HHS Increases and Begins Distributing Over $24 Billion in Phase 3 COVID-19 Provider Relief Funding

December 16, 2020

Today, the Trump Administration, through the Health Resources and Services Administration (HRSA) is announcing it has completed review of Phase 3 applications from the Provider Relief Fund (PRF) program and will distribute $24.5 billion to over 70,000 providers. Up from the $20 billion originally planned, the addition of another $4.5 billion in funding is being used to satisfy close to 90 percent of each applicant’s reported lost revenues and net change in expenses caused by the coronavirus pandemic in the first half of 2020. The U.S. Department of Health and Human Services (HHS) recognizes this pandemic has upended the health care system and caused significant financial hardships. These resources, along with previous distributions, have provided much needed relief. Payment distribution started today and will continue through January, 2021.

“HHS is providing more than $24 billion in new relief to more than 70,000 healthcare providers, meeting close to 90 percent of the losses they’ve reported from the COVID-19 pandemic in the first half of the year,” said HHS Secretary Alex Azar. “With the Provider Relief Fund, we’ve been able to support providers hardest hit by COVID-19, including safety net hospitals, rural providers, and nursing homes, helping ensure they can continue serving their communities during and beyond the pandemic.”

HHS has designed the PRF program to be agile and responsive to the shifting dynamics of this pandemic. As with other General Distributions, applicants that have not already received a baseline payment of 2 percent of annual revenue from patient care were eligible to do so. Recognizing the ongoing challenges for providers, HHS enhanced the Phase 3 distribution to consider the actual revenue losses and expenses experienced by providers that were attributable to COVID-19. With this opportunity, previously eligible PRF applicants were invited to apply for additional funding, along with first time applicants.

As HHS began analyzing applications, it realized the submissions for lost revenues and net changes in expenses would exceed the $20 billion budgeted for the Phase 3 allocation. In an effort to meet the demand, HHS worked to add another $4 billion to the allocation bringing the new total to over $24 billion. This funding will distribute to providers up to 88 percent of their reported losses. It is worth noting that over 35,000 applicants will not receive an additional payment either because they experienced no change in revenues or net expenses attributable to COVID-19, or because they have already received funds that equal or exceed reimbursement of 88 percent of reported losses.

HHS was pleased to find in its analysis that providers disproportionately impacted by this pandemic applied and will be receiving another infusion of financial relief. Nursing homes for example, will be receiving another $1.10 billion in Phase 3 funding. This builds on the half billon in incentive payments HHS recently announced and the over $15 billion in aggregate funding already distributed. Ambulance, or transportation services providers, will be receiving $1.48 billion in Phase 3 funding.

As the nation celebrates the historic arrival of COVID-19 vaccines, equipping providers with resources to address personal protective equipment needs, expand capacity and explore other responses to combat this pandemic remains an urgent and present priority. The PRF program will continue to support providers in addressing these immediate needs as demonstrated by today’s announcement and through future funding opportunities.

Payments to Phase 3 applicants will begin today and continue as application quality reviews and recipient payment set up are completed before payment can be made. A state-by-state breakdown on the first batch of Phase 3 payments can be found here – PDF. This data will be updated through January as Phase 3 payments are completed. It is important to note this state-by-state data is tied to the state in which a recipient’s IRS Tax Identification Number (TIN) is registered. It is possible recipients render health care services in states other than their listed TIN. After recipients attest to the terms and conditions for funding, they will be listed in the PRF public dataset.

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27 senators urge inclusion of surprise-billing deal in year-end package

Alia Paavola

Twenty-seven senators are urging Senate leaders to include a measure to ban surprise billing in a year-end government funding package, according to The Hill. 

Democratic and Republican leaders of four committees in the House and Senate reached a deal to end surprise medical billing Dec. 11. 

The committees decided that the best approach would be banning physicians and hospitals from charging patients fees their insurer will not cover and holding patients harmless when they receive emergency care from out-of-network providers. Payment rates would be based on the median amount insurers in a given area pay in-network providers and also allows providers to enter into arbitration to gain higher reimbursements.

But the fate of the bill is undecided because it is unclear whether Senate Majority Leader Mitch McConnell, R-Ky., will agree to include it in the funding package. 

“There will never be a broader bipartisan, bicameral solution to ending surprise medical billing, and we should deal with it now,” the 27 senators wrote to Mr. McConnell and Senate Minority Leader Chuck Schumer, D-N.Y.,  according to The Hill. “Patients cannot wait any longer.”

The deal reached Dec. 11 has support from unions, insurers and consumer groups. The White House has also expressed support. 

But the American Medical Association and American Hospital Association expressed concerns about the legislation. 

The AMA said it is worried that small physician practices might not be able to receive fair compensation under the arbitration process outlined in the bill. The AHA said it wants to see penalties for health plans that fail to reimburse providers for out-of-network care and clarification that out-of-network providers are responsible for managing their own notice and consent process with patients.

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Hospital CEOs among first to get COVID-19 vaccine to send public message

Morgan Haefner

In several states, hospital CEOs have been among the first to receive the COVID-19 vaccine. Many leaders hope the move will help their communities see the vaccine as safe and increase adoption.

On Dec. 11, the FDA authorized Pfizer-BioNTech’s vaccine for emergency use in the U.S. At Providence, R.I.-based Care New England, President and CEO James Fanale, MD, was the first in line at the health system for the vaccine on Dec. 15. Dr. Fanale is a practicing geriatrician, and wanted to send a strong public message that the vaccine is safe, according to The Providence Journal.

In Washington, D.C., Anita Jenkins, the CEO of Howard University Hospital, was among the first to be vaccinated in a move she hopes would address doubts that Black Americans may have about the vaccine. Black Americans have been disproportionately affected by the pandemic.

“Healthcare disparities, research, all of that has not necessarily been a smooth ride for Black and brown people in the United States,” Ms. Jenkins told WUSA 9. “That’s why this COVID vaccine is met with skepticism. But let’s please understand, we are losing the battle with COVID. Black and brown people are dying about three times more from this disease than others.”

In addition to being among the first to get the COVID-19 vaccine, hospital CEOs are also using the stories of their front-line workers as a symbol for their communities. Maritza Beniquez, an emergency room nurse at University Hospital in Newark, N.J., was the state’s first person to receive the vaccine, according to ROI-NJ.

University Hospital CEO Shereef Elnahal, MD, said Ms. Beniquez’s, and other healthcare workers’ “adoption of this vaccine will be key to convince community members to vaccinate later. Our healthcare heroes have been, and continue to be, trusted voices for healthcare in our community, and we hope that they will carry the message that these vaccines are safe and effective,” he told ROI-NJ.

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ACA heads to Supreme Court Nov. 10: 5 things to know

Kelly Gooch

The U.S. Supreme Court is set to hear a case questioning the legality of the ACA on Nov. 10.

Five things to know:

1. At the center of the case is whether the health law should be struck down. In a brief filed June 25 in Texas v. United States, the Trump administration argues the entire ACA is invalid because in December 2017, Congress eliminated the ACA’s tax penalty for failing to purchase health insurance. The administration argues the individual mandate is inseverable from the rest of the law and became unconstitutional when the tax penalty was eliminated; therefore, the entire health law should be struck down.

2. The administration’s brief was filed in support of a group of Republican-led states seeking to undo the ACA. Meanwhile, California Attorney General Xavier Becerra is leading a coalition of more Democratic states to defend the ACA before the Supreme Court. 

3. The case goes before the Supreme Court days after media outlets projected Joe Biden as the next president of the U.S. President-elect Biden has said he seeks to expand government-subsidized insurance coverage and wants to the bring back the ACA’s tax penalty for failing to purchase health insurance, according to The Wall Street Journal. If a change regarding the tax penalty did occur, the publication notes that Republicans’ argument on severability would no longer apply.

4. The case also goes before the Supreme Court about two weeks after the Senate voted Oct. 26 to confirm Amy Coney Barrett to the Supreme Court. Ms. Barrett previously criticized Chief Justice John Roberts’ 2012 opinion sustaining the law’s individual mandate, The New York Times reported, but she said during her confirmation hearings in October that “the issue in the case is this doctrine of severability, and that’s not something that I have ever talked about with respect to the Affordable Care Act.”

5. According to the Journal, the Supreme Court is not expected to make a decision in the case until the end of June.

Pfizer’s COVID-19 vaccine prevents 90% of infections, interim trial analysis finds

Katie Adams

Clinical trial data for the COVID-19 vaccine Pfizer is developing  with BioNTech shows the candidate can prevent more than 90 percent of infections, the drugmaker said Nov. 9.

The results are based on an interim analysis of a trial in which 94 participants, half of whom received a placebo and half of whom received a vaccine, contracted COVID-19. Pfizer will continue the trial until 164 COVID-19 cases occur in order to gather more data and determine the candidate’s performance against other study endpoints.

Pfizer plans to collect two months of safety follow-up data, a key requirement laid out by the FDA before it grants emergency use authorization. That data is expected to be gathered by the third week of November, and if it raises no concerns, the drugmaker could apply for emergency use authorization by the end of the month. An accelerated review of the vaccine is underway in the U.K.

“This is about the best the news could possibly be for the world and for the United States and for public health,” William Gruber, Pfizer’s senior vice president for vaccine clinical research and development, told Bloomberg, saying the findings were better than even the best result he had wished for.

Analysis has not yet been conducted on the vaccine’s efficacy among key subgroups, such as older patients. Pfizer also has not yet studied how the vaccine  prevents severe cases of COVID-19.

HHS unveils plan to get coronavirus vaccines to nursing homes

Associated Press

WASHINGTON (AP)  Federal health officials on Friday unveiled a plan to get approved coronavirus vaccines to nursing home residents free of cost, with the aid of two national pharmacy chains.

No vaccine has yet been approved by the Food and Drug Administration, and the distribution program is contingent on that happening first.

Under the plan, trained staff from CVS and Walgreens will deliver the vaccines to each nursing home and administer shots. Assisted-living facilities and residential group homes can also participate in the voluntary program. Nursing home staffers can be vaccinated too, if they have not already received their shots. Needles, syringes and other necessary equipment will be included.

The idea is to give hard-pressed states an all-inclusive system for vaccinating their most vulnerable residents, said Paul Mango, a senior policy adviser at the Department of Health and Human Services. “We are trying to eliminate all potential barriers to getting folks safe and effective vaccines,” Mango said.

People in nursing homes and other long-term care facilities account for less than 1% of the U.S. population, but they account for about 40% of the deaths from COVID-19, with more than 83,600 fatalities logged by the COVID Tracking Project.

The Trump administration’s initial attempts to promote coronavirus testing in nursing homes and to ensure sufficient supplies of protective gear were hampered by missteps and led to widespread complaints from nursing home operators and advocates for older people. The vaccine program seems designed to prevent a repeat at a time when President Donald Trump is battling to hang on to support from older voters.

Vaccines will be on their way to nursing homes within 24 to 48 hours after the FDA approves their use, Mango said.

The effort is taking place under the auspices of Operation Warp Speed, a White House-backed effort to quickly produce and distribute hundreds of millions of doses of approved vaccines, enough for every American.

Mango said he anticipates that if a vaccine is approved this year, initial supplies would be limited. Availability will improve markedly in the first three months of 2021, he said.

HHS is fielding an online survey for nursing homes to assess their interest in the program, but the allocation of vaccines will be done through state and territorial governments.

Nursing homes and long-term care facilities will not be charged for the program. CVS and Walgreens will be reimbursed for administering the shots at standard Medicare rates, officials said.

Texas hospital seeks critical access status as break with Baylor Scott & White looms

Morgan Haefner, Becker’s Healthcare

Llano (Texas) County Memorial Hospital is applying for a critical access designation that would allow the rural hospital to reduce its financial vulnerability through increased Medicare reimbursement, according to DailyTrib.com.

The application comes as Llano County Memorial prepares to part ways with Dallas-based Baylor Scott & White. An operating agreement between the two organizations expires at the end of 2020, with no renewal planned. Baylor Scott & White has managed Llano County Memorial for the past 10 years, according to the news site.

Part of the reason the contract isn’t being renewed is due to the rural hospital’s finances, according to the news site. El Campo, Texas-based MidCoast Health System is vying to take over management of Llano County Memorial.

Llano County Memorial is working with a tight deadline for its critical access application as the operating contract deadline approaches. Under the designation process, a third-party contractor helping the hospital has up to 45 days to review the application, followed by an up to 45-day state review and another up to 60-day review from CMS.

“We’re still pressing against that December 31 deadline. Hopefully, we can have some sort of determination before that,” Brett Fuller, an accountant working with LCHA, told DailyTrib.com. “I do know that at least the communications with CMS have been positive at least in expediting their review.”

Read the full report here.

FTC urges Texas regulators to block CHS’ divestiture of 2 hospitals

Alia Paavola Becker’s Healthcare

The Federal Trade Commission is urging Texas regulators to block Franklin, Tenn.-based Community Health Systems’ planned divestiture of two hospitals in the state.

In April, CHS announced its intent to sell the 231-bed Abilene (Texas) Regional Medical Center to Abilene-based Hendrick Health System and its 171-bed San Angelo (Texas) Community Medical Center to Shannon Health System in San Angelo. 

The Texas Health and Human Services Commission ultimately will approve or block the proposed transactions as Texas implemented a law that shields the deals from federal oversight in exchange for state oversight.

In a letter to the Texas commission, the FTC argues that if the deals are allowed to move forward, the combinations would remove competition in the markets, resulting in higher prices and harming consumers.

Particularly, if Hendrick Health System is allowed to purchase Abilene Regional, the combined organization would have an 85 percent market share of inpatient services in the region, the FTC said. 

“Hendrick competes vigorously with Abilene Regional to be included in health plan networks and to attract patients. The proposed Hendrick merger would eliminate this competition and would likely lead to increased prices and reduced quality and availability of healthcare services in Midwest Texas,” the FTC wrote in the letter. 

In addition, the FTC argues that if the divestiture of San Angelo Community Medical Center to Shannon Health moves forward, the combined organization will have a 62.3 percent market share of inpatient hospital services and would have concentration numbers that “approach monopoly levels.”

Read the full letter here

States ranked by COVID-19 test positivity rates: Sept. 2

Molly Gamble (Twitter) – Tuesday, July 14th, 2020 Print  | EmailShare  

Here are the rates of positive COVID-19 tests in each state, along with the number of new cases most recently reported and number of tests conducted per 1,000 people. 

Data points were last updated Sept. 2. Data for positivity rates and tests are seven-day moving averages; new cases are daily counts as reported by state and the District of Columbia. The information cited is from the Johns Hopkins Coronavirus Resource Center. States are arranged in descending order of test positivity rates. 

Editor’s note: A jurisdiction might report a negative number of probable cases on a given day if more probable cases were disproven than were initially reported on that day. Furthermore, some states modify their reporting to include both confirmed cases and probable cases, which may cause new case data to spike. Due to limited reporting on Sundays, some data is unavailable until later hours Monday, including new daily cases.

Alabama: 32.8 percent positive

New daily cases: 1,558

Tests per 1,000: 0.9

South Dakota: 22.2 

New daily cases: 240

Tests per 1,000: 1.6

North Dakota: 20.1

New daily cases: 184

Tests per 1,000: 1.7

Iowa: 18.5

New daily cases: 708

Tests per 1,000: 1.6

Kansas: 16

New daily cases: 363

Tests per 1,000: 1.3

Nevada: 15.3

New daily cases: 405

Tests per 1,000: 1

Mississippi: 14.5

New daily cases: 634

Tests per 1,000: 1.5

Missouri: 13.6

New daily cases: 1,103

Tests per 1,000: 1.6

South Carolina: 13.2

New daily cases: 854

Tests per 1,000: 1.3

Florida: 12.2

New daily cases: 7,569

Tests per 1,000: 1.4

Idaho: 11.5

New daily cases: 272

Tests per 1,000: 1.4

Georgia: 10.4

New daily cases: 2,226

Tests per 1,000: 1.9

Nebraska: 9.9

New daily cases: 287

Tests per 1,000: 1.7

Texas: 9.9

New daily cases: 4,982

Tests per 1,000: 1.5

Minnesota: 9.4

New daily cases: 491

Tests per 1,000: 1.5

Oklahoma: 9.3

New daily cases: 665

Tests per 1,000: 2.0

Indiana: 8.9

New daily cases: 695

Tests per 1,000: 1.5

Wisconsin: 8.8

New daily cases: 981

Tests per 1,000: 1.5

Hawaii: 8.6

New daily cases: 181

Tests per 1,000: 1.7

Kentucky: 8.4

New daily cases: 789

Tests per 1,000: 1.8

Utah: 7.8

New daily cases: 296

Tests per 1,000: 1.5

Tennessee: 7.6

New daily cases: 1,396

Tests per 1,000: 3

Arkansas: 7.3

New daily cases: 273

Tests per 1,000: 2.7

Virginia: 7.1

New daily cases: 1,018

Tests per 1,000: 1.7

Arizona: 6.6

New daily cases: 507

Tests per 1,000: 0.9

North Carolina: 6

New daily cases: 2,115

Tests per 1,000: 2.6

Montana: 5.6

New daily cases: 88

Tests per 1,000: 2.1

Louisiana: 5

New daily cases: 689

Tests per 1,000: 2.9

California: 4.9

New daily cases: 3,142

Tests per 1,000: 2.6

Pennsylvania: 4.8

New daily cases: 753

Tests per 1,000: 1.1

Oregon: 4.6

New daily cases: 233

Tests per 1,000: 1.1

Maryland: 4.6

New daily cases: 614

Tests per 1,000: 2

Delaware: 4.4

New daily cases: 106

Tests per 1,000: 1.9

Illinois: 4.4

New daily cases: 1,492

Tests per 1,000: 3.5

Wyoming: 3.8

New daily cases: 24

Tests per 1,000: 1.5

Ohio: 3.4

New daily cases: 1,451

Tests per 1,000: 3

Colorado: 3.3

New daily cases: 351

Tests per 1,000: 1.5

West Virginia: 3.2

New daily cases: 264

Tests per 1,000: 2.8

Washington: 3.2

New daily cases: 304

Tests per 1,000: 1.7

Michigan: 2.5

New daily cases: 795

Tests per 1,000: 3

New Mexico: 2.4

New daily cases: 108

Tests per 1,000: 2.5

Washington, D.C.: 1.7

New daily cases: 57

Tests per 1,000: 4.3

Massachusetts: 1.6

New daily cases: 355

Tests per 1,000: 3.1

New Jersey: 1.4

New daily cases: 330

Tests per 1,000: 2.6

Rhode Island: 1.2

New daily cases: 53

Tests per 1,000: 6.9

Alaska: 1.2

New daily cases: 34

Tests per 1,000: 7.9

New Hampshire: 1.1

New daily cases: 22

Tests per 1,000: 1.2

Connecticut: 0.9

New daily cases: 127

Tests per 1,000: 4.4

New York: 0.8

New daily cases: 754

Tests per 1,000: 4.3

Maine: 0.6

New daily cases: 20

Tests per 1,000: 3.3

Vermont: 0.4

New daily cases: 11

Tests per 1,000: 3.7

Henry Ford researchers defend hydroxychloroquine study, slam politics surrounding drug

Gabrielle Masson 

The persisting political climate has made any objective discussion about hydroxychloroquine “impossible,” two Henry Ford Health System executives wrote in an open letter dated Aug. 3.

Adnan Munkarah, MD, executive vice president and chief clinical officer at the Detroit-based system, along with Steven Kalkanis, MD, senior vice president and chief academic officer for Henry Ford, penned the letter in response to comments by Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, that their study on hydroxychloroquine was “flawed.” 

The situation is a bellwether for the kind of tension other systems may face when their clinical research overlaps with commentary from the White House. 

Four things to know:

1. Addressing friends and colleagues around the world, Dr. Munkarah and Dr. Kalkanis said the most accepted and definitive way to determine treatment efficacy is a double-blind, randomized clinical trial. But this type of study takes a long time to design, execute and analyze, so observational research is used to get as best an answer as soon as possible.

2. Observational research can never completely account for biases inherent in how physicians make different decisions to treat different patients, the leaders said. It’s not unusual that results vary in different studies, and no one study should be considered on its own.

3. The Henry Ford treatment study should be considered as another important contribution to hydroxychloroquine research, Drs. Munkarah and Kalkanis wrote in a letter to the editor published in the International Journal of Infectious Diseases July 31. Based on their findings, the authors believe the drug can have a role in reducing mortality for COVID-19.

4. Scientific debate is common, and can, in part, fuel the advancement of knowledge, the leaders write. They said their only goal was to report validated findings and allow the science to speak for itself, regardless of political considerations. In light of the recent events, Drs. Munkarah and Kalkanis said they have decided to no longer comment about the topic outside of the medical community and will stay focused on their patients, community and commitment to clinical and academic integrity

https://www.beckershospitalreview.com/hospital-management-administration/henry-ford-researchers-defend-hydroxychloroquine-study-slam-politics-surrounding-drug.html