CMS Issues New Frequently Asked Questions (FAQs) Regarding Medicaid Home and Community-Based Services (HCBS)

March 2019

The Centers for Medicare & Medicaid Services (CMS) has issued Frequently Asked Questions (FAQs) that provide more information to State Medicaid programs on what settings have the qualities of an institution and are ineligible for Home and Community Based Services (HCBS), which settings qualify for HCBS, and under what circumstances CMS needs to conduct a review with heightened scrutiny to determine if the setting qualifies for HCBS.  The guidance clarifies that while rural settings may appear to meet the criteria to conduct a heightened scrutiny review, States should only request such a review if a setting has the qualities of an institution and if individuals qualifying for HCBS in a rural area do not have the same access to engage in the community as enrollees not receiving Medicaid HCBS in the same area. 

CMS Issues Report on Quality Payment Program Clinician Experience

March 2019

The Centers for Medicare & Medicaid Services (CMS) has published information on clinician participation, reporting, and performance in year one (2017) of the Quality Payment Program (QPP). Among the findings, CMS noted that rural clinicians eligible for the Merit-Based Incentive Payment System (MIPS) had a participation rate (94 percent) virtually equal to the overall average, and 93 percent of rural clinicians participating in MIPS received a positive payment adjustment. CMS also reiterated their commitment to alleviating barriers and creating pathways for improvement and success for rural clinicians through the Small, Underserved, and Rural Support initiative.

Wolf Administration Awards $15 Million in Housing Grants to Help Individuals Battling Opioid Use Disorder

March 27, 2019
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Harrisburg, PA – Governor Tom Wolf announced today that the departments of Drug and Alcohol Programs (DDAP) and Human Services (DHS) have awarded $15 million in federal Substance Abuse and Mental Health Services Administration (SAMHSA) grants for a new program to provide case management and housing support services for Pennsylvanians with an opioid use disorder (OUD). The pilot programs will support innovative practices that increase access to support services for individuals with OUD, keep people engaged in treatment and recovery, and help prevent overdose-related deaths.

“With these grant announcements we are taking an important step in removing a barrier to recovery and independence for those suffering from opioid use disorder,” Gov. Wolf said. “As we continue to battle this health crisis, being able to address housing as a means to get people into treatment and on the road to recovery is a key component.”

First announced in October, the program will direct the $15 million through 16 grant agreements that will assist urban and rural counties throughout the commonwealth. The pilot programs will assist individuals as they become and remain engaged in evidence-based treatment programs and will provide individuals with support services such as pre-tenancy and tenancy education services to maintain stable housing.

The counties selected for pilot programs under the request for applications were identified via a formula that equally considered the rate of individuals diagnosed with a substance use disorder (SUD) and rate of overdose-related deaths in a county. The selected grant recipient are:

Awardee Counties Served
Allegheny Department of Human Services Allegheny
Armstrong County Community Action Agency Armstrong
Blair County Community Action Program Blair
Center for Community Resources Butler
Commission on Economic Opportunity Luzerne
Community Counseling Center for Mercer County Mercer
Connect, Inc. Greene, Washington
Delaware County Office of Behavioral Health Delaware
Family Health Council of Central PA Dauphin
Fayette County Community Action Agency Fayette
Juniata Valley Tri-County Drug & Alcohol Abuse Commission Mifflin
Lawrence County Drug & Alcohol Commission Lawrence
Lehigh Conference on Churches Lehigh
Northern Tier Community Action Corporation Cameron
Philadelphia Single County Authority Philadelphia
The Wright Center for Community Health Lackawanna, Luzerne

 

“We know that each individual seeking treatment is just that – an individual,” said DDAP Secretary Jennifer Smith. “They each have different situations and circumstances hindering their recovery. In order to truly combat this crisis, we must build capacity to support individuals by providing necessary, supportive wrap around services like stable housing and case management.”

“The conditions in which a person lives play a substantial role in a person’s health. When a person experiences homelessness in addition to a substance use disorder, the lack of a secure home is often a barrier to staying engaged with treatment and recovery, if they are able to access treatment at all,” said DHS Secretary Teresa Miller. “These programs will soon assist people with housing access and stability and will help more people stay engaged in treatment and reach recovery.”

SAMHSA has distinguished four major dimensions that support a life in recovery: Health, Home, Purpose, and Community. This project aims to support two components of the dimensions – Home and Purpose. By giving an individual a stable, safe place to focus on their recovery, paired with the independence and self-worth that housing provides, an individual’s overall health and wellbeing is greatly improved.

Housing instability, combined with unmet basic needs, makes the road to recovery and independence extremely challenging. According to national data, about one in five people experiencing homelessness has a chronic substance use disorder. This aligns with information gathered from Pennsylvania’s 45 state-sponsored OUD Centers of Excellence, a majority of which identify housing as a major barrier for their clients.

The grants are made possible by the $55.9 million SAMHSA grant secured to bolster the state’s response to the prescription opioid and heroin epidemic. Additional initiatives included in the grant are focused on expanding services to pregnant women and veterans affected by OUD, developing the treatment and recovery workforce, and strengthening criminal justice and law enforcement initiatives with a focus on reentrant supports.

Find more information on the state’s efforts to battle the opioid crisis here.

MEDIA CONTACT:    J.J. Abbott, 717-783-1116

Pennsylvania Department of Health Earns National Public Health Accreditation

March 26, 2019

Harrisburg, PA – The Pennsylvania Department of Health achieved national public health accreditation on Monday, demonstrating the department’s continued commitment to protecting and improving the health and safety of Pennsylvanians.

“This is a very important milestone in our continued efforts to promote healthy lifestyles, prevent injury and disease and to assure the safe delivery of quality health care to Pennsylvanians,” Secretary of Health Dr. Rachel Levine said. “Each day, we are working to address health issues in a wide range of areas, including ensuring Pennsylvania has healthy moms and healthy kids, protecting seniors in nursing homes and addressing the opioid crisis. We are committed to working toward a healthy Pennsylvania.”

There are 34 states that have achieved their accreditation through the Public Health Accreditation Board since the national accreditation program launched in 2011 with funding from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. More than 240 health departments nationwide have achieved the prestigious designation, including Allegheny County, Erie County, the Bethlehem Health Bureau and the Philadelphia Department of Public Health in Pennsylvania.

Accreditation also satisfies a goal of the Centers for Disease Control and Prevention (CDC), which identified accreditation as a key strategy for strengthening our nation’s public health infrastructure. A strong public health infrastructure is more important than ever in the constantly changing local, national and global health environment.

The department began preparing for this step several years ago. Before submitting its application, the department completed several crucial steps, including finalizing the state’s health improvement plan and its organizational strategic plan, addressing challenges identified in a self-assessment and strategy maps for health reform and health equity.

“Public health is an ever-changing landscape, with potential threats including Ebola, pandemic influenza and the misinformation regarding vaccinations,” Secretary Levine said. “We are committed to preparing for each of these concerns and also being aware of new potential issues that could affect the health of Pennsylvanians each day.”

For more information on the Department and the work being done to ensure the health of Pennsylvanians, visit www.health.pa.gov or follow us on FacebookOpens In A New Window and TwitterOpens In A New Window.

MEDIA CONTACT: Nate Wardle, 717-787-1783 or ra-dhpressoffice@pa.gov

CDC: Tracking Transmission of HIV

CDC: Tracking Transmission of HIV.   On Monday, the Centers for Disease Control and Prevention (CDC) released their latest report on rates of HIV transmission in the United States.  Data for sexual and needle-sharing behaviors were obtained fromNational HIV Behavioral Surveillance, a system of research on behaviors of three populations at increased risk for HIV: 1) gay, bisexual and other men who have sex with men; 2) persons who inject drugs; and 3) heterosexuals at increased risk of infection.  These data for behavioral factors in 2016 were compared to data for newly diagnosed cases from the National HIV Surveillance System.  The analysis found that, of the 38,700 new infections diagnosed in 2016, approximately 80% of new HIV transmissions were from persons who did not know they had HIV infection, or who had received diagnosis but were not receiving care.  The report concludes that decreasing the rate of transmission relies on increasing the rate of testing and treating those who are HIV-positive with newer drugs proven to be effective at suppressing the virus.  Last year, the CDC identified 220 mostly rural counties experiencing or at-risk of significant increases of infection.  See the Approaching Deadlines section below for current funding opportunities related to the effort of reducing HIV transmission.

2019 County Health Rankings

2019 County Health Rankings.  Released on Tuesday of this week, the 2019 ranking of health for nearly every county in the nation reminds us that health outcomes are heavily influenced by where we live.  This year’s analysis focuses specifically on homes and the way they shape the health of individuals, families and communities.  Among the key findings is evidence showing that severe housing cost burden has decreased in large urban areas since the end of the real estate crisis that ended in 2010.  In that same period of time, however, nearly half of all rural counties experienced an increase in severe housing costs.

Ongoing Work on Rural Health Issues at the CDC

Ongoing Work on Rural Health Issues at the CDC.  In the latest edition of The Rural Monitor, Senior Policy Analyst Diane Hall answers questions about the work on rural health at the Centers for Disease Control and Prevention (CDC). What started as a series in 2017 for their Morbidity and Mortality Weekly Report (MMWR) has continued with ongoing work with representation from each of the CDC’s centers ensuring that rural communities are included in funding opportunities and projects.  The MMWR series oriented the public and policymakers to the rural specifics on topics such as drug overdose deaths, leading causes of death, suicide trends, and cancer incidence and deaths.

Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics

Abigail Barker, PhD; Lindsey Nienstedt, BA; Leah Kemper, MPH; Timothy McBride, PhD; and Keith Mueller, PhD

This brief uses data from the 2012–13 Medicare Current Beneficiary Survey (MCBS) to describe rural and urban differences in the populations that enroll in the Medicare Advantage (MA) program. Combined with county-level data on MA issuer participation, this dataset also allows us to assess the degree to which issuers may engage in selective MA market entry on the basis of observed demographic characteristics. Rural and urban MA and fee-for-service populations did not differ much by any characteristics reported in the data, including age, self-reported health status, cancer diagnosis, smoking status, Medicaid status, or by other variables assessing frailty and presence of chronic conditions. Most measures of access were similar across rural and urban respondents. While rurality on its own was often a significant predictor of lower issuer participation in a county’s MA market, the addition of other demographic characteristics did not influence the prediction. In other words, we found no evidence, based upon MCBS data, that issuers exclude rural counties due to other demographics. These findings suggest that poor health – as approximated by the demographic characteristics captured in MCBS data – is also captured similarly in risk adjustment formulas, meaning that MA issuers are compensated for this observed risk.

Click to download a copy: Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics