RISE rounds up the latest regulatory headlines involving emerging infectious disease emergencies; mental health, deceitful health plan marketing practices, health care cost-related problems and racial disparities, health literacy, and the American Hospital Association’s lawsuit on site-neutral payments.

OIG warns CMS can’t ensure hospitals are prepared for emerging pandemics

A new Office of Inspector General (OIG) audit indicates that the Centers for Medicare & Medicaid Services (CMS) can’t ensure that accredited hospitals are prepared for emerging infectious disease emergencies like COVID-19.

CMS has well-designed and implemented controls, but they aren’t sufficient to ensure hospitals maintain quality and safety during these emerging threats, OIG said. For example, CMS announced in February 2019 that hospitals must plan for these threats, but the agency can’t determine whether they updated their emergency preparedness plans until 2022 because it conducts inspection surveys every three to five years. In addition, CMS requested (but could not require) accredited organizations to perform special targeted infection control surveys to help hospitals prepare for COVID-19 patients. But as of August 2020, state survey agencies only performed these surveys at about 13 percent of accredited hospitals and did not perform any in 13 states because of CMS’ limited authority over accredited hospitals.

OIG recommended that CMS make regulatory changes to allow it to require accreditation organizations to perform special surveys after it issues new participation requirements or guidance and during a public health emergency to address the risks presented by the emergency. CMS concurred with the recommendation and in March 2021 updated its State Operations Manual to include additional planning considerations and preparedness guidance that expanded on emerging infectious diseases.

CDC: Nearly a quarter of public health workers threatened, harassed

Public health workers reported experiencing traumatic events or stressors since March 2020, according to a new report by the Centers for Disease Control and Prevention (CDC). The CDC said 26,174 public health workers responded to the online, anonymous survey conducted March 29-April 16. Among the findings:

  • Seventy-two percent reported feeling overwhelmed by workload or family/work balance
  • Nearly 12 percent received job-related threats because of work and 23 percent said they felt bullied, threatened, or harassed because of work
  • Nearly 13 percent reported having received a diagnosis of COVID-19

Furthermore, respondents who reported traumatic events or stressors, either personal or work-related, were more likely to report symptoms of PTSD than respondents who did not experience these events or stressors.

Study authors said that addressing work practices that contribute to stress and trauma is critical to managing workers’ adverse mental health status during emergency responses. It is also important to encourage behavior changes that promote mental health, such as building awareness of symptoms of mental health conditions and developing sustainable coping strategies that might improve mental health conditions, particularly for public health workers who are at increased risk. Researchers also suggested organizations evaluate and adjust employee assistance programs so they are more accessible and acceptable to workers and focus more on building workplace cultures that promote wellness and destigmatize requests for mental health assistance.

3 California health insurers sued for deceiving consumers with inaccurate provider directories

San Diego City Attorney Mara W. Elliott has filed lawsuits against three major California health insurers for misleading consumers with inaccurate provider directories that include doctors who are not affiliated with the providers and whose work is not covered by their plans.

The lawsuits allege that the provider directories of health insurers Kaiser and HealthNet have error rates of at least 35 percent, and in Molina’s case, as high as 80 percent, despite California law requiring that they provide up-to-date, complete, and accurate provider directories. The false, out-of-date, or incomplete information found in these “ghost networks” impede attempts by enrollees to find needed care from in-network providers.

“Consumers should be able to trust their health insurers when seeking medical attention,” Elliot said in a statement. “Error-filled directories create dangerous barriers to health care services, with patients struggling to find a directory-listed doctor who will accept their insurance. These misleading ghost networks not only violate state law but undermine the health of San Diegans and Californians.”

The three complaints filed in San Diego Superior Court on behalf of the People of the State of California against health insurers Molina, Kaiser, and HealthNet allege that such practices are unlawful business practices under both state and federal law. The complaints also allege that the directories constitute false advertising.

Black Medicare and MA beneficiaries more likely to have cost-related problems with health care than white beneficiaries

Black beneficiaries with Medicare are more likely to have cost-related problems with their health care than white beneficiaries, according to a new Kaiser Family Foundation analysis, with the racial disparity persisting among beneficiaries in both traditional Medicare and Medicare Advantage (MA) plans.

While 17 percent of all Medicare beneficiaries, or about 1 in 6, reported health care cost-related problems in 2018, the rate among Black beneficiaries was double that among white beneficiaries (28 percent vs. 14 percent), according to the analysis of data from the 2018 Medicare Current Beneficiary Survey (MCBS).

Among MA enrollees, the rate of cost-related problems among Black beneficiaries was also higher than among white beneficiaries (32 percent vs. 16 percent), the analysis finds.

Among Black beneficiaries specifically, a larger share of those in Medicare Advantage reported cost-related problems than those in traditional Medicare (32 percent vs. 24 percent). The rate of cost-related problems was lower still among the subset of Black beneficiaries in traditional Medicare who had Medicaid or other sources of supplemental insurance (20 percent).

Cost-related problems were defined in the analysis as trouble getting care due to cost, a delay in care due to cost, or problems paying medical bills.

Across all Medicare beneficiaries, a somewhat smaller share of those in traditional Medicare than in MA reported cost-related problems (15 percent vs. 19 percent), with a lower rate among beneficiaries in traditional Medicare with supplemental coverage (12 percent). The analysis also shows that, overall and across racial and ethnic groups, the Medicare beneficiaries who are most likely to experience cost-related problems are those in traditional Medicare without supplemental coverage–30 percent of whom reported cost-related problems in 2018.

Rates of cost-related problems were even higher among Black beneficiaries in fair or poor self-reported health, where half (50 percent) of those in MA experienced cost-related problems and one-third (34 percent) of those in traditional Medicare.

The analysis finds that enrollees in MA, who now account for more than 4 in 10 beneficiaries overall, do not generally receive greater protection against cost-related problems than beneficiaries in traditional Medicare with supplemental coverage despite requirements for MA plans to have out-of-pocket limits. Differences in cost-related problems between MA and traditional Medicare with supplemental coverage are not fully explained by differences in the characteristics of beneficiaries, such as income and health status.

The new findings are noteworthy in that half of all Black beneficiaries are enrolled in MA (compared to just over one third of white beneficiaries).

However, the analysis does not estimate actual differences in average out-of-pocket spending among these groups because it is not possible to derive comparable and accurate estimates of spending for MA enrollees using the Medicare Current Beneficiary Survey, as can be done for traditional Medicare beneficiaries.

HHS awards $250M to fight COVID-19 and improve health literacy among vulnerable populations

The U.S. Department of Health and Human Services (HHS) Office of Minority Health announced it has awarded $250 million in grants to 73 local governments as part of a new, two-year initiative to identify and implement best practices for improving health literacy to enhance COVID-19 vaccination and other mitigation practices among underserved populations. The Advancing Health Literacy (AHL) to Enhance Equitable Community Responses to COVID-19 initiative is part of the Biden/Harris Administration's National Strategy for the COVID-19 Response and Pandemic Preparedness.

"The Advancing Health Literacy initiative is a vital part of the HHS efforts to help communities hardest hit by the pandemic access and understand COVID-related information," said Assistant Secretary for Health Rachel L. Levine, M.D., in the statement. "This funding, and the partnerships with local and community entities across the country, will help our national efforts to continue to tackle health disparities surrounding COVID-19 vaccination, testing, and treatment."

Health literacy is a central focus of the Healthy People 2030 blueprint for improving the health of the nation, which is sponsored by the HHS Office of the Assistant Secretary for Health. Healthy People 2030 has elevated health literacy within one of its overarching goals: Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

Over the next two years, awardee projects will demonstrate the effectiveness of working with local community-based organizations to develop health literacy plans to increase the availability, acceptability, and use of COVID-19 public health information and services by racial and ethnic minority populations. The projects will also focus on other populations considered vulnerable for not receiving and using COVID-19 public health information. Recipients are also expected to leverage local data to identify racial and ethnic minority populations at the highest risk for health disparities and low health literacy, as well as populations not currently reached through existing public health campaigns. The initiative is expected to begin on July 1.

Supreme Court declines to hear AHA lawsuit on site-neutral payments

The Supreme Court on Monday declined to consider a lawsuit brought by the American Hospital Association (AHA) asking the court to reverse federal appeals court decisions that upheld the Department of Health and Human Services’ (HHS) site-neutral payments policy.

The Supreme Court did not explain why it declined to hear the case.

The AHA in May filed a lawsuit that challenged the HHS’ payment reductions in the 2019 outpatient payment rule for certain hospital outpatient off-campus provider-based departments. Although a lower court twice found that HHS exceeded its statutory authority when it reduced these payments, a three-judge appeals panel reversed this decision in July.

The AHA’s general counsel said in a statement that the AHA was disappointed in the decision. “These cuts to hospital outpatient departments directly undercut the clear intent of Congress to protect them because of the many real and crucial differences between them and other sites of care,” Melinda Hatton said. “Hospital outpatient departments are held to higher regulatory standards and are often the only point of access for patients with the most severe chronic conditions, all of whom receive treatment regardless of ability to pay. While we are disappointed, we will continue to fight to ensure the ability of all hospitals and health systems to continue to provide the essential services and programs their patients and communities need to realize their highest potential for health.”