The Biden-Harris Administration announced today that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic. View the press release for the PRF Phase 4 here. For more information on eligibility requirements and the application process for PRF Phase 4 and ARP Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.
As an organization serving and consisting of public health leaders, NRHA has a responsibility to abide by and serve as a model for proper health precautions. That is why we have made the difficult decision to shift the association’s Rural Health Clinic and Critical Access Hospital Conferences to a virtual environment.
The fourth wave of the COVID-19 pandemic is hitting harder than anyone expected. While Delta variant forecasts are difficult to project, the situation is unlikely to improve between now and this fall.
For these reasons, we ask for your patience as we transition our RHC and CAH Conferences away from our plans to host in Kansas City. As usual, you can register for these events at reduced virtual rates, and all content will be available Sept. 21-24 and on demand at your convenience for a full year.
At NRHA, the health and well-being of our members and all rural Americans is our top priority. We do not want to risk contributing to the spread of this deadly virus, and we don’t want to place rural health care workers, hospitals, and health systems under any more pressure than they already face.
We know it is not ideal, but virtual events allow NRHA to present – and you to experience – even more educational content than at an in-person event. NRHA will utilize the same platform as our 2021 Annual Rural Health Conference, by far our most intuitive and seamless virtual environment.
Though this is certainly not what any of us had planned, we look forward to seeing everyone virtually this fall. Rural America is nothing if not resourceful, and together we will continue to overcome the challenges we face.
We have received several calls and e-mails in the last few weeks regarding monoclonal antibody infusions in the rural health clinic setting. Tommy Barnhart with the National Rural Health Association provided this breakdown of MA injection reimbursement.
Click here to view a CMS transmittal for freestanding RHCs issued 4/30/21 effective for cost reports ending after 3/31/2021.
Among other things, it adds lines on Worksheet A specific to Covid vaccine administration (line 31.10) and monoclonal antibody (line 31.11) expenses and new columns on Worksheet B-1 to calculate reimbursement. The calculation is similar to flu and pneumonia and reimbursed through the cost report in addition to the AIR. For Covid and monoclonal antibody, this includes Medicare Advantage in addition to traditional Medicare. As with flu and pneumonia, there is no method to bill the MAC for these services. Hospital forms have not been adjusted yet but expect those to be done likewise soon. FQHC forms have been updated similar to freestanding RHC.
We’re pleased to announce that The University of Alabama College of Community Health Sciences (UA CCHS) has recently opened several services throughout rural Alabama. Find the services listed below:
- University Medical Center has opened a location in Carrollton, Alabama that offers family medicine, sports medicine, and obstetrics health-care services. New patients are being accepted. Call (205) 463-1350 to schedule an appointment.
- UMC-Fayette now offers gynecology and obstetrics services in addition to prenatal care services. Appointments are available on Fridays from 8:30 am to noon, and new patients are being accepted. For more information, call (205) 348-6700.
- UMC-Demopolis is now providing comprehensive family medicine and prenatal care. To schedule an appointment, call (205) 348-0087. For new patients, please print and complete the forms in our New Patient Packet (Paquete para Paciente Nuevo).
- UMC-Northport is providing comprehensive care in family medicine and obstetrics. To schedule an appointment, call (205) 348-6700. For new patients, please print and complete the forms in our New Patient Packet (Paquete para Paciente Nuevo).
- UMC – Livingston/York is underway
On June 21, 2021, the Occupational Safety and Health Administration (OSHA) released an emergency temporary standard (ETS) rulemaking with the goal of protecting health care workers from occupational exposure to COVID-19 in settings where people with COVID-19 are reasonably expected to be present.
As an ETS, the rule because effective when published on June 21, 2021. Health care employers are required to be compliant with the sections of the rule on July 6, 2021, or July 21, 2021, depending on the provision.
NRHA feels the timeline for compliance with this regulation is onerous. Additionally, we believe the 916-page ETS is overly burdensome for rural providers, requiring health care employers to go above and beyond what many have already put in place following CDC guidelines such as social distancing barriers, patient screening, and a wholistic COVID-19 plan.
Some requirements to note within the ETS include:
- Providers must develop and implement a COVID-19 plan
- Providers must limit and monitor points of entry to mitigate COVID-19 exposure
- Providers must ensure employees wear facemasks when indoors and when operating a vehicle with another person (this includes employees who are not directly caring for patients) and other restrictions on PPE
- Providers must require employees stay at least six feet apart from all other people when indoors except in situations where that is not possible
- Employer must install cleanable or disposable solid barriers at each fixed workstation located outside of direct patient care areas, where each employee is not able to be separated by all other people by at least six feet
- Provisions regarding proper ventilation with their heating, ventilation, and air conditioning (HVAC) systems to ensure that the amount of outside air circulated is maximized
The ETS applies to a number of settings where suspected or confirmed COVID-19 patients are treated, including hospitals, home health care works, nursing homes, assisted living facilities, EM, and ambulatory care facilities. It does not apply to settings where all employees are full vaccinated, non-employees are screened prior to entry and suspected or confirmed COVID-19 patients are not present.
NRHA believes these regulations listed above will be particularly difficult for rural providers to comply with. Additionally, we have already heard from several members that they believe the facemask and social distancing requirements will run contrary to both the science and the current state and Federal guidelines for individuals who have been vaccinated. Further, implementing overly burdensome cleaning guidelines, installing physical barriers, and ensuring proper ventilation will be particularly difficult for rural providers already operating on slim margins. Health care providers could have used the PRF allocations to implement these kinds of regulations over the past 15-months, but instead OSHA implemented this rulemaking after the deadline for the majority of rural providers use of the funds.
NRHA plans to submit comments on this ETS ahead of the July 21, 2021, deadline. In our comments, NRHA will urge OSHA to remove, or at a minimum delay, this regulation from taking effect. Health care providers have done an outstanding job of keeping their patients and employees safe throughout the COVID-19 pandemic. Adding a burdensome regulation like the ETS proposes will not protect patients or employees. Rather it will pull limited staff and financial resources in directions that could be better used providing health care to patients during the ongoing pandemic. Further, NRHA believes the rule is being implemented at an unnecessary point in the pandemic. Providers have had COVID-19 protocols in place for over 15 months. Adding new regulations from OSHA at this time is not needed for patients and employers to feel safe in the health care setting.
NRHA encourages members to comment on this regulation if you believe it will be overly burdensome to comply with, especially given the tight timeline turnaround. OSHA released a subsequent message saying they have determined that no changes to the ETS are necessary at this time, so we believe comments expressing the need for removal, or delay, of the regulation will be important to OSHA’s decision-making process. NRHA will share our comments for the regulation in the coming days so you can read them as a guidepost in crafting your own comments.
You can find the rule posted on Regulations.gov here. Additionally, OSHA has posted related summaries, fact sheets, and compliance assistance materials and tools here. Comments are due to the Federal Register by July 21, 2021.