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CMS Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers

Yesterday, CMS released the interim final regulations requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. These requirements will apply to approximately 76,000 providers and cover over 17 million health care workers across the country.

Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 5, 2021All eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson – by January 4, 2022.  

At this time, CMS is not allowing for daily or weekly testing of unvaccinated individuals as an alternative to vaccination.  The regulation provides for exemptions based on recognized disability, medical conditions or religious beliefs, observances, or practices.  With regard to recognized clinical contraindications to receiving a COVID-19 vaccine, facilities should refer to the CDC informational document, Summary Document for Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, accessed at www.cdc.gov/vaccines/covid-19/downloads/….  CMS directs providers and suppliers to the Equal Employment Opportunity Commission (EEOC) Compliance Manual on Religious Discrimination160 for information on evaluating and responding to requests related to religious beliefs, observances, or practices. While employers have the flexibility to establish their own processes and procedures, including forms, CMS points to The Safer Federal Workforce Task Force’s “request for a religious exception to the COVID-19 vaccination requirement” template as an example.

Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law. CMS will ensure compliance with these requirements through established survey and enforcement processes.  If a provider or supplier does not meet the requirements, it will be cited by a surveyor as being non-compliant and have an opportunity to return to compliance before additional actions occur.

The requirements apply to: Ambulatory Surgical Centers, Hospices, Programs of All-Inclusive Care for the Elderly, Hospitals, Long Term Care facilities, Psychiatric Residential Treatment Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Home Health Agencies, Comprehensive Outpatient Rehabilitation Facilities, Critical Access Hospitals, Clinics (rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), Community Mental Health Centers, Home Infusion Therapy suppliers, Rural Health Clinics/Federally Qualified Health Centers, and End-Stage Renal Disease Facilities.

NRHA will be reviewing the regulation and submitting comments on behalf of our members expressing concern about the workforce and access implications in rural areas.  Comments on the interim final regulation must be provided within 60 days of November 5th, 2021 to be considered. 

To view the interim final rule with comment period, visit: public-inspection.federalregister.gov/…

To view a list of frequently asked questions, visit: www.cms.gov/files/document/cms-omnibus-staff-vax-requirements-2021.docx

NRHA will be sharing a more detailed summary of the regulation shortly.  In meantime, feel free to contact our government affairs team at ccochran@ruralhealth.us. Thank you.

What to Gift Active Kids for the Holidays to Keep Them Moving

Most kids are always moving, but some are more daring than others. To keep the active child in your life occupied, exploring, and growing, the right gift is crucial. Here are the holiday gifts that active kids will want—and need—to keep them on a roll all through the new year.

The Alabama Rural Health Association is dedicated to promoting and advocating for rural health matters. Learn about membership today.

Indoor Gifts for Active Kids

Depending on the weather and where they live, some more adventurous kids can’t get outside as often as they’d like. No problem—these indoor gifts will have them jumping and moving before you know it.

Balance Boards

Commonly called Spooner boards, indoor (and outdoor) balance boards are an engaging toy. They require the balance and coordination of riding, say, a skateboard, but without wheels that can wreak havoc on the floor and elsewhere in the house.

Children as young as preschool age can begin to balance on such a board, making this an excellent gift for every age and stage of development. Older kids will enjoy doing tricks and taking healthy risks, too.

Basement or Playroom Gym

From the Gorilla Gym to DIY rock walls, there are many ways to build an indoor gym for kids. The Gorilla Gym, for example, hangs in a doorway and offers up attachments like swings, pull-up bars, rope ladders, and more to encourage activity.

If you have the square footage, building a rock wall or installing gym equipment can be an excellent way for kids to keep moving year-round. You can DIY a climbing wall (or gift the materials) for kids using plywood, climbing holds, lag screws, and, of course, floor mats for safety.

And, as REI explains, rock climbing teaches kids decision-making skills and discipline, helps boost their confidence, and enhances focus—necessary for keeping energetic kids safe in their adventures.

Outdoor Gifts for Active Kids

For kids who have access to a vast backyard, neighborhood parks, or wilderness, these outdoor gifts are the perfect fit for year-long play.

A New (and More Challenging) Bike

Riding a bicycle is old hat for most kids. But mountain biking presents new and stimulating challenges. Between the benefits of being in nature (like building confidence, reducing stress, and more) and the physical endurance required to handle a mountain bike, kids will be working off excess energy for years to come. If they’re going to spend more time in nature, consider picking them up a smartwatch as well. Kid-friendly smartwatches allow them to take and share pictures and also include safety features like GPS.

A Swing Set (Even DIY)

If the child in your life has room outside for a swing set, this might be the perfect holiday gift. Studies show that unstructured play enhances kids’ social-emotional development, cultivates imagination, and stimulates their senses, Genius of Play explains.

Plus, it gets them moving as they climb ladders, navigate slides, and pump their legs on the swings.

For older kids, you don’t even have to choose one that’s boxed up and ready to go. What better gift for an active kid than a DIY swing set or fort-building kit? Tweens and teens can put their engineering, critical thinking, and problem-solving skills to good use as they read directions, consult diagrams, and hammer nails—while wearing appropriate safety gear, of course.

Need to level out a part of your yard so your swing set is on level ground? Search for “land leveling near me” and look over reviews and ratings from grading contractors. You may be able to find deals as well so you can save on this service.

Kids who like to move may never slow down. But to make sure they’re pursuing healthy activities, consider one or more of these athletic gifts this holiday season. Even for kids who prefer screen time to sweating, the right type of (physical) outlet could change their minds.

FY 2022 Appropriations Requests & Allocations

Hello NRHA members,

This week, the Senate Appropriations Committee (SAC) released the text of their nine remaining appropriations bills, including the Labor, Health and Human Services, Education, and Related Agencies (L-HHS) bill. Below is an update on NRHA’s fiscal year (FY) 2022 appropriations requests.

Both the House Appropriations Committee (HAC) and SAC recommended increasing funding for the U.S. Department of Health and Human Services (HHS) rural health programs, which are administered by the Federal Office of Rural Health Policy (FORHP). The HAC recommended increasing funding to $70.7 million above the FY 2021 enacted level, and the SAC recommended increasing funding to $73.2 million above the FY 2021 enacted level. NRHA is extremely pleased that both Congressional appropriations committees are seeking to provide more funding for rural health programs. However, we will continue to advocate that both committees match NRHA’s requested allocations for individual programs.

The HAC and SAC matched NRHA’s requested funding allocations for the Rural Maternal and Obstetric Management Strategies (RMOMS) program ($10 million) and Rural Residency Planning and Development (RRPD) program ($12.7 million). Additionally, the HAC and SAC included report language to encourage HRSA to expand the current program to include RTTs in obstetrics and gynecology and request a report in the fiscal year 2023 Congressional Budget Justification on the progress made to date and efforts to expand RTTs in obstetrics and gynecology. 

The HAC matched NRHA’s requested funding allocations for the Medicare Rural Hospital Flexibility (Flex) program ($61.2 million) and Rural Emergency Hospital (REH) Technical Assistance (TA) program ($10 million) but did not match NRHA’s requested funding allocations for the Rural Provider Modernization Technical Assistance program ($8 million) and Rural Provider Modernization Grants ($13 million). The SAC did not match NRHA’s funding allocation for any of these programs. Neither the HAC or SAC matched NRHA’s requested funding allocations for the United States Department of Agriculture (USDA) Rural Hospital Technical Assistance (TA) program ($5 million. 

Below is a chart of FY 2022 requests and allocations:  

Links:  

President Biden’s FY 2022 budget request

FY 2022 HAC L-HHS bill report

FY 2022 SAC L-HHS explanatory statement

FY 2022 HAC Ag bill report

FY 2022 SAC Ag bill report

$25.5 billion in Provider Relief Fund & American Rescue Plan rural funding is now available

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced a new application cycle for $25.5 billion in COVID-19 provider funding. Applicants will be able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). 

What Is the Provider Relief Fund?
Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus. These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions.

What Is ARP Rural?
ARP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers; funding will be available to providers who serve patients in these communities. Eligible applicants can apply for the ARP Rural funds through the same Application and Attestation Portal that is available to apply for the Phase 4 General Distribution. Providers will apply for both programs in a single application.

In order to be considered for an ARP Rural payment, applicants must include any billing Tax Identification (TIN) owned by the applicant. ARP Rural payments will be determined based on the amount and type of Medicare, Medicaid, and CHIP services provided by billing TINs to rural beneficiaries. Applicants do not need to verify whether their beneficiaries live in an area that meets the definition of rural. HRSA will base payments on data already available to it using the Federal Office of Rural Health Policy definition of rural.

Please remember you have to APPLY for this funding. It will not be automatically allocated as with past phase funding.  In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.

The application is open now and will close on October 26, 2021 at 11:59 p.m. ET. 

Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application. 

Real time technical assistance is available by calling the Provider Support Line at (866) 569-3522, for TTY dial 711. Hours of operation are 8 a.m. to 10 p.m. CT, Monday through Friday.

Please go to the following HRSA web site to find out more information and access resources for your application: 
https://www.hrsa.gov/provider-relief/future-payments

Update on Recent Funding from HRSA

Dear Regional Partners, 

I am pleased to share with you that today, a new application cycle for $25.5 billion in COVID-19 provider funding has opened.  Applicants are able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve rural beneficiaries covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

See a detailed list of eligible provider types and application instructions here.

Applications must be received by October 26, 2021 at 11:59 p.m. ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application. In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.Yesterday, the U.S. Department of Health and Human Services (HHS) awarded nearly $1 billion in American Rescue Plan funding to nearly 1,300 Health Resources and Services Administration (HRSA) Health Center Program-funded health centers in all 50 states, the District of Columbia, and the U.S. territories to support major health care construction and renovation projects. These awards will strengthen our primary health care infrastructure and advance health equity and health outcomes in medically underserved communities, including through projects that support COVID-19 testing, treatment, and vaccination.  Health centers will use this funding for COVID-19-related capital needs, constructing new facilities, renovating and expanding existing facilities to enhance response to pandemics, and purchasing new state-of-the-art equipment, including telehealth technology, mobile medical vans, and freezers to store vaccines.    FY 2021 American Rescue Plan Funding for Health Center Construction and Capital Improvements award recipients in Region 6 can be found here. Recent awards of over $5 Million to Expand Services at HRSA’s Health Center Program School-Based Service Sites can be found here
Recent awards of over $48 Million to Health Centers for Ending the HIV Epidemic in the U.S. Initiative can be found here

Finally, on September 17, 2021 HRSA announced nearly $350 million in awards to every state across the nation to support safe pregnancies and healthy babies. Funding will expand home visiting services to families most in need, increase access to doulas, address health disparities in infant deaths, and improve data reporting on maternal mortality. 

FY2021 awards to strengthen maternal and child health in Region 6 can be found here: 

Our team at the HRSA Office of Intergovernmental and External Affairs (IEA) remain committed to supporting your COVID-19 response efforts.  Please do not hesitate to reach out to us with questions, concerns, or requests for support and engagement.

Best,
Jeri D. Pickett
HRSA Regional Administrator, Region 6