RISE rounds up recent news on COVID-19.

CMS to phase out temporary emergency waivers for some nursing home policies

The Centers for Medicare & Medicaid Services (CMS) last week announced plans to restore some pre-COVID-19 policies in long-term care and other facilities. It will phase out some temporary emergency declarations waivers that provided flexibilities to respond to the pandemic and that have been in effect throughout the COVID-19 Public Health Emergency. Those flexibilities are no longer needed due to a steady increase in vaccination rates for nursing home residents and staff and improvements in nursing homes’ abilities to respond to COVID-19 outbreaks. Some of the same waivers will also end in inpatient hospices, intermediate care facilities for individuals with intellectual disabilities, and end-stage renal disease facilities.

CMS said that recent long-term care survey findings offered insight into issues with resident care that aren’t related to infection control, including an increase in residents’ weight loss, depression, and pressure ulcers. The agency worries that a lack of certain minimum standards, such as training for nurse aides, may be contributing to these issues.

Waivers that will end in 30 days includes those that allow physicians to delegate tasks to physician assistants, nurse practitioners, and clinical nurse specialists; those that allow telehealth visits instead of in-person appointments; and those that restricted resident participation in in-person meetings in resident groups. Emergency declaration blanket waivers that will end in 60 days include those that waived training requirements for nurse aides and paid feeding assistants; and those that allow nursing homes to use non-resident rooms to accommodate beds and residents during surges.  

CMS said in the announcement that if there is another nationwide surge of nursing home COVID-19 cases, the agency can quickly re-issue national blanket waivers during the public health emergency.

For more details, click here to read the CMS April 7 memo.

End of PHE declaration means loss of flexibilities, including Medicare beneficiary access to telehealth

A new Kaiser Family Foundation (KFF) report explores the flexibilities that will end when the COVID-19 Public Health Emergency (PHE) expires. The PHE is set to expire on April 16, but the Biden administration is expected to renew it. However, once it ends for good, KFF notes that it will eliminate a pathway through Medicaid to free COVID-19 testing, treatment, and vaccines for people without health insurance; millions could lose Medicaid coverage; and most Medicare beneficiaries would lose access to coverage of nearly all telehealth services within a few months. In addition, any COVID tests, vaccines, or therapeutics that were granted emergency authorization for use but haven’t been approved by the Food and Drug Administration could no longer be used.

Appeals court upholds federal employee vaccine mandate

A federal appeals court last week reversed a lower court decision and has upheld President Joe Biden’s requirement that all federal employees be vaccinated against COVID-19. A panel of the 5th Circuit Court of Appeals ruled 2-1 to dismiss a lawsuit that challenged the mandate. Biden issued an executive order on Sept. 9, 2021, mandating vaccination for all executive branch employees with exceptions for medical and religious reasons. The policy requires federal employees to get vaccinated or face disciplinary action, including termination. Several plaintiffs filed suit, alleging Biden exceeded his authority. In January, U.S. District Judge Jeffrey Brown agreed and blocked the nationwide mandate. But the appeals court panel vacated the district court’s ruling and dismissed the lawsuit challenging the requirement. This week the Department of Justice asked the federal appeals court to allow the government to reinstate the policy and enforcement of it.

Commonwealth Fund study: Vaccines prevented more than 2.2M deaths in the US

Vaccination efforts in the United States prevented 2.2 million COVID-19 deaths and 17 million hospitalizations, according to a recent study by the Commonwealth Fund. Without vaccinations, study authors estimated there would have been 66 million additional COVID infections and nearly $900 billion in associated health care costs.  Researchers evaluated the impact of the vaccine rollout by simulating the pandemic trajectory under the counterfactual scenario of no vaccination program. The simulated outcomes of total infections, hospitalizations, and deaths were compared to the fitted model, reflecting the actual pandemic in the U.S. and vaccinations that occurred between December 12, 2020 and March 31, 2022. To estimate health care costs averted, the researchers used their projections of COVID-19 symptomatic infections and hospitalizations and calculated direct costs associated with COVID-19 illness and hospitalizations with and without vaccination. Costs of health outcomes were stratified into outpatient visits for symptomatic infection, hospitalizations and/or intensive care for severe illness, emergency medical services calls, and emergency department visits.

The results indicate that continuing to vaccinate and boost Americans can produce substantial health benefits and financial returns to the country, study authors say, adding that unvaccinated Americans have rates of preventable COVID-19 hospitalization and death that are significantly higher than those for vaccinated Americans. “Redoubling efforts to increase vaccine uptake, especially among the elderly and other vulnerable groups, will be critical to avert outbreaks as pandemic restrictions are lifted,” the authors wrote.