The House voted 221-213 on a procedural move that advances a modified version of the Build Back Better Act.

House passes infrastructure bill; Build Back Better Act advances

The U.S. House of Representatives voted 228 to 206 on November 5 to pass the Infrastructure Investment and Jobs Act, a $550 billion bill including federal investments in broadband internet deployment, equity and affordability; clean drinking water; investments to improve federal coordination and assistance with response and recovery from significant cybersecurity incidents and various other infrastructure investments. President Joe Biden is expected to sign the bill into law on Monday at a bipartisan ceremony.

In addition, the House voted 221-213 on a procedural move that advances a modified version of the Build Back Better Act (H.R. 5376), a roughly $1.75 trillion social spending package including many healthcare provisions. The House is expected to pass the legislation before the Thanksgiving congressional recess. The American Hospital Association (AHA) and seven other national organizations representing hospitals and health systems have urged congressional leaders to remove the reductions to the Medicaid disproportionate share hospital program and uncompensated care pools from the Build Back Better Act. 

CMS omnibus rule requires COVID-19 vaccination for healthcare workers

On November 5, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule, requiring COVID-19 vaccinations for workers in most healthcare settings, including hospitals and health systems, that participate in Medicare and Medicaid programs. A vaccination mandate was also issued by the Occupational Safety and Health Administration (OSHA) on the same date; however, the CMS rule supersedes the OSHA regulation for all entities subject to the CMS rule.

In Phase 1 of compliance with the CMS rule, employers must put procedures in place and ensure employees receive their first dose (or a single dose vaccine) by December 5, 2021. In Phase 2, employers must ensure employees receive their second dose (if applicable) by January 4, 2022. Exemptions may be granted for medical or religious reasons consistent with federal law, and employers must develop accommodations for exempted staff. CMS will utilize established survey and enforcement processes to monitor compliance. Please refer to AzHHA’s Summary and CMS’s FAQs for more information.

10 states challenge CMS rule requiring COVID-19 vaccination for healthcare workers

A number of states filed a complaint in federal court on November 10 challenging CMS’ Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule requiring COVID-19 vaccinations for employees of healthcare entities that participate in the Medicare and Medicaid programs. The plaintiff states argue that the CMS vaccine mandate is unlawful and request that the court issue an injunction to stay its enforcement. The suit was brought by the following 10 states Missouri, Alaska, Nebraska, Arkansas, Kansas, Iowa, Wyoming, South Dakota, North Dakota and New Hampshire in the U.S. District Court for the Eastern District of Missouri.

CMS releases 2022 OPPS final rule

The calendar year 2022 final payment rule was released by CMS on November 2 for the Hospital Outpatient Prospective Payment System (OPPS). In the OPPS Final Rule, CMS announced, among other updates, that it will reverse the phased elimination of the inpatient-only list and restore nearly all the procedures that were removed from the list in 2021; continue to pay for 340B drugs at average sales price minus 22.5% and modify the hospital price transparency rule to include a significant increase to the civil monetary penalty for noncompliance. 

More information about the OPPS Final Rule is available here. AzHHA members will be receiving a detailed analysis regarding the impacts of this rule, including hospital-specific analysis. 

CMS announces telehealth expansions in 2022 Physician Fee Schedule final rule

CMS announced telehealth expansions in its calendar year 2022 Physician Fee Schedule Final Rule released on November 2. Certain services added to the Medicare telehealth services list during the COVID-19 public health emergency (PHE), which would otherwise expire as of the later of the end of the PHE or December 31, 2021, will remain on the list through 2023. During this period, CMS states it will continue to gather data and review stakeholders’ requests that services be permanently added to the Medicare telehealth services list.

Additionally, CMS is removing geographic restrictions and adding the home of the beneficiary as a permissible originating site for telehealth services furnished for diagnosis, evaluation or treatment of a mental health disorder as long as an in-person, non-telehealth visit is furnished at least every 12 months for these services. CMS is also allowing certain mental and behavioral health services to be provided via audio-only calls.

More information about the Physician Fee Schedule Final Rule is available here. AzHHA members will soon receive a detailed analysis regarding the impacts of this rule, including hospital-specific analysis.

Big changes to Arizona State Legislature

Turnover at the state legislature will bring many changes to the upcoming session, which convenes in around 60 days. So far, over 10% of state legislators will not be serving out the remainder of their terms, and that percentage may increase before the legislature convenes in January. AzHHA expects the turnover to change the composition of the Health and Human Services Committees, meaning education will be crucial starting now and through the end of the session. From a fiscal perspective, we have a flush outlook from the Joint Legislative Budget Committee. The FY 2023 state budget will likely be at the center of discussion as legislators debate how to spend the extra money. From a public health and healthcare perspective, we also expect continued conversation and bills relating to vaccines and mask mandates. As Governor Ducey closes out his second and final term, we can also expect this to have an impact on priorities and focus areas for next year. Below is a list of legislators who will not be returning in their current capacity come January 2022.

ADOSH issues a Notice of Proposed Rulemaking to implement ETS

The Industrial Commission of Arizona’s Division of Occupational Safety and Health (ADOSH ) issued a Notice of Proposed Rulemaking on November 5 to implement the federal COVID-19 Emergency Temporary Standards (ETS) issued last summer. In August, AzHHA sent a letter to OSHA expressing concerns about the ETS, and AzHHA has consistently communicated an appreciation for careful deliberation in the implementation of new standards that may not be consistent with already applicable rules and regulations. AzHHA strongly believes in the effectiveness of the COVID-19 vaccines and programs our members have put in place to protect patients and staff and urged OSHA to withdraw the ETS.

ADOSH is accepting comments on the proposed rule until 5 p.m. December 6, 2021. Comments should be sent to [email protected]. An oral proceeding is scheduled for December 7 at 9 a.m. at the Industrial Commission of Arizona, 800 W. Washington, room 206, Phoenix, AZ 85007. AzHHA members will be receiving an advisory with more information.

2022 NHSC loan repayment programs are accepting applications

Due to historic funding levels, the Health Resources & Services Administration’s National Health Service Corps (NHSC) is accepting applications for its loan repayment programs for its fall cycle. The three offered are

• NHSC Loan Repayment Program – awards up to $50,000 in exchange for a two-year commitment to provide primary medical, dental or mental/behavioral healthcare at approved sites in high-need, underserved areas.

• NHSC Substance Use Disorder (SUD) Workforce Loan Repayment Program - provides up to $75,000 in exchange for a three-year commitment to healthcare professionals who provide substance use disorder treatment services.

• NHSC Rural Community Loan Repayment Program – awards up to $100,000 for three years of service to providers in rural communities.

To apply, click here.

FDA authorizes iHealth COVID-19 Antigen Rapid Test under EUA

The U.S. Food and Drug Administration approved the use of the iHealth COVID-19 Antigen Rapid Test on November 5 under emergency use authorization(EUA). The newly approved test delivers results in 15 minutes. iHealth anticipates producing 100 million tests per month, with capacity increasing to 200 million per month in early 2022, according to the FDA’s news release.

CDC updates guidance on retesting children who received recalled blood lead tests

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Update November 5 to clarify options for retesting children who were tested with the recalled LeadCare lead test kits. Although most of the information remains the same as in the HAN recalling the tests kits, new information has been added under the Recommendations for Clinicians section.

Request for information for CYE 2023 AHCCCS DAP Metrics

The Arizona Health Care Cost Containment System (AHCCCS) released a Request for Information last week on the calendar year end 2023 Differential Adjusted Payment (DAP) strategies and is requesting feedback. Proposed metrics include:

All hospitals except IHS/638 facilities

• continue the development and execution of a data quality improvement effort, as defined by the qualifying health information exchange (HIE) organization.

• require usage of the closed-loop referral system at least 10 times per month as a milestone in the HIE DAP.

IHS/638 facilities

• develop and execute a data quality improvement effort, as defined by the qualifying HIE organization.

Integrated Clinics

• develop a DAP to incentivize providers to serve members with serious mental illness designations who are enrolled in the American Indian Health Program.

• develop and execute a data quality improvement effort, as defined by the qualifying HIE organization.

• add a minimum threshold of an average of 10 monthly referrals through the closed-loop referral system.

Behavioral Health Outpatient Clinics

• develop a DAP to incentivize providers to serve members with serious mental illness designations who are enrolled in the American Indian Health Program.

• develop a data quality improvement plan with a qualifying HIE organization as well as access patient health information via a qualifying HIE organization utilizing one or more HIE services.

• add a minimum threshold of an average of 10 monthly referrals through the closed-loop referral system.

AzHHA is seeking member input before submitting comments to AHCCCS. Please send comments or questions to Amy Upston, director of financial policy at [email protected] by Monday, November 29.

Upcoming Events

November 16 - Advancing DEI (diversity, equity and inclusion) in Healthcare Leadership

The Arizona Telemedicine Program will host a webinar November 16 at noon geared towards identifying strategies to advance and incorporate diversity, equity and inclusion (DEI) within healthcare practices through the creation of DEI councils. To learn more or register, here.

December 2 - 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. Register, here.

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