST and learn the process of submitting healthcare planning documents to the Arizona Healthcare Directive Registry. To register for a workshop, click on a date below.
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