Federal policy

U.S. Preventive Services Task Force recommends anxiety screenings for all adults under 65

A panel of medical experts on Tuesday recommended for the first time that doctors screen all adult patients under 65 for anxiety, guidance that highlights the extraordinary stress levels that have plagued the United States since the start of the pandemic (Source: “Health Panel Recommends Anxiety Screening for All Adults Under 65,” New York Times, Sept. 20).

The advisory group, called the U.S. Preventive Services Task Force, said the guidance was intended to help prevent mental health disorders from going undetected and untreated for years or even decades. It made a similar recommendation for children and teenagers earlier this year.

The panel, appointed by an arm of the federal Department of Health and Human Services, has been preparing the guidance since before the pandemic. The recommendations come at a time of “critical need,” said Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School, who serves on the task force. Americans have been reporting outsize anxiety levels in response to a confluence of stressors, including inflation and crime rates, fear of illness and loss of loved ones from Covid-19.


Uninsured rate for children dropped during pandemic, federal data shows

The rate of children without health insurance declined during the COVID-19 pandemic, likely the result of a provision passed by Congress that barred states from dropping anyone from Medicaid during the public health emergency (Source: “More Children Have Gained Health Insurance During Pandemic,” Pew Stateline, Sept. 21).

According to an analysis of new U.S. Census Bureau data by Georgetown University’s Center for Children and Families, the child uninsurance rate in 2021 was 5.4%, compared with 5.7% in 2019, the year before the pandemic took hold.

The center described that change as a “small but significant decline,” equating to 200,000 more children with health insurance in 2021 than in 2019. Overall, about 4.2 million children were uninsured in 2021, according to the analysis.

The data comes from the Census Bureau’s American Community Survey, which provides annual estimates of income, education, employment, health insurance coverage and housing costs and conditions for U.S. residents. The Census Bureau did not release standard results in 2020 because of difficulties in data collection in the pandemic’s first year.

The Georgetown analysis speculated that the downward trend in child uninsurance was the result of Congress’s provision in the Families First Coronavirus Response Act, passed in March 2020, that prohibited states from involuntarily dropping anyone from Medicaid, the health plan covering lower-income Americans.


Federal report finds telehealth fraud during pandemic cost Medicare $128 million

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.
 
A report released last week by federal government investigators found that nearly $128 million in telehealth claims submitted during the first year of the pandemic may have been fraudulent (Source: “'Guardrails' needed? Telehealth fraud cost Medicare $128M in first year of COVID pandemic, feds say,” USA Today, Sept. 11).
 
Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.
 
Before 2020, Medicare largely restricted telehealth to people who accessed medical care via video and audio connections set up in rural clinics. Amid the pandemic, Medicare allowed recipients in cities and suburbs to get care remotely, often from their home, via a phone call or a video chat. Medicare also more than doubled the types of services eligible for reimbursement to make it easier for people to get care without the risk of COVID-19 exposure during a visit to a clinic or hospital.


CMS proposes rule change to simplify Medicaid, CHIP enrollment

A proposed federal rule change was introduced last week that aims to make the Children’s Health Insurance Program (CHIP) and Medicaid enrollment easier (Source: “Proposed CMS rule would streamline Medicaid, CHIP enrollment,” Healthcare Dive, Sept. 1).

The Centers for Medicare and Medicaid Services on Aug. 31 issued a proposed rule with the goal of reducing coverage gaps by streamlining the application and renewal process for Medicaid enrollees and other programs such as CHIP by limiting renewals to once a year, establishing standardized statewide renewal processes and giving applicants 30 days to respond to information requests.

The proposed rule comes as states begin to notify Medicaid beneficiaries about potential losses of coverage due to the impending end of the COVID-19 public health emergency.

Earlier this year, HPIO released an Ohio Medicaid Basics update, Trends in Enrollment and Expenditures During the COVID-19 Pandemic, that provides information on enrollment and spending changes to the Ohio Medicaid program during the pandemic.


Following COVID missteps, CDC plans major overhaul

Following a series of missteps in the COVID-19 pandemic and monkeypox outbreak, the Centers for Disease Control and Prevention will undergo an “ambitious” overhaul, its director announced Wednesday (Source: “In an effort to address its missteps during Covid, CDC plans an ‘ambitious’ agency overhaul,” STAT News, Aug. 17).

In an email to staff, CDC Director Rochelle Walensky said the renewal effort will focus on making the agency more nimble and responsive to needs that arise in health emergencies. The priority will be to gather data that can be used to rapidly dispense public health guidance, rather than craft scientific papers.

Walensky also said the agency needs to acknowledge the flaws of its response to Covid-19. Those mistakes date to the earliest days of the pandemic, when a test designed by CDC scientists to detect the new disease failed to work on the ground — leaving the country blind to how quickly the SARS-CoV-2 virus was transmitting at a critical juncture when aggressive measures could have slowed Covid’s spread.

“For 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said in the email, sent to the agency’s 11,000-person staff.  “My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”


CMS approves Ohio Medicaid coverage extension for new moms

Federal officials have approved Ohio Medicaid’s plan to extend benefits for new mothers from 60 days to 12 months after the birth of their child (Source: “Ohio Medicaid extends postpartum coverage for new mothers,” Dayton Daily News, Aug. 17).

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), on Tuesday approved the state’s request to extend the coverage.

“Maternal health is a strong predictor of a child’s health, so by extending health coverage for new moms, we are helping to provide the healthiest possible start in life for Ohio’s children,” said Gov. Mike DeWine.

The American Rescue Plan Act (ARPA) provided the option for states to expand this Medicaid coverage for new moms from 60 days to 12 months. The state of Ohio’s budget included this expanded coverage in its portion of Medicaid funding. DeWine said the state of Ohio began this extended coverage on April 1 and CMS’s final approval is the last step to continuing those services.


HHS designates $60 million to address rural health workforce shortages

The federal Department of Health and Human Services (HHS) announced this week that it has designated $60 million to strengthen healthcare workforces in rural communities through a number of initiatives (Source: “HHS investing $60M to boost rural healthcare workforce,” Healthcare Dive, Aug. 9).

According to an HHS press release, About $46 million in funding through the American Rescue Plan will go to 31 recipients with the goal of expanding healthcare capacity in rural and tribal areas by creating job development, training and placement programs for dental hygienists, medical assistants, doulas and other community-based healthcare professionals.

Another $10 million will go to 13 organizations to create new medical residency programs in rural communities to boost the number of physicians training in those areas. And about $4 million will go to 18 recipients with the goal of improving health outcomes and quality for rural patients and veterans living in those communities.

About 14% of Americans live in rural communities, though those areas represent nearly 75% of primary care health professional shortage areas in the county, according to a February report from the Center for American Progress, a left-leaning think tank.


Federal lawsuit could end ACA free preventive services

A federal lawsuit heard in Texas last month could upend or even eliminate the preventive care requirement in the Affordable Care Act (Source: “Lawsuit Could End Free Preventive Health Checkups,” Pew Stateline, Aug. 9).

A group of patients and employers are arguing that the requirement is unconstitutional. The federal judge hearing the case, Reed O’Connor of the U.S. District Court for the Northern District of Texas, in 2018 struck down the Affordable Care Act as unconstitutional, only to be overturned by the U.S. Supreme Court in 2021.

According to a July report by the Urban Institute, a nonprofit research organization, health plans now cover more than 100 preventive health services with no out-of-pocket cost to patients. Among them are screening and counseling for alcohol misuse and obesity, screenings for blood pressure and depression, and immunizations.

Eliminating the preventive care mandate, many health policy analysts agree, could have far-reaching and dramatic effects, potentially causing millions of patients to put off or neglect health screenings that could detect diseases early. More than 60 professional medical organizations, including the American Medical Association, published a joint statement last month warning of a dire impact of striking down the provision.


Report finds flawed Medicare data inhibits analysis of health disparities

Inaccuracies in Medicare's race and ethnicity data have hurt the program’s ability to assess health disparities, a new federal report found (Source: “Flawed Medicare data hampering analysis of health disparities, inspector general says,” Becker’s Payer Issues, June 15).

According to a report from the HHS Office of the Inspector General, Medicare's enrollment data is inconsistent with federal data collection standards, and the inconsistencies "inhibit the work of identifying and improving health disparities within the Medicare population,"

By comparing Medicare data to other federal sources, the report found that Medicare's race and ethnicity data is less accurate for certain groups, particularly for beneficiaries who identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic. 

The report includes recommendations that CMS develop its own source of race and ethnicity data, use self-reported race and ethnicity information to improve data for current beneficiaries, develop a process to ensure that the data is as standardized as possible and educate beneficiaries about CMS efforts to improve the race and ethnicity information.


Schools slow to use federal COVID funding to improve indoor air quality

Despite billions of dollars in federal covid-relief money available to upgrade heating and air-conditioning systems and improve air quality and filtration in K-12 schools, U.S. public schools have been slow to begin projects that have the potentional to improve the overall health of students (Source: “Covid Funding Pries Open a Door to Improving Air Quality in Schools,” Kaiser Health News, June 13).

According to a report released this month from the Centers for Disease Control and Prevention, fewer than 40% of public schools had replaced or upgraded their HVAC systems since the start of the pandemic. Even fewer were using high-efficiency particulate air, or HEPA, filters in classrooms (28%), or fans to increase the effectiveness of having windows open (37%).

Both the CDC and White House have stressed indoor ventilation as a potent weapon in the battle to contain covid. And a wealth of data shows that improving ventilation in schools has benefits well beyond covid.

Good indoor air quality is associated with improvements in math and reading; greater ability to focus; fewer symptoms of asthma and respiratory disease; and less absenteeism. Nearly 1 in 13 U.S. children have asthma, which leads to more missed school days than any other chronic illness.