More than 90% of Americans are unaware of a CMS rule allowing patients to view and compare treatment costs on hospital websites so they can shop for lower priced care, according to a recent Kaiser Family Foundation survey.

While only 9% of seniors have researched treatment prices online, they are more likely to know about the rule change than any other age group. Households with incomes over $90,000 are also more likely to know about hospitals’ requirement to disclose pricing data. But these wealthier households spent less time researching prices than those with incomes under $40,000. 

“The low level of awareness of this federal requirement is consistent across different age groups, income levels and health status,” KFF said.

The Trump administration rule, which went into effect on January 1, requires hospitals to make pricing information accessible to patients so that they can shop for lower priced care from different providers. The rule also requires they make available a consumer-friendly display of at least 300 shoppable services, including 70 specified by CMS. Hospitals don’t need to post a list of shoppable services if they allow consumers to use a price estimator tool to calculate their out-of-pocket costs.

Prior to the rule’s implementation, hospitals published aggregate, undiscounted charges for services, but that price is rarely what an insurer or patient would pay.

More than 80% of respondents to the May survey said they have not researched the price of hospital treatments in the last six months.

Experts say that consumers aren’t likely to shop around unless it’s easy. The newly available pricing data is more likely to help third-party app developers, researchers and policymakers. 

The Biden administration has promised a crackdown on hospitals shirking transparency obligations. More than 50 hospitals didn’t include payer-specific negotiated rates or didn’t comply with some part of the price transparency rule as of March, according to Health Affairs. A dozen hospitals didn’t post any files or provided links to searchable databases that users couldn’t download. 

Nearly 92% of survey respondents with a chronic condition, who are more likely to need hospital care, are either unaware or convinced hospitals do not have to share pricing information online. Only 4% of Black consumers polled were aware of the rule compared to their white (9%) and Hispanic (12%) counterparts. Black consumers are also more likely to suffer from chronic conditions than other groups, according to the Centers for Disease Control and Prevention.

Many adults who searched for prices online weren’t more aware of price transparency requirements, with 33% reporting there was no mandate for hospitals to disclose prices compared to 20% among those who did not search for prices. 

CMS started auditing hospital websites and reviewing complaints shortly after the rule took effect. According to an agency spokesperson, the first round of warning letters to hospitals were sent in April. CMS can also fine hospitals up to $300 per day for violating the disclosure requirements.

Some hospitals have been fighting price transparency regulations, arguing that consumers don’t use price estimators to determine their care plans and releasing payer-specific rates could increase prices.

OSHA’s emergency standard protecting health-care workers from Covid-19 that was issued June 10 after months of anticipation originally was intended to protect all workers, a draft version of the rule obtained by Bloomberg Law showed.

The 780-page draft standard and justification formally submitted to the White House on April 26 made it clear Occupational Safety and Health Administration staff had concluded a “grave danger” threatened the health of all U.S. workers, not just workers in health care who had been deemed essential during the darkest days of the pandemic.

“OSHA has determined that employee exposure to this new hazard, SARS-CoV-2 (the virus that causes COVID-19) presents a grave danger in every shared workplace in the United States,” the draft said. “This finding of grave danger is based on the science of how the virus spreads as well as the adverse health effects suffered by those diagnosed with COVID-19.”

Yet, the final version of the emergency temporary standard that took effect June 21 and has a July 6 compliance deadline for employers limited the standard to only health-care employees, prompting at least two lawsuits by unions seeking a broader regulation.

The White House’s Office of Management and Budget provided a copy of the draft standard in response to a request from Bloomberg Law.

While acknowledging the impact vaccines would have on Americans, the April draft still concluded a standard should apply to all workplaces. As more workers become vaccinated and more was learned about the effectiveness of vaccines, OSHA would have several options—including terminating the standard, revising it, or pausing its enforcement.

“OSHA recognizes the promise of vaccines to protect workers, but as of the time of the promulgation of the ETS, vaccination has not eliminated the grave danger presented by the SARS-CoV-2 virus,” the draft said.

A U.S. Department of Labor spokesperson in a statement Monday defended the health-care only decision. 

“On June 10, OSHA announced that it could make the most impact by issuing an emergency temporary standard focused on healthcare settings,” the spokesperson wrote in an email. “This approach closely follows the CDC’s guidance for healthcare workers and the science, which tells us that those who come into regular contact with people either suspected of having or being treated for COVID-19, are most at risk.”

Guidance Is Lacking

Organized labor supporters said workers will have to rely on non-mandatory guidelines for protection since most industries were removed from the final standard.

“Current guidelines are inadequate, and are not enforceable, resulting in millions of workers left unprotected on the job,” AFL-CIO President Richard Trumka said in a statement to Bloomberg Law. “An enforceable workplace safety standard that protects all workers is key to beating this pandemic.”

OSHA said in its April draft that regulations and non-mandatory guidance from the agency and the Centers for Disease Control and Prevention at the time were insufficient.

“OSHA has determined that each of these tools, as well any combination of them, is inadequate to address COVID-related hazards, thereby establishing the need for this ETS,” the draft standard said.

The final version of the emergency standard also dropped the draft’s requirements for employers outside of health care to track all Covid-19 cases among workers and report hospitalizations and deaths to the agency.

Debbie Berkowitz, safety and health program director for the National Employment Law Project in Washington, said the recordkeeping mandates must apply to all employers “to assure that any possible new outbreak in the workplace is found early.”

Meatpackers at Risk

A significant difference between the draft and final version of the standard are references to the hazards meatpacking workers faced: The final version, which doesn’t apply to the meat-processing industry, made only five references to meatpacking, while the draft version included more than 30 references.

OSHA sometimes relied on general duty clause citations to convince employers, including meatpackers, to comply with OSHA guidance to protect workers from contracting the virus. The clause requires employers to provide workplaces free of known, lethal hazards that can be mitigated.

“One of the General Duty Clause citations OSHA issued in 2020 was to a large, international employer running a meatpacking plant that failed to take sufficient measures to mitigate the spread of COVID-19 among workers,” the draft said. OSHA determined it could only issue one general duty clause citation with a total proposed penalty of $13,494, the maximum penalty allowed by law for serious violations.

“OSHA has been limited in its ability to impose penalties high enough to motivate the very large employers who are unlikely to be deterred by penalty assessments of tens of thousands of dollars, but whose noncompliance can endanger thousands of workers,” the draft said.

Long Haul

It’s not clear from the draft when OSHA dropped the idea of covering all workers in favor of a health-care-only standard.

President Joe Biden issued an executive order to OSHA on Jan. 21 telling the agency to consider the need for a standard and if warranted, prepare the standard by March 15. But OSHA missed that deadline and more weeks passed. Labor Secretary Marty Walsh said on April 6 he had “ordered a rapid update” of the unfinished standard based on the Centers for Disease Control and Prevention analysis of virus dangers and the latest information on vaccinations and the variants.

The draft rule went to the White House’s Office of Information and Regulatory Affairs for a review on April 26. That’s considered the last step before a regulation is published in the Federal Register and becomes official. During a typical review, other agencies vet a draft standard for possible program and jurisdictional conflicts and to ensure the standard can withstand legal challenges.

The emergency standard spent six weeks under review at OIRA, part of the Office of Management and Budget, where it was the focus of more than four dozen meetings with business and worker representatives before being released June 10 (RIN:1218-AD36). 

Howard Shelanski, who led OIRA during the second term of the Obama administration, said in an interview earlier this month the OSHA standard was likely subject to a close OIRA review because as an emergency standard, the proposal hadn’t been through a public comment period where OSHA would have listened to concerns and explained why the standard was needed and viable against a court challenge. 

When the standard finally was issued, it applied only to health-care workers; other workers would be protected by updated guidance. 

During the months between Biden’s order and the standard’s release, business groups argued increasing vaccination rates were making it implausible for OSHA to claim Covid-19 still posed grave danger to workers. And as OIRA’s review continued, the CDC on April 27 and May 13 updated its guidance, relaxing mask requirements for fully vaccinated people.

Unions and other worker support groups said the standard was still needed to protect unvaccinated workers and serve as backstop if Covid-19 variants made vaccines less effective.

The AFL-CIO labor federation, the United Food and Commercial Workers, and National Nurses United filed lawsuits with federal appeals courts on June 24 asking the courts to review the standard.

The standard “fails to protect employees outside the healthcare industry who face a similar grave danger from occupational exposure to COVID-19,” the AFL-CIO said in its petition for review.

The agency wants to pay home health agencies for the quality of care they provide, instead of the quantity of services delivered. In a new rule released Monday, CMS proposed expanding its Innovation Center’s value-based purchasing model — which previously operated in nine states — nationwide effective Jan. 1, 2022.

The Biden administration is looking to extend Obamacare’s annual enrollment season and allow some of the poorest marketplace customers to buy coverage essentially whenever they want, under a new proposal aimed at bolstering the health care law.

CMS on Monday also proposed rolling back Trump-era rules that Democrats argued would have undermined the marketplaces.

Longer enrollment window: CMS said it wants to lengthen the open enrollment season by 30 days starting this fall. For the last few years, the annual enrollment season has run between Nov. 1 and Dec. 15, and CMS plans to extend the deadline to Jan. 15.

However, the agency plans to eliminate the strict sign-up window for Americans who earn under 150 percent of the federal poverty level. These shoppers, who receive generous premium subsidies, would be allowed to sign up each month.

CMS said the policy could help those who lose their Medicaid coverage at the end of the coronavirus public health emergency, when states are again allowed to remove people from the safety net program.

More reversals: CMS is proposing to pull back a Trump-era policy, approved in the previous administration’s final days, that would have allowed states to eliminate their marketplaces and turn enrollment entirely over to private web brokers and agents.

No state had announced plans to ditch their Obamacare markets, and CMS under President Joe Biden was widely expected to roll back the policy. Trump’s CMS last fall separately approved a decentralized enrollment system for Georgia through an Obamacare waiver program, but CMS has signaled it’s likely to revoke that permission.

The Biden administration is also proposing to rescind a Trump policy that relaxed many of Obamacare’s strict guardrails for approving states’ marketplace changes through the Obamacare waiver program. And CMS will roll back another Trump policy requiring insurers to send a separate monthly bill to cover abortion-related services.

Bigger role for navigators: The agency is proposing to hike HealthCare.gov insurers’ user fees by a half-percentage point to fund expanded responsibilities for groups helping enroll people in plans. These so-called navigators, who will receive a record $80 million in the 2022 enrollment season, will be required to give consumers more information about health coverage and their rights. 

The Biden administration Monday loosened requirements for drug addiction treatment providers to dispense methadone through mobile clinics, a move that could help ease access for underserved communities.

A final rule (RIN: 1117-AB43) by the Drug Enforcement Administration provides that narcotic treatment providers wishing to dispense drugs through a mobile component don’t need to separately register for that unit. The rule takes effect July 28.

The rule marks the administration’s latest effort to address America’s addiction crisis. The White House previously said it intended to review policies around the anti-opioid drug methadone and publish a final rule on registering methadone treatment vans.

• Discussion Draft
• Summary
• Statement

After weeks of negotiations, President Biden and a bipartisan group of senators have announced a deal on infrastructure spending. The agreement focuses on investments in roads, railways, bridgesand broadband internet, but it does not include investments Biden has referred to as “human infrastructure,” including money allocated for child care and tax credits for families.

According to the White House fact sheet, the plan will be paid for with unused coronavirus relief funds, unused unemployment insurance and sales from the Strategic Petroleum Reserve, among other measures. It is unclear at this point if “unused coronavirus relief funds” includes the roughly $30 billion remaining in the CARES Act Provider Relief Fund.

WHAT’S IN THE AGREEMENT

Transportation: $312 billion

• Roads, bridges, major projects: $109 billion
• Safety: $11 billion
• Public transit: $49 billion
• Passenger and freight rail: $66 billion
• Electric vehicles: $7.5 billion
• Electric buses/transit: $7.5 billion
• Reconnecting communities: $1 billion
• Airports: $25 billion
• Ports and waterways: $16 billion
• Infrastructure financing: $20 billion

Other infrastructure: $266 billion

• Water: $55 billion
• Broadband: $65 billion
• Environmental remediation: $21 billion
• Power, including grid authority: $73 billion
• Western water storage: $5 billion
• Resilience: $47 billion

New spending + baseline (over 5 years) = $975 billion

New spending + baseline (over 8 years) = $1.209 trillion

PAY-FORS

• Reduce the IRS tax gap.  
• Unemployment insurance program integrity.  
• Redirect unused unemployment insurance relief funds.  
• Repurpose unused relief funds from 2020 emergency relief legislation.  
• State and local investment in broadband infrastructure. 
• Allow states to sell or purchase unused toll credits for infrastructure.  
• Extend expiring customs user fees.  
• Reinstate Superfund fees for chemicals.  
• 5G spectrum auction proceeds. 
• Extend existing spending restraints over mandatory government programs.
• Strategic Petroleum Reserve sales. 
• Public-private partnerships, private activity bonds, direct pay bonds and asset recycling for infrastructure investment. 
• The expectation that infrastructure investment will generate economic growth.

Click HERE for the WSC Brief on the Infrastructure Agreement

Health policies aren’t part of the bipartisan infrastructure agreement President Biden and a group of senators announced yesterday.

But the deal did move the ball forward for Democrats on their quest to further expand health coverage and lower drug prices: Now they can push top health priorities in a separate, partisan package later this year.

Congress can save budget reconciliation for health care and other stuff.

Until yesterday, it was unclear whether Democrats would need to use a budget reconciliation bill to pass their infrastructure priorities on a partisan basis (budget reconciliation requires just a simple Senate majority to pass). But Biden has signed off on a bipartisan agreement crafted by five Democratic and five Republican senators — meaning Democrats can save a reconciliation bill for later.

The bipartisan measure “would pump hundreds of billions of dollars in new spending into infrastructure projects across the country — handing him, if it survives congressional approval, a significant cross-party achievement,” The Post’s Seung Min Kim, Mike DeBonis and Jeff Stein report.

“We have a deal,” Biden said alongside the senators who had negotiated for weeks on a package to revitalize the nation’s road and transit systems, while upgrading broadband and investing in other public-works projects.

“Biden spoke during an impromptu appearance on the driveway outside of the West Wing of the White House after a shorter-than-expected meeting with senators, in which he delivered his formal endorsement of the proposal crafted by Sens. Rob Portman (R-Ohio), Kyrsten Sinema (D-Ariz.) and eight others in the Senate,” our colleagues write.

“The new agreement is nowhere near as expansive as the $2.2 trillion American Jobs Plan, Biden’s own infrastructure measure that he detailed in April,” they add. “But Democratic leaders have made it clear that they hope to push through, potentially with only Democratic votes, a separate package encompassing priorities such as climate initiatives, paid leave and expanded education.”

There’s a laundry list of health policies Democrats probably will try to fold in, too.

Some of the items were already outlined by Biden in his previous spending proposals, including $200 billion for permanently expanding the federal subsidies that make private insurance plans sold on HealthCare.gov and state-run marketplaces more affordable. Congress already expanded the subsidies, but only temporarily.

Biden has also proposed $225 billion to create a new paid family leave program, administered by the Social Security Administration, and $400 billion on long-term care.

There’s drug pricing legislation, too. Earlier this month, House Energy and Commerce Chairman Frank Pallone Jr. (D-N.J.) said he’s aiming to get H.R. 3 attached to a spending package this year. The measure allows the federal government to directly negotiate lower drug prices and caps out of pocket spending for prescription drugs in the Medicare program.

And then there’s legislation to get more people enrolled in Medicare and Medicaid. Sen. Bernie Sanders (I-Vt.) has been floatinglegislation to lower the Medicare eligibility age to 60 and expand its coverage to include vision and dental. In the House, Democrats have been working on ways to get Medicaid expansion to people in states where GOP policymakers still refuse to expand it themselves.

Sen. Bob Casey (D-Pa.) Thursday unveiled his plan to make what he calls a “historic investment” in Medicaid home- and community-based services. The goal is to cut down the waitlists for such services for the elderly and disabled, as well as improve pay for home-care workers.

“We can’t just say we’re going to expand Medicaid to get rid of the waiting list—but we’re still going to have the same $12-an-hour-workforce,” Casey said in an interview. “We want that balance.”

Casey said he’s found no support from Republicans for the plan, and hopes to pass the measure as part of a larger jobs and infrastructure package with only Democratic votes in the Senate.

That means Casey will need to unify Democrats behind his plan in a 50-50 split chamber. Already 40 Senate Democrats have signed onto the legislation.

Democrats Seek to Advance Biden Home-Care Plan Via Medicaid Cash

Price Tag

Casey told reporters Thursday that the main obstacles are likely the price tag and finding ways to pay for it. The plan would authorize $100 billion for state grants, but the final cost may wind up much higher, depending on how many states elect to participate.

Helping Casey’s effort: unions and domestic workers groups that often align with Democrats are backing the proposal, saying it’s an essential start to better pay and benefits for home-care workers.

“So many years we’ve been pushing on this, with no traction,” Ai-jen Poo, executive director of the National Domestic Workers Alliance, said.

The U.S. overall spent $379 billion in 2018 for long-term services and support—which are used to help seniors and people with disabilities with tasks such as preparing meals, bathing, dressing, and managing medication or mobility, according to figures from the Kaiser Family Foundation. Medicaid paid for more than half of the total, which includes nursing home and home health services.

Biden $400 Billion Care Plan Would Have a Caveat: States Opt In

Long Waitlist

Demand for home health services is already high: almost 820,000 people in the U.S., most with intellectual or developmental disabilities, are on waiting lists to get home- or community-based care.

Home health aides and personal care aides represent the sixth-fastest growing occupation in the country, according to Labor Department data, and get paid about $12.15 per hour, or $25,280 per year.

In many areas those earnings aren’t enough: Most home health aides qualify for federal help such as food assistance and Medicaid, according to research from PHI, a nonprofit that focuses on direct care workers.

Casey said injecting Medicaid programs with as much as $400 billion over eight years might not solve all these problems, but will go a long way to bolstering the industry.

“I’m certain of one thing: if we don’t make this investment now these waiting lists will grow exponentially,” Casey said.

Senate Democrats will release legislation as soon as Thursday to meet President Joe Biden‘s promise to expand in-home care for the elderly and disabled while boosting caregivers’ wages and unionizing opportunities, according to a draft bill obtained by Bloomberg Law.

States would implement the proposal using a major influx of federal funding through Medicaid. The bill would condition the funds on states’ ability to shift people to home-based care from nursing homes, recruit and train more home health workers, provide caregiver pay increases, and establish oversight capacity. 

The bill’s goal is to deliver on Biden’s pledge—from the “human capital” portion of his infrastructure plan—to put $400 billion toward reducing the sizable waiting lists facing those who wish to receive support in their homes instead of in institutional settings, and also to improve the quality of life for a predominantly female, minority workforce. 

Congress would initially authorize $100 billion for state grants, but the ultimate price tag may wind up much higher, depending on how many states elect to participate.

Sources briefed on the legislation said the draft is in near-final form ahead of its official introduction, tentatively planned for Thursday. It offers the first-known details of a critical piece of a package Democratic lawmakers aim to pass this year using the budget reconciliation process, which would avoid the need for Republican votes in the Senate. 

The bill was drafted with the intention of meeting reconciliation rules, but it remains to be seen whether it’s actually in compliance, as determined by the Senate parliamentarian. Reconciliation can only be used for provisions with budget effects that are more than just incidental, among other requirements.

The bill’s architect and lead sponsor, Sen. Bob Casey (D-Pa.), briefed his caucus on the details Tuesday, along with Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Finance Chair Ron Wyden (D-Ore.), said three sources familiar with the process. 

Worker Raises, Recruitment

Under the legislation, states could receive grants to create plans for expanding their home-based services and boosting worker pay. If approved, the federal government would pay up to 90% of the costs for implementing those plans.

States would have flexibility in designing their programs to revamp their home- and community-based care systems, but would need to prove they have achieved outcomes related to home-care service availability, worker raises, and recruitment and retention of enough in-home aides to meet demand. States could also get funds to continue programs to expand home health started this year using funds from a Covid-19 relief law enacted in February (Public Law 117-2).

Officials Lay Out Rules for Expanding Medicaid’s Home-Based Care

States could apply for an additional 2% bump in federal Medicaid dollars if they establish an oversight entity to administer a program for “self-directed care,” which lets those receiving care customize their plan without involving an outside employer agency. 

Among the oversight entity’s mandates: registering qualified caregivers and connecting them to beneficiaries; recruiting and training workers; and ensuring that the program policies are cooperative with home-care worker labor unions—either when it comes to bargaining with existing unions or remaining neutral in the face of a union organizing drive. 

This final prong is geared toward meeting demands of the Service Employees International Union, which represents some 740,000 home-care workers and has been lobbying for inclusion of robust home care funding in an infrastructure package. 

Congressional Negotiations

The draft is the product of months of negotiations between congressional lawmakers and a broad range of constituents in the aging, disability, and labor communities. 

Republicans, some of whom are separately trying to reach a narrower bipartisan deal focused on roads, bridges, and other physical repairs, have resisted the arguments from Democrats and worker advocates that home care investments belong in an infrastructure bill. That’s an obstacle shaping Democrats’ preference for the go-it-alone strategy in a budget reconciliation measure.

“We’re working with reconciliation, and we have got a broad but somewhat unique coalition in the disability community. We have AARP, SEIU,” Casey said in a June 10 interview. “It’s a pretty broad coalition that hasn’t always been on the same page.”

Read AHA Letter

The American Hospital Association flipped on Tuesday (June 23) from praising HHS’ revised provider relief guidance to saying the phased spending deadlines are unfair and HHS should give all hospitals more time to spend their relief funds — either until the end of the public health emergency or until June 30, 2022, the final spending deadline currently set for only new recipients in HHS’ latest guidance.

HHS’ phased provider relief spending deadline strikes a balance between providers who finally received their relief after waiting months to get it and those who received and immediately spent their relief. While hospitals and other providers support the new guidance broadly, AHA points out advocates had asked for all providers to receive an extension.

AHA, the Medical Group Management Association and lawmakers had earlier asked HHS to tie the spending deadline to the public health emergency, which the Biden administration has indicated could last the entirety of 2021. Nursing homes had asked HHS to extend the June 30 spending deadline to Dec. 30, 2022. Providers said the additional time was necessary as providers have on-going costs related to the pandemic.

HHS stopped short of a complete extension of the June 30 spending deadline in its guidance released June 11. The department instead created four provider relief payments periods, giving providers one year to spend all their relief.

This means the upcoming deadline of June 30 applies to distributions received from April 10, 2020 to June 30, 2020. The next deadline of Dec. 31 applies to monies received July 1, 2020 to Dec. 31, 2020, and next year’s June 30 spending deadline will be for the period Jan. 1 to June 30.

AHA initially cheered HHS’ new guidance like other advocates, but in its letter to HHS Tuesday (June 22) raises concerns that the phased spending deadline is unfair for rural hospitals and hospitals serving high numbers of Medicaid and uninsured patients.

“While we had previously requested an extension and appreciate HHS’ action, we believe that providing additional flexibility is necessary, fair and appropriate,” AHA says, arguing the new guidance disadvantages certain providers without giving a clear reason. “Specifically, some providers will need to spend their funds well before others simply because they received a [provider relief] payment earlier in the distribution process.”

The AHA letter points out what Inside Health Policy previously reported that HHS began distributing a large chunk of the $178 billion provider relief fund early on. The first general distribution was set at $46 billion, while $20 billion in targeted relief for hospitals in so-called hot spots, $13 billion for safety net hospitals and $11 billion for rural facilities were all announced and distributed before June 30, 2020.

The other general and targeted distributions, including the problematic second general distribution, went to providers no earlier than July 3, 2020, according to the Government Accountability Office. HHS is still distributing provider relief.

AHA also raises concerns that some providers won’t be able to use provider relief to address the added costs that will go along with the new Occupational Safety and Health Administration Emergency Temporary Standards, which require certain health care employers to implement a plan that addresses COVID-19 hazards in the workplace.

Some providers think the presence of a fourth payment period in the newly released HHS guidance means the next provider relief distribution will be announced in July.

The last distribution was announced in October, and there is an estimated $24 billion left in unallocated provider relief.

“I think the FAQs that were released this time, in my opinion, look a lot more complete,” Donna Martin, American Network of Community Options and Resources director of state partnerships & special projects, said. “It looks like they’ve got a year’s worth of kind of managing these portals, dealing with both the technical side and the understanding — making it understandable by people that received those funds.”

This is a significant step as previous guidance seemed to change daily and at one point, Congress had to step in to clarify how it wanted HHS to let providers calculate their lost revenue due to COVID-19.

While AHA says additional spending flexibility is needed, some providers are praising the new HHS guidance.

One of those is a Pennsylvania provider that will benefit from the guidance’s final spending deadline. SPIN Inc., which serves children and adults with intellectual and developmental disabilities, waited eight months — July 15, 2020, until March 8 — to receive its $1.47 million in provider relief. It will have until June 30, 2022, to spend all this relief.

In the meantime, SPIN furloughed or cut administrative staff while using state COVID-19 relief to give its low-paid, direct care staff hazard pay and overtime.

“SPIN is a provider in an historically underfunded system in which we have struggled to pay Direct Support Professionals the wages that they deserve,” Patti Parisi, SPIN, Inc. chief financial officer, said in an email. “Due to the COVID-19 pandemic, we are now experiencing an unprecedented level of employee vacancies.”

Parisi said SPIN needs additional COVID-19 relief so it can pay a family-sustaining wage to recruit and retain its direct care staff. It will also need better state reimbursement rates so it can sustain the higher, more competitive wages into the future and stabilize a fragile system.

Northern Nevada Emergency Physicians, which received $801,139 in total from initial provider relief distributions, according to HHS, welcomed the clarity offered by the new guidance. Karen Massey, the organization’s executive director, said every piece of guidance providers receive creates certainty and stability.

“Understanding the final disposition of [provider relief] and all these programs allows us to demonstrate the appropriate use of these funds for taxpayer transparency and remove any uncertainty about our ability to retain the funds,” Massey said in an email. “This allows medical practices to pivot to these new challenges with the financial certainty we need to serve our patients through hiring staff, investing in technology and maintain the new level of care required by COVID-19.”

Massey said in addition to helping providers pay for personal protective equipment, COVID-19-positive patients and testing supplies, provider relief offered financial stability when there was very little certainty in business operations.

“For most medical practices, there was this odd dichotomy of seeing substantially reduced volume, yet knowing that there was pent-up demand from the routine conditions we care for, and also new challenges of COVID-19,” Massey said.

Michael Strazzella, Buchanan, Ingersoll and Rooney federal government relations leader, said HHS might not have given providers everything they asked for, but the new timeline gives them the needed stability to rebuild and plan what their post-COVID-19 normal will look like.

“While the community was asking for the June 30 date to be moved, they [HHS] did address other pieces of it and there are other benchmarks to now be used,” Strazzella said. “In many ways, they have responded to the community’s concerns.” — Dorothy Mills-Gregg (dmillsgregg@iwpnews.com)

Senate Finance Committee Chair Ron Wyden has released a document outlining “legislative principles” for controlling drug prices.

The major provisions include: Medicare price negotiation and inflation rebates, giving commercial insurers the same drug prices that Medicare negotiates, blocking a Trump-era ban on rebates, and tailoring policies to protect small biotechnology companies.

The bill also will include cost-saving measures for Medicare beneficiaries, which both parties want. Legislation from 2019 in both the House and Senate called for restructuring the Part D benefit to cap beneficiaries’ annual out-of-pocket spending and reduce the government’s responsibility for catastrophic costs.

Senate Finance Committee: Principles for Drug Pricing Reform

Wyden Releases Principles For Lowering Drug Prices for Americans

Physician Workforce: Caps on Medicare-Funded Graduate Medical Education at Teaching Hospitals

Before physicians practice medicine independently, they receive on-the-job training as residents in teaching hospitals. These residents are vital providers of health care during their training, and many stay in the geographic area to practice after their training is completed.

Medicare pays these hospitals to offset some of the costs of training physician residents. For most hospitals, Medicare caps the number of residents it will fund per hospital based on how many residents it funded in 1996.

We found that 70% of hospitals trained more residents than Medicare funded—indicating they can train more physicians now than when these caps were set.

Read the report.