In The News

HHS Announces Historic, First-in-the-Nation Program that Seeks to Expand Coverage to Nearly 10,000 Coloradans

New “Colorado Option” will lower premiums and ensure greater access to health care for more residents, advancing health equity in the state.

[Last week], the U.S. Department of Health and Human Services (HHS) announced approval of Colorado’s Section 1332 State Innovation Waiver amendment request to create the “Colorado Option,” a state-specific health coverage plan that increases health coverage enrollment and lowers health care costs, making insurance more affordable and accessible for nearly 10,000 Coloradans starting in 2023. It is designed to reduce racial and ethnic health disparities by providing new coverage options for Coloradans, reflecting the Biden-Harris Administration’s commitment to advancing health equity. 

“We are thrilled to partner with Colorado in our shared commitment to lowering health care costs and ensuring greater access to quality, affordable care,” said HHS Secretary Xavier Becerra. “The Colorado Option will help thousands more families sign up for health coverage. I applaud Governor Jared Polis and encourage all states to pursue innovative ways to ensure health care is within reach for their residents.”

Section 1332 of the Affordable Care Act (ACA) allows states to apply for State Innovation Waivers to pursue innovative strategies for providing residents with access to high-quality, affordable coverage. Colorado is the first in the nation to adopt this waiver to introduce a new and more affordable state-based health insurance option, and leverage federal savings to support state subsidies to improve affordability and coverage initiatives. Colorado projects that approximately 32,000 Coloradans will gain health insurance under the amended waiver by 2027, which would be an increase of approximately 15% in the individual market.

This 1332 waiver amendment implements the Colorado Option, which lowers premiums and health care costs while making it easier for consumers to compare their coverage options and select the best plan that fits their needs. Starting in 2023, the Colorado Option will be available to all Coloradans who enroll in health insurance plans on the individual market (i.e., not through an employer) and small employers with less than 100 employees. Colorado Option plans will lower health insurance premiums for individuals, families, and small businesses by up to 15% by 2025.

The Colorado Option will operate in tandem with Colorado’s existing section 1332 waiver, a state-based reinsurance program, which is authorized to continue under the amended waiver. The amended waiver is expected to lower premiums by an average of approximately $132 per person per month (or 22%). This is even further than the state’s reinsurance waiver program alone, which has already resulted in statewide average premium reductions of approximately 20% since its implementation in 2020.

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Find more information about the Colorado Option here: Colorado Option website

View a fact sheet for additional information here: https://www.cms.gov/newsroom/fact-sheets/colorado-state-innovation-waiver-0

 

CDC Authorizes COVID Vaccines for Children Ages 6 Months+

The Centers for Disease Control and Prevention (CDC) issued recommendations for vaccinating children 5 years of age and younger against COVID-19. The recommendation clears the way for the nearly 241,000 Utah children in this age group who are now eligible to get vaccinated.

Additionally, the U.S. Food and Drug Administration (FDA) has authorized both the Pfizer and Moderna mRNA vaccines for use with all ages (6 months and older) eligible for COVID-19 vaccinations. Previously, only the Pfizer vaccine was available for children younger than 18. 

Vaccines for this youngest age group will begin to arrive in Utah the week of June 20th. The first batch of doses is expected early in the week and another batch of doses is expected later in the week. According to the Utah Department of Health and Human Services (DHHS), providers have already ordered 32,300 doses of the vaccines. 

Providers such as local health departments, select pharmacies, and doctor’s offices will begin offering vaccinations to the youngest Utahns over the next several days to weeks. “We encourage parents to reach out to their child’s healthcare provider if they have questions about the COVID-19 vaccines and to find out when they can get their children vaccinated. Please be patient with vaccine providers over the next couple of weeks as they receive vaccines and prepare to administer them to our youngest children,” said Dr. Leisha Nolen, a pediatrician and the state epidemiologist at the DHHS.

A list of vaccine providers is available on the state’s coronavirus webpage. Vaccines will not be available for this youngest age group at all locations right away. Parents can visit vaccines.gov to verify which providers have younger pediatric vaccines available or call their child’s doctor’s office or local health department for information on scheduling a vaccination.  

Vaccine dosage is based on the brand of the vaccine and a person’s age the day they receive the vaccine, not weight. Depending on the type of vaccine given, children younger than 5 may need 2 or 3 doses. 

  • Pfizer vaccine: Children ages 6 months through 4 years of age will need 3 doses to complete their primary vaccine series. The 2nd dose should be given 21 days after the 1st dose and then a 3rd dose 2 months after the 2nd dose.
  • Moderna vaccine: Children ages 6 months through 5 years of age will need 2 doses to complete their primary vaccine series. The 2nd dose should be given at least 28 days after the 1st dose. 

For more information visit https://coronavirus.utah.gov/vaccine/ or call the COVID-19 hotline at 1-800-456-7707.

 

'Part of a New Normal': Covid Reinfections are Here to Stay

NBC News | By Akshay Syal, M.D. and Sara G. Miller

In 2020, Covid reinfections were considered rare.

In 2021, breakthrough infections in vaccinated individuals could occur, but again, the risk was low.

In 2022, that's no longer the case for either. As more immune-dodging coronavirus variants emerge, reinfections and breakthrough infections appear increasingly normal. 

The United States isn't currently tracking Covid reinfections. However, U.K. researchers have found that the risk of reinfection was eight times higher during the omicron wave than it was in last year's delta wave

“I would not be surprised if we see people get infected more than once per year,” Dr. Anthony Fauci, chief medical adviser to President Joe Biden, said in an interview with NBC News last week, though he added that he feels optimistic that it will eventually settle into becoming just a seasonal occurrence, like the flu. (Fauci, who has received two vaccine boosters, himself tested positive for Covid on Wednesday, saying he has mild symptoms.)

Of course, just because reinfections are possible, doesn’t mean people should give up on all efforts to prevent them; staying up-to-date on vaccinations and wearing masks indoors in places with high transmission still work to lower risk.

Here’s what we know so far about reinfections.

Can I be Reinfected if I’ve Already Had Covid, or Been Vaccinated or Boosted? 

To put it bluntly, yes. Experts are in agreement that reinfections are possible, even in people who have already been infected or those who are up-to-date on their vaccines.

“Reinfections, unfortunately, are not unusual for coronavirus,” said Akiko Iwasaki, a professor of immunobiology at Yale University. “It’s just the nature of this virus infection.”

The coronavirus that causes Covid is not unique — other types of coronaviruses that cause common colds can also reinfect, Fauci said. But those reinfections may occur every two or three years, because those viruses don’t change very much. 

That’s not the case for SARS-CoV-2, and particularly the rapidly evolving omicron subvariants, which are good at evading existing immunity. Combine that with the fact that people’s immunity naturally wanes over time, Iwasaki said, and “it’s not that surprising to see a lot of reinfections now.”

That’s especially true for people who were infected with the original omicron variant, dubbed BA.1, in the winter. The BA.4 and BA.5 subvariants — currently gaining a foothold in the U.S. — are quite different from BA.1, so “it’s no guarantee” that having a past omicron infection will protect you from subsequent subvariants, she said.

How Many Times Can I be Reinfected? 

It’s impossible to put an exact number on how many times a person can be reinfected, experts say.

With a high level of Covid currently spreading in the U.S., any of us have a good chance of being exposed to someone who is contagious — and becoming reinfected.

Whether a person is reinfected depends on the strength of the immune response when the person was exposed, as well as whether he or she has been recently vaccinated, said Dr. Julie McElrath, director of the vaccine and infectious disease division at the Fred Hutchinson Cancer Center in Seattle. Multiple exposures to the virus — which may not necessarily lead to symptoms — could have a silver lining, McElrath said.

Each time a person is exposed, the immune response matures and improves.

“We should consider reinfection as part of the new normal,” she said. “The hope is that with these multiple exposures continually improving antibody response will occur.”

Read Full Article for answers to the following questions:

  • How long does Covid immunity last after infection?
  • If reinfected, will symptoms be milder or worse?
  • Are certain people more vulnerable to reinfection?
  • Am I more likely to develop long Covid if I get reinfected?
 

How Home Health Providers Are Training Staff to Improve Patient Survey Scores

Home Health Care News | By Patrick Filbin
 
With a number of home health regulatory changes coming once the calendar flips to 2023, agencies are focusing on getting a head start adjusting their staff to changes.
 
Many leaders consider major regulatory shifts as an issue that needs to be dealt with from the top, down. But that’s not necessarily the case.
 
The Home Health Value-Based Purchasing (HHVBP) Model, for example, will be implemented on Jan. 1 of 2023.
 
That happens to be the same date when OASIS-E will finally be implemented as well.
 
Arming staff with the ability to deal with these changes is as important – if not more – than leaders’ ability to adapt themselves.
 
“Our staff has really emphasized that our ultimate goal with value-based purchasing is to continue to keep providing the best possible care for our patients,” Cheryl Foster, director of home health at North Kansas City Hospital, told Home Health Care News. “The biggest challenge, I think for a lot of people, is the cost of getting the staff and educating the staff on these changes.”
 
Foster has been in the home health industry for about 30 years and management for a majority of that time. North Kansas City Hospital’s home health arm has a patient census of about 350 and up to 85 full- and part-time employees.
 
The ultimate goal, of course, is for the home health division to continue to provide the best possible care for its patients under HHVBP.
 
“That needs to really be our focus,” she said. ”We’re going to look at the different things that roll into value-based purchasing, but the reason we’re looking at them is because we want to provide better care for our patients and better outcomes.”
 
However, reaching that goal will prove difficult for several reasons.
  
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Regulators Taking Aim at Hospice PE Backers

Hospice News | By Jim Parker

Private equity firms are pouring investment dollars into hospices at a record pace. Meanwhile, legislators and regulators as far up as the White House are taking aim at those firms.

Despite a cool down in the hospice mergers and acquisitions market during the first quarter of 2022, private equity firms have stayed aggressive on deals. About 30% to 50% of home health and hospice transactions in 2021 involved private equity, according to the M&A advisory firm The Braff Group.

With this growing influence comes renewed scrutiny about their impact on patient care, federal policymakers have indicated. Even President Joe Biden called out PE investors during his State of the Union address this year.

“As Wall Street firms take over more nursing homes, quality in those homes has gone down and costs have gone up. That ends on my watch,” Biden said. “Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect.”

Though the president’s remarks focused on nursing homes, investors throughout the health care continuum should take note. A number of agencies and some lawmakers have also started to step up oversight of these firms.

The U.S. Securities and Exchange Commission (SEC) in January proposed amendments to reporting requirements for advisors to large hedge funds and private equity funds.

If made final, the new rules would require these individuals to file reports within one business day of events that could indicate potential harm to investors or signal broader financial risks.

Current SEC rules mandate that these advisors report their private equity assets under management when they meet or exceed $2 billion. The proposal would reduce that threshold to $1.5 billion and would require firms to provide more information used for risk assessment and regulatory enforcement.

Another key finance regulator, the U.S. Federal Trade Commission, is also sharpening its gaze on private equity, based on recent actions and statements from the commission’s leaders.

Stakeholders have raised similar antirust questions about PE firms that invest in health care, as well as perceived lack of oversight.

“Private equity firms operate under the public and regulatory radar. Most private equity acquisitions in health care are not reportable to antitrust or financial regulatory authorities under current law,” a report from the American Antitrust Institute recently stated. “And, even where transactions are reportable, the complex structure of private equity funds obscures the competitive impact of those deals. As a result, private equity companies operate in health care without any effective oversight.”

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