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Policy Update
HHS COVID-19 Treatments Transition Reminders
The U.S. Department of Health and Human Services (HHS) is committed to ensuring timely and transparent communication with stakeholders so that you can prepare for the transition of COVID-19 therapeutics from a government-managed distribution process to traditional commercial distribution. Pfizer will be transitioning away from USG distribution to the commercial market before the end of the year. Given the pressing timeline associated with this transition, there is an urgent need to ensure that our central partners maintain a consistent supply of Paxlovid products throughout this shift.
To facilitate a smooth transition and to ensure continuity in the availability of essential medications, IDPH requests your cooperation in validating and updating the current in-field numbers in Tiberius. Specifically, we are seeking accurate data at the jurisdiction level within HPOP.
Reminders:
- Lagevrio and Paxlovid will be available for commercial ordering and distribution beginning November 1, 2023.
- HHS-purchased Lagevrio can be ordered for free through the out of cycle request process through 3 p.m. ET, November 10, 2023. Federal entities, excluding DoD and VA, can continue to order Lagevrio after November 10.
- Paxlovid thresholds will be set to zero November 27, 2023. Between November 27 and 3 p.m., December 15, Paxlovid will be available for ordering through the out-of-cycle process. Federal entities can continue to order Paxlovid after December 15.
- November 15-December 31, 2023, dispensing sites with excess HHS-distributed, EUA-labeled Paxlovid are able to return product with an expiration date of December 2023 or later through the Pfizer returns process to facilitate a credit to HHS which will be used to provide free NDA-labeled product to patients with Medicare or Medicaid, or who are uninsured. Beginning November 15, 2023, USG distributed EUA-labeled product with an expiration date of December 2023 or later is eligible to be returned via the Pfizer return process. Returns will be accepted through December 31, 2023. HHS recommended that returns occur in December to allow time to secure NDA-labeled inventory, for the USG Patient Assistance Program (PAP) operated by Pfizer to go live, and for commercial payer coverage to be established.
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For more details on the transition from government-led distribution to traditional commercial distribution, please see Sunsetting the U.S. Government COVID-19 Therapeutics Distribution Program
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The next stakeholder update call is 2-3 p.m. ET, Wednesday, November 8. You can register for the call online.
Prevention and Control of Influenza Outbreaks
IDPH recently issued guidance regarding the prevention and control of Influenza outbreaks. Remember to notify your local health department when an outbreak of any kind occurs. HFS also needs to be contacted. If an outbreak is identified, please call or email LaTatia Danner at (217) 782-0558,
Latatia.danner@illinois.gov. To learn more, click here.
Also, as a reminder, the HFS COVID-19 reporting form must be completed for staff and residents who test positive. if you need the report template, please contact Kara.helton@illinois.gov.
CMS Broadens Coverage of PET Scans for Alzheimer’s Patients
On Friday, October 13, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Analysis decision memo outlining Medicare’s expansion of coverage for Positron Emission Tomography (PET) beta amyloid imaging, or scans for the protein that is believed to contribute to Alzheimer’s disease (AD). Since 2013, CMS has provided a one-time amyloid PET scan per patient; however, CMS will permit Medicare coverage determinations for this type of imaging to be made by the Medicare Administrative Contractors (MACs). AD is a currently irreversible, fatal brain disorder that progressively degrades memory, cognitive function (thinking and reasoning), and eventually motor function. With over six million individuals living with Alzheimer's, AD is the number one cause of dementia in older Americans, and one of the most burdensome diseases for the Medicare population.
Click here for additional information.
Release of the Medicaid LTSS Annual Expenditures Report and Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report
Last month, the Centers for Medicare & Medicaid Services (CMS) published the “Medicaid LTSS Annual Expenditures Report for Federal Fiscal Year (FFY) 2020,” and the Medicaid Section “1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2018-2019.” These reports discuss the long-term services and supports (LTSS) rebalancing trends and patterns in expenditures for different home and community-based services (HCBS) and institutional care, nationally and across states.
Medicaid LTSS Annual Expenditures Report for Federal Fiscal Year (FFY) 2020
Summary: This report contains detailed information about Medicaid LTSS expenditures for federal fiscal year (FY) 2020 (October 1, 2019, to September 30, 2020) at the national and state levels by service category, type of LTSS (institutional and HCBS), and payment model. The last half of the FY 2020 period covers the first six months of the COVID-19 Public Health Emergency (PHE) in 2020, which had a major impact on the use of all health care services, including LTSS paid by Medicaid.
Highlights: The percentage of HCBS expenditures comprising total Medicaid LTSS expenditures has steadily increased over the last three decades, but it has slowed in recent years. The U.S. total surpassed the long-standing benchmark of 50 percent of LTSS expenditures in FY 2013 and has remained higher than 50 percent since then, reaching 62.5 percent in FY 2020. This was an all-time high and represented a 3.9 percentage point increase from FY 2019.
1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2018-2019.
Summary: This is the ninth CMS report analyzing information from annual 372 report submissions, and it focuses on trends in section 1915(c) waiver program participants, service use, and expenditures for waiver program year 2019.
Highlights: Nationally, approximately 1.9 million individuals participated in section 1915(c) waiver programs in 2019, representing a 5.2 percent increase from the prior year. In 2019, average section 1915(c) waiver program expenditures per participant per year were $30,063, an increase of 1 percent over 2018.
Click here to view the full reports.
Social Security Administration (SSA) Cost-of-Living Adjustment (COLA) Information for 2024
Social Security and Supplemental Security Income (SSI) benefits for more than 71 million Americans will increase 3.2 percent in 2024. The 3.2 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 66 million Social Security beneficiaries in January 2024. Increased payments to approximately 7.5 million SSI recipients will begin on December 29, 2023. (Note: some people receive both Social Security and SSI benefits). The maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $168,600. The earnings limit for workers who are younger than "full" retirement age will increase to $22,320. The earnings limit for people reaching their “full” retirement age in 2024 will increase to $59,520. Social Security begins notifying people about their new benefit amount by mail starting in early December. Individuals who have a personal "my Social Security" account can view their COLA notice online.
Click here to read more about the Social Security Cost-of-Living adjustment for 2024.
Supportive Living Program Room and Board Amounts Increase for 2024
Last month, the Department of Healthcare and Family Services announced that effective January 1, 2024, the Room and Board amounts will increase based on the 2024 Social Security Income (SSI) increases.
- The Room and Board amounts for a single occupancy apartment will increase from $824.00 per resident per month to $853.00 per resident per month.
- The Room and Board amounts for a double occupancy apartment will increase from $595.50 per resident per month to $617.50 per resident per month.
If you have questions regarding this notice, contact the Bureau of Long Term Care toll free at 844-528-8444.
FTC Issues Annual Report to Congress on Agency’s Actions to Protect Older Adults
The Federal Trade Commission (FTC) recently published its latest report to Congress on protecting older adults, which highlights key trends based on fraud reports by older adults, and the FTC’s comprehensive efforts to combat the problem through law enforcement actions, rulemaking, and outreach and education programs. The FTC found that older adults reported losing more than $1.6 billion to fraud in 2022. Because the vast majority of frauds are not reported, this figure likely represents only a fraction of the overall cost of fraud to older consumers, which the FTC estimates to be as high as $48 billion. The report also calls on Congress to update the FTC Act in response to the Supreme Court’s 2021 ruling in the AMG Capital Management case, which severely limited the FTC’s ability to recover money that older adults and other consumers lose to scammers.
Click here to view the full report.
How the PACE Model Integrates Medical Care with Long-Term Services and Supports
AARP's latest Spotlight report highlights the Program of All-Inclusive Care for the Elderly (PACE), a combined federal and state program designed to integrate medical care with long-term services and supports (LTSS) for adults with complex care needs. Eligible adults age 55+ who participate in PACE are able to access a comprehensive range of services, including medical and dental care, physical therapy, prescription drugs, and long-term services and supports (LTSS). PACE has demonstrated success in improving the health and well-being of participants, has high satisfaction among family caregivers, and is cost-effective.
This Spotlight provides essential information on the program, including:
What PACE is and how it works
Who uses PACE
How PACE is financed
Evidence of PACE’s success
Challenges and opportunities to scale and enhance PACE
Click here to view the Spotlight report.
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