MSSNY eNews: September 22, 2021 – Healthcare Worker Vaccination Mandate: Federal Judge Extends Delayed Enforcement as it Pertains to Religious Exemptions
Federal Judge Extends Delayed Enforcement of Healthcare Worker Vaccination Mandate as it Pertains to Religious Exemptions
A Central New York federal judge has extended until October 12 a temporary restraining order (TRO) that will, at least temporarily, permit health care workers to evade the State’s vaccination requirement if they claim a religious exemption.
In response to the initial TRO issued last week, MSSNY President Dr. Joseph Sellers issued a statement expressing dismay with the federal court’s ruling (MSSNY Opposes Northern District Decision to Permit Religious Exemptions to State’s Healthcare Worker Vaccination Requirements), noting that “No major religious denomination opposes vaccinations, and the Supreme Court has for over 100 years upheld vaccination requirements as a means to protect the public health.” Dr. Sellers’ statement was included in dozens of articles regarding this court decision.
In August, the New York Public Health and Health Planning Council (PHHPC) approved an emergency regulation requiring health care workers in all Article 28 regulated settings – hospitals, nursing homes, clinics, Ambulatory Surgery Centers, dialysis facilities, etc. – to be vaccinated against Covid, with the first shot to be received by September 27. This includes physicians and other care providers who may not be employed directly but who provide care at these health care settings (such as a physician with privileges at a hospital or who sees patients at a nursing home).
The only exemption in the regulation for health care workers is for documented medical contraindications, though the court ruling means that a religious exemption can also be claimed until a decision is made by the court on October 12.
The DOH regulation provides that an acceptable medical exemption to the required vaccine is where a “licensed physician or certified nurse practitioner certifies that immunization with COVID-19 vaccine is detrimental to the health of member of a covered entity’s personnel, based upon a pre-existing health condition”. It further provides “the requirements of this section relating to COVID-19 immunization shall be inapplicable only until such immunization is found no longer to be detrimental to such personnel member’s health.” Furthermore, it instructs these covered health care entities that “the nature and duration of the medical exemption must…be in accordance with generally accepted medical standards, (see, for example, the recommendations of the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services), and any reasonable accommodation may be granted and must likewise be documented in such record”.
This week, the DOH released Frequently Asked Questions (FAQs) regarding what health care entities and health care professionals need to know regarding the health care worker vaccination mandate, including acceptable vaccination contraindications.
President Biden also announced that he would impose a vaccination worker mandate on hospitals, dialysis, home health, and ambulatory surgical centers also require vaccinations that accept Medicare and Medicaid payments.
Hurricane Ida Added to MIPS Exemption for New York and New Jersey Physicians
In response to the Federal Emergency Management Agency (FEMA) designation of Hurricane Ida as a major disaster, CMS has determined that the automatic extreme and uncontrollable circumstances (EUC) policy will apply to Merit-based Incentive Payment System (MIPS) eligible clinicians in FEMA-designated disaster areas of Louisiana, Mississippi, New York, New Jersey, and Missouri.
MIPS eligible clinicians in these areas will be automatically identified and receive a neutral payment adjustment for the 2023 MIPS payment year. During the data submission period for the 2021 performance period (January 3, 2022, to March 31, 2022), all 4 performance categories for these clinicians will be weighted at 0%, resulting in a score equal to the performance threshold.
However, if MIPS eligible clinicians in these areas choose to submit data on 2 or more performance categories, they’ll be scored on those categories and receive a 2023 MIPS payment adjustment based on their 2021 MIPS final score.
The automatic EUC policy won’t apply to MIPS eligible clinicians participating in MIPS as a group, virtual group, or Alternative Payment Model (APM) Entity.
Sharp Decreases in Opioid Prescribing, Increases in Drug-Related Overdose and Death According to New AMA Report
The AMA issued a report yesterday showing a 44.4 percent decrease in opioid prescribing nationwide in the past decade. At the same time, the country is facing a worsening drug-related overdose and death epidemic.
To address this continuing epidemic, the AMA is urging policymakers to join physicians to reduce mortality and improve patient outcomes by removing barriers to evidence-based care. The report shows that overdose and deaths are spiking even as physicians have greatly increased the use of prescription drug monitoring programs (PDMPs), which are electronic databases that track controlled substance prescriptions and help identify patients who may be receiving multiple prescriptions from multiple prescribers. The report shows that physicians and others used state PDMPs more than 910 million times in 2020. In 2019, physicians and others used state PDMPs about 750 million times.
Yet, the nation continues to see increases in overdose mainly due to illicit fentanyl, fentanyl analogs, methamphetamine, and cocaine, according to the U.S. Centers for Disease Control and Prevention. In addition, state public health, media and other reports compiled by the AMA show that the drug-related overdose and death have worsened across the nation. Research and data from the National Institutes of Health, U.S. Substance Abuse and Mental Health Services Administration, and Indian Health Service underscore the continued challenges and inequities for Black, Latinx, and American Indian/Native Alaskan populations.
Opioid prescriptions have decreased by 44.4 percent between 2011-2020, including a 6.9 percent decrease from 2019-2020. Along with the sharp decreases in opioid prescriptions, new AMA data also shows that physicians and other health care professionals used the state PDMP more than 910 million times in 2020. The report also highlights that more than 104,000 physicians and other health care professionals have an “X-waiver” to allow them to prescribe buprenorphine for the treatment of opioid use disorder. This is an increase of 70,000 providers since 2017, yet 80 to 90 percent of people with a substance use disorder receive no treatment.
MSSNY President Dr. Sellers Tells Newsday: “We Believe There’s an Obligation by Health Care Workers to Do Everything We Can to Protect the Patients Who Are in Our Care”
Newsday (NY) (9/19, Olson) reports, “New York hospitals and nursing homes are worried that a state COVID-19 vaccine mandate set to take effect Sept. 27 for their employees could cause staffing shortages, leading to an adverse impact on patient care.” Some officials worry “firing employees who refuse to get the shot could exacerbate existing shortages of nurses and other employees” but “supporters of the mandate said it is necessary to reduce the risk that hospital and nursing home employees infect patients with the coronavirus.” Medical Society of the State of New York president Dr. Joseph Sellers said, “We believe there’s an obligation by health care workers to do everything we can to protect the patients who are in our care. The vaccines for COVID are a very effective way for us to decrease the risk of our patients acquiring COVID infections from us as health care workers. It’s also to keep our health care workers healthy so they’re there to provide care to patients.” Nursing home leaders, however, “urged the state to be more flexible about the mandate deadline by, for example, extending it for a month for some nursing homes, with unvaccinated employees required to pay for COVID-19 tests twice a week” which would also “allow more time to recruit and train new employees.”
MSSNY Tip of the Week: Which Agency Regulates Which Type of Health Plan?
Physicians and their billers facing claims payment or other problems that cannot be resolved with the health plan may need to turn to the government regulator for assistance. But how do you know which regulator is the appropriate agency that oversees the type of claim with which you are having a problem? There are so many different regulators that it can be difficult to keep track.
MSSNY has compiled this quick reference guide to help you decipher the difference and provide you key contact information. If you have any questions, contact MSSNY’s Director of Physician Payment and Practice Heather K. Lopez at firstname.lastname@example.org.
Additional $25.5 Billion Provider Relief Funding Made Available
As previously reported, The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), recently announced it 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.
Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based on providers’ lost revenues and expenditures between July 1, 2020, and March 31, 2021. According to the HHS press release, PRF Phase 4 will reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers. PRF Phase 4 will also include bonus payments for providers who serve Medicaid, CHIP, and/or Medicare patients, who tend to be lower income and have greater and more complex medical needs. HRSA will price these bonus payments at the generally higher Medicare rates to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.
For more information, click here: HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding
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