Announcements and Resources from HHS: Vaccine Reimbursement Toolkit, Spousal Impoverishment Standards, Stark Rule, Hospital Flexibility on Acute Care

To assist our members as they navigate regulations surrounding the Medicaid program, we share the following announcements from the Department of Health and Human Services (HHS), including the Centers for Medicare and Medicaid Services (CMS), which HHS oversees.

• Updated COVID-19 vaccine toolkit from CMS. This update includes information regarding the Public Readiness and Emergency Preparedness (PREP) Act authorizations related to COVID-19 vaccinations, implications on Medicaid and Children’s Health Insurance Program coverage and reimbursement, and authorization for pharmacies distributing and administering certain covered countermeasures (including COVID-19 vaccinations). 

• 2021 Social Security Income (SSI) and Spousal Impoverishment Standards from CMS. “Certain Medicaid income and resource standards are adjusted beginning each January in accordance with changes in the SSI federal benefit rate (FBR) and the Consumer Price Index (CPI).” This information is also available in a chart.

• HHS announces revisions to Stark Rule. The Stark Rule contains important anti-kickback provisions that govern disability supports. As reported by Politico Pro: “New safe harbors are established for providers in value-based arrangements, enabling the sharing of technology, services and financial exchanges in value-based models that assume financial risk. Among other changes, the revised rule reduces the amount of downside risk needed to qualify for the legal protections. Several provisions also address cybersecurity needs, such as allowing health systems to furnish security technology for physician practices and facilitating the sharing of electronic health records.”

• CMS announces new flexibilities around acute care in hospitals. As reported by Modern Healthcare: “Hospitals can apply for a waiver that would allow then to transfer Medicare and Medicaid beneficiaries who are in the emergency department or admitted as inpatients to their homes for continued care with daily monitoring, evaluations and in-person visits from clinical staff.”