News

Genetic Sequencing Finds Tie Between Bird Flu and Dairy Farm Virus

• On July 19, the CDC confirmed a sixth case of H5N1, commonly known as bird flu, among poultry workers in Colorado. This follows the announcement from state officials on July 14 that five workers at an egg farm in Weld County tested positive for the virus. These Colorado cases were reported to be mild, with those infected experiencing traditional flu symptoms, though some infected dairy workers reported conjunctivitis as a symptom. Earlier in the summer, 54 farmworkers in Michigan were exposed to infected cows and had reported flu-like symptoms but only two of them tested positive for H5N1. The CDC has reported that genetic sequencing of the virus infecting one of the poultry workers is related to the first dairy farm case in Michigan. Due to the concentration of dairy farms in Colorado, the state is seeing a “sustained mammal-to-mammal transmission of H5N1 in dairy cows, which is leading to a potential source of continued spillovers into our poultry operations,” said Maggie Baldwin, a Colorado State Veterinarian. Leaders in the field speak on the multitude of unknowns with this virus, including what dairy farm the virus originates from and how farmworkers can effectively protect themselves from the virus during strenuous environmental factors, such as the 104-degree temperatures Weld County workers worked in (Stat News, July 22).

CMS Releases Statement on Broker Access to the Federal Marketplace

• On July 19, CMS released a statement on system changes to stop unauthorized agent and broker marketplace activity. The announcement comes after mounting complaints from consumers, that insurance brokers were switching consumers’ Affordable Care Act (ACA) plans without their consent. In the first six months of the year, over 200,000 people reported to CMS that they were either enrolled in ACA plans or switched from one plan to another without their permission. The Biden administration announced that insurance agents will now be blocked from making changes to ACA enrollments made through the federal marketplace unless the agent is already associated with a consumer’s policy. These changes are effective immediately (Fierce Healthcare, July 22).

Medicare Model for Dementia and Alzheimer’s Care Has Providers Split

• Hospitals and healthcare providers are divided on whether Medicare’s new Guiding an Improved Dementia Experience (GUIDE) model will provide adequate reimbursement for dementia patients who receive care at home. The GUIDE program is set to run for eight years and aims to manage the rising care costs for Alzheimer’s and dementia patients, which are projected to escalate significantly in future years. Providers in the pilot offer home-based healthcare services such as primary care, care navigation, and caregiver support with the goal of reducing hospitalizations. Medicare reimbursements range from $150 to $390 per month, depending on patient complexity. However, monthly rates are reduced by half for patients in the program after a 6-month period. Nearly 100 providers have started enrolling patients in the GUIDE pilot program as of July 1, with an additional 300 providers slated to begin enrolling patients on July 1, 2025. Some providers expressed that the monthly care management payments are sufficient to cover costs that were previously absorbed. However, others remain hesitant that the payments will cover the cost of comprehensive services or support program scalability (Modern Healthcare, July 23).

Federal Regulation and Guidance

CMS Issues SHO Letter on Statutory Requirements in Consolidated Appropriations Act for Incarcerated Youth

• On July 23, CMS issued a State Health Official Letter (SHO# 24-004) to address statutory requirements in the Consolidated Appropriations Act, 2023 (CAA, 2023). Two provisions in the law impact the availability of certain Medicaid state plan services for incarcerated youth. The CAA, 2023, also includes a provision that modifies CHIP eligibility requirements for children who become incarcerated. Starting on January 1, 2025, state Medicaid programs and CHIP are required to have a plan in place regarding services and eligibility for qualified youths who are within 30 days of their scheduled release from incarceration. Under section 5122 of CAA, 2023, states have the option to provide Medicaid coverage to eligible youths who are inmates of a public institution while waiting on disposition of charges and receive federal financial participation (FFP). Additionally, this section provides the option for states to consider children who are inmates of a public institution and waiting on disposition of charges as eligible for CHIP during this time. As a result of these new provisions, states must submit state plan amendments (SPA) with an effective date no later than January 1, 2025, to implement the coverage that is required in section 5121 of the CAA, 2023. If a state wishes to implement the optional coverage provided by the CAA, 2023 for this population, the SPA cannot have an effective date earlier than January 1, 2025 (CMS, July 23).

GOP House Appropriators Request GAO to Issue Report on Federal Government Use of AI on Prior Authorization

• On July 10, the House Appropriations Committee passed their FY 2025 HHS spending bill, which includes an ask for the Government Accountability Office (GAO) to issue a report to Congress outlining current and future AI use within prior authorization, how the federal government evaluates the data to make decisions regarding prior authorization, and existing AI safeguards, along with a preliminary briefing to be held with the Energy & Commerce and Ways & Means committees within 12 months of the enactment of their spending bill (Inside Health Policy, July 16).