- Biden-Harris Administration Invests $74 Million to Improve Health Care for People Living in 37 States, Guam and Puerto Rico
- HHS Invests Nearly $60 Million to Strengthen Health Care Workforce and Improve Access to Care in Rural Communities
- A Proclamation on National Health Center Week, 2022
- The US Mental Health Hotline Network Is Expanding, but Rural Areas Still Face Care Shortages
- American Institute of Dental Public Health Rural Oral Health ECHO Call for Case Presentations
- CMS: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating
- Inflation is Crushing Rural America and May Even Drive People to the Cities
- House Members Ask HHS to Clarify Enforcement Plans for 96-hour Rule
- Northern Navajo Medical Center Delivers Care Directly to Patients Experiencing Homelessness
- There Aren't Nearly Enough Native American Physicians. A Crash Course in Medicine Seeks to Change That
- Public Inspection: CMS: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; etc.
- Nurse Midwives Step Up to Provide Prenatal Care After Two Rural Hospitals Shutter Birthing Centers
- Rural Infection Rate Climbs for Third Consecutive Week
- Rural Hospital Rescue Program is Met with Skepticism from Administrators
- Rural Hospital Rescue Program is Met with Skepticism from Administrators
Today, the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) announced the launch of FindTreatment.gov, a newly designed website that will help connect Americans looking for substance abuse treatment with approximately 13,000 locations across the United States. HHS Secretary Alex Azar and SAMHSA Assistant Secretary Elinore McCance-Katz issued the following statements:
“Better access to treatment, prevention, and recovery services is one of the five pillars of HHS’s strategy to end the opioid crisis,” said HHS Secretary Alex Azar. “Under President Trump, we have unequivocally and strongly supported medication-assisted treatment in particular because we see addiction as a medical issue, not a moral failing. Addiction demands treatment, not judgment. We know that finding access to the right provider, at the right time, can be essential to helping someone start on the road to recovery. Now, thanks to FindTreatment.gov, more Americans will have easier ways to the find the treatment that they or loved ones might need.”
“An easily-accessible system to locate treatment will be a critical tool for individuals to get the care they need” said Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use. “Increasing treatment access is an integral part of the approach to address substance use disorders across the country.”
Further background from HHS:
Over 19.3 million American adults had substance use disorder (SUD) in 2018, and connecting them with appropriate treatment is a critical step to combating the opioid crisis in America
· In 2019, estimates suggest 1.27 million Americans are receiving medication-assisted treatment, a 38 percent increase from an estimated 921,000 Americans in 2016
· FindTreatment.Gov is designed to provide the most relevant information for each individual’s recovery needs by creating a modern, user-friendly experience that is visually clear, simple, and welcoming to those in crisis
· Visitors can access information on location, treatment options, payment and insurance information, and over 13,000 state-licensed facilities, based on data compiled by SAMHSA
Examples of treatment include:
· Residential treatment – Live-in care, lasting for a month up to one year
· Outpatient treatment – Treatment at a program site while the patient continues to live on their own
· Detoxification – Supervised withdrawal from substance use
· Interim care – When immediate admission to other care isn’t available
· Content and design were developed over the last year by incorporating 300 pieces of feedback, plus 60 long-form informational interviews, from recovery professionals, help line operators, local advocates, parents seeking help, and Americans in active recovery
Honesdale, PA (October 30, 2019) — Treatment for nearly 2,000 additional patients at the Pike Dental Center will be made possible through a $300,000 grant from the Oral Health Infrastructure Grant Program of the Health Resources and Services Administration (HRSA).
Officials of Wayne Memorial Community Health Centers (WMCHC) were notified of the grant award earlier this month. The monies will be used to create a 748 square foot expansion within the existing dental center located in Lords Valley, PA. The result, an increase from five to nine operatories at the facility, has the potential of generating between 8,500 – 9,000 additional dental visits per year.
Pike Dental Center was constructed to meet the growing demand for accessible dental care for the greater Pike County area. The state-of-the-art facility first opened its doors in January of 2014 with a total of five operatories. The Lords Valley office, currently staffed by Megan Martino, DMD and John Ridd, DMD, is an extension of the Together For Health Dental Center in Honesdale.
“Even with the development of the Pike office having taken place no more than five years ago, it remains a challenge to provide care as timely as we’d like,” stated Frederick Jackson, executive director, WMCHC. “Wait times exceed four months for some services.”
According to WMCHC’s Dental Manager Nichole Yannone, it became evident as early on as 2015 that the current Pike facility wasn’t large enough to meet the need of the service area. Yannone says the dentists, hygienists and support staff at Pike Dental look forward to the “increased access to care, appointment availability and additional space in which to work” that will be realized when the expansion comes to fruition.
Jackson explained that WMCHC is still “in the design phase of the project” at this time. However, it is hoped that construction will begin in early 2020 with completion by the summer.
WMCHC is a federally qualified health center clinically affiliated with Wayne Memorial Health System, Inc. In addition to dental services, WMCHC offers primary care, women’s health, pediatric services, pulmonology, general surgery and behavioral health services at satellite offices located in Wayne, Pike, Lackawanna and Susquehanna Counties. For more information on all services, call 570-253-8390 or visit wmchc.net.
From the Rural Yonder, October 29, 2019
Rural America as a whole has struggled with population loss and sluggish job growth during the past decade, but some areas have managed to buck these trends and may serve as bright spots for those focused on economic development outside of cities.
New research from the Center for American Progress, a liberal think-tank, attempts to highlight some of the assets rural areas might use to their advantage and also points out that the fortunes of rural communities differ widely by region and based on other factors.
“What we’re trying to drive home is that rural America is not an economic liability,” said Zoe Willingham, who co-authored the center’s policy brief.
Read the full article here.
This brief from the Pennsylvania State Data Center celebrates the fall season with a look at agriculture across Pennsylvania according to the 2017 Census of Agriculture. Some of the data highlights include:
- Pennsylvania had over 4 million acres of harvested cropland in 2017.
- Nearly half (48.5%) of Lancaster County’s land area is devoted to harvested cropland.
- Over 48,000 acres of vegetables were harvested in Pennsylvania in 2017.
Which vegetable was the most harvested in each county? Click here to read more about trends in harvested cropland and vegetables harvested across the state.
In 2018, 127 cases of human trafficking were reported in Pennsylvania, according to the National Human Trafficking Hotline. At the 2019 Rural Human Trafficking Summit hosted by the Pennsylvania Office of Rural Health at Penn State Tuesday, advocates said that to target and stop trafficking, the public needs to first recognize the situation.
The National Human Trafficking Hotline reported nearly 8,000 cases of sex trafficking in 2018, and about 1,200 case of labor trafficking. The organization says the statistic doesn’t necessarily mean sex trafficking is more prevalent than labor trafficking, only that people are more aware of the former.
Jane Guerino, a survivor of sex trafficking, said most people don’t believe trafficking is happening in Pennsylvania or outside of urban areas. She was abducted at the age of 30 in Allentown, Pennsylvania.
“It is here. It’s in your backyard. It is with your children, and you don’t know it and you don’t realize it until they’re abducted or they’re taken into trafficking,” she said.
Guerino is the president of the Glory House in Allentown, a transitional home for victims of human trafficking and domestic violence. She warned that dating websites and the internet as a whole are often used by traffickers to lure potential victims into trafficking. Young girls and women should be especially vigilant and cautious, she said, as they’re the most likely targets.
Guerino, who was one of the speakers at the summit, said medical professionals and law enforcement agencies need more training on recognizing signs of human trafficking in victims. They may come in contact with emergency rooms or police officers while showing bruising or displaying anxiety.
Shea Rhodes, who directs the Institute to Address Commercial Sexual Exploitation at Villanova University, talked about prosecuting the traffickers and buyers in the billion-dollar industry instead of the victims.
“Pennsylvania is really starting to — and our legislature is recognizing that, unless we target the sex buyers to drive down that demand for commercial sex, the traffickers are going to continue to capitalize and be able to make money,” Rhodes said.
She helped push the state to enact a comprehensive legislation that defines both sex trafficking and labor trafficking in 2014, “the most meaningful change” from the legal perspective.
“Every year since that law has gone into effect, we’ve been working with the legislature to continue to move that ball forward,” Rhodes said.
One of the additions is a Safe Harbor Law, which the state enacted in 2018, ensuring child victims of human trafficking don’t get prosecuted for prostitution or other crimes.
“We really need to change the public perception as to what prostitution is,” Rhodes said. “And all of those terrible synonyms and the stigma that goes along with that particular crime. It’s actually, in our opinion, exploitive, and we don’t think anyone, who is being either sold for sex, or selling sex because they have no other way to survive, should be criminalized.” So far, the 2014 legislation has led to 46 convictions in the state.
If you or someone you know is a victim of human trafficking, you can get help by calling the National Human Trafficking Hotline, 1-888-373-7888 or text 233733.
Did you know that people living in poverty spend ten times more as a proportion of their annual family income on dental services than high-income families? Click here to read Part 1 of our 3-part series that outlines barriers to dental care based on income, and how expansion of an adult dental benefit could increase access to care and reduce out-of-pocket costs.
Stay tuned for Parts 2 and 3 in our series about the burden of out-of-pocket costs of dental care for low-income families. Visit our Research page for other research briefs, white papers, articles and more.
Read the report from DentaQuest here: https://www.dentaquestpartnership.org/system/files/Poverty%20Report.pdf
The Centers for Medicare and Medicaid Services (CMS) announced it is delaying the start of several new voluntary value-based payment models, including the Primary Care First and Kidney Care First models, until at least 2021. However, CMS continued to encourage Medicare providers to apply to participate in the models. (Source: Modern Healthcare‘s “Transformation Hub,” 10/24)
A federal judge in a final judgement issued last week ordered the federal government to reimburse nearly 100 health insurers about $1.6 billion in unpaid cost-sharing reduction payments called for under the Affordable Care Act. The ruling is the latest of several decisions stating that the federal government is required to make the payments, which total billions of dollars, but the Department of Justice has appealed those rulings. (Source: Modern Healthcare, 10/24)
Window shopping begins with quality rating information displayed on HealthCare.gov across states for the first time
The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2019 to December 15, 2019, for coverage starting on January 1, 2020. Similar to previous years, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience, and use consumer feedback to drive ongoing improvements across the Exchange platform. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2020 plans and prices before Open Enrollment begins and for the first time HealthCare.gov will also display quality rating information in states that use HealthCare.gov, expanding the information available for consumers in their decision-making when comparing health coverage choices.
NEW THIS YEAR
Key Updates and Enhancements to Healthcare.gov for the 2020 Open
Quality Rating Information Displayed in HealthCare.gov States
Quality ratings will be displayed on HealthCare.gov when consumers view the list of plans available in their area in HealthCare.gov states this year. Under the five-star Quality Rating System, Exchange health plans are given an overall rating on a 1 to 5 scale, with 5 stars representing highest quality. The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration. In some cases — such as when plans are new to the Exchange or have low enrollment — ratings may not be available.
Star ratings in the Exchange help make it easy for consumers to compare health coverage choices by giving consumers a snapshot of how each health plan’s quality compares to that of other Exchange plans in each state in a given year. A quality rating of 3 or above means that a health plan is considered average or above average as compared to other plans across the country. For the 2020 coverage year, 80 percent of plans eligible to receive a rating of at least 3 stars. Similar to national quality reporting programs due to the time needed to collect and analyze survey and clinical quality measure data, the data CMS uses to calculate star ratings is based on plan performance data from two years prior. When shopping for a plan in 2020, consumers should keep in mind that star ratings displayed on HealthCare.gov are generally based on how the plan performed in prior years.
HealthCare.gov will display the Overall Rating with the number of stars from 1 to 5 filled in towards the top of each plan, or let the consumer know if the individual plan hasn’t been rated. Consumers can see three additional star ratings for Member Experience, Medical Care, and Plan Administration which comprises the Overall Rating when selecting an individual plan’s detailed information along with other coverage and benefits. The Overall Rating and the three additional quality rating categories are also displayed when consumers choose to compare up to three plans side-by-side.
For more information, please see the Exchanges Quality Rating System fact sheet.
Summary information is provided in the Plan Year 2020 quality ratings results at a glance.
Expanded Streamlined HealthCare.gov Application
As part of the continued commitment to improving the customer experience, the streamlined application on HealthCare.gov is expanded this year to handle nearly all consumer applications, both simple and more complex eligibility scenarios. The streamlined application provides improved content and integrates help information throughout the application in order to provide a more seamless enrollment experience from start to finish, as well as enhanced mobile optimization. CMS will continue to make enhancements to the application based on consumer feedback and testing.
Visual Refresh of Consumer Shopping Experience
This year, the visual experience for consumers when they preview plans (“See plans & prices”) and shop, compare and enroll on HealthCare.gov has been refreshed based on consumer research and feedback. The visual refresh provides a more consistent user experience throughout the entire enrollment process on HealthCare.gov that includes updates to filters, the plan results list, improved help content and enhanced mobile optimization.
Enhanced Direct Enrollment (EDE) Expanded
Enhanced Direct Enrollment (EDE) will be available throughout the entire Open Enrollment Period for the first time this year. This key development allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage. Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center. This year, more approved partners are offering EDE-capable websites. As of October 25, CMS has approved more than 5 private sector partners to operate an EDE pathway.
The safety and security of consumer information is our number one priority. Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform. CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.
For more information please see the Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage fact sheet.
New resources about Health Reimbursement Arrangements (HRA)
New rules released this year permit employers to fund individual market premiums for their employees through a new type of HRAs – Individual Coverage HRAs. CMS is adding educational information and a consumer worksheet tool to assist employees in determining whether to use an individual coverage HRA from their employer to help pay for coverage. HRAs are employer-funded accounts from which employees are reimbursed tax-free for qualified medical expenses.
For more information please see the Health Reimbursement Agreements webpage.
Consumer Tools and Support
On October 25, 2019, CMS launched updates to window shopping (the “See plans & prices” page on HealthCare.gov) which allow consumers to preview 2020 plans and prices before Open Enrollment begins. As in previous years, window shopping lets consumers browse plans without logging in, creating an account, or filling out the official application. Starting November 1, consumers can log in to HealthCare.gov and CuidadodeSalud.gov or call 1-800-318-2596 to fill out an application and enroll in a 2020 Exchange health plan.
Consumer Call Center
The Call Center is often the front line of assistance for consumers as they apply for coverage and compare plan options. For the last two consecutive Open Enrollments, the consumer satisfaction rate remained at all-time high – averaging 90 percent – throughout the entire Open Enrollment Period. In order to help prepare the Call Center representatives to handle high consumer demand, CMS will continue providing extensive training to Call Center staff prior to Open Enrollment and weekly refreshers throughout the Open Enrollment Period.
In addition to the Call Center, in-person assistance will continue to be available to help consumers with enrollment. This includes local agents and brokers, Certified Application Counselors, and federally-funded Navigators.
Helping Consumers Connect with Agents & Brokers
CMS will continue to partner with a third party to offer the “Help On Demand” services from agents and brokers. This service allows consumers to choose to request that an agent or broker in their area contact them directly for help applying and enrolling. Registered agents and brokers are able to set times when they’re available and then reach out to consumers who expressed interest in assistance.
Learn more about Help On Demand services.
Find Local Help
Find Local Help is a tool that allows consumers to search by city and state or ZIP code to see a list of local people and organizations who can help them enroll in coverage. Consumers can search for a specific person or organization by entering their name and can filter the results based on their preferences and services provided. Additionally, consumers can filter agents and brokers by their minimum years of participation on the Federal Exchange.
Premium tax credits will be available in 2020 for individuals who qualify. Consumers can continue to use Exchange coverage and take advantage of its benefits, including premium tax credits. Plans available from insurance companies will continue to reflect reduced copayments, coinsurance, and deductibles for eligible consumers.
Small Business Health Options Program (SHOP)
Similar to previous years, employers will be able to enroll directly with an issuer, or with a SHOP-registered agent or broker. HealthCare.gov allows small business employers to preview available SHOP plans and find an issuer or agent/broker to work with to offer SHOP coverage to their employees. Quality rating information will also be available for SHOP plans.
Open Enrollment Notices
Each year, the Federal Health Insurance Exchange sends notices to consumers who are currently enrolled in a plan prior to November 1 about the upcoming Open Enrollment Period. This notice provides consumers with the dates for this year’s Open Enrollment and the importance of returning during this time to update their application and actively re-enroll in a plan for 2020. The notice also provides consumers with customized messaging for their situation, such as if they’re at risk of losing tax credits. Consumers receive additional notices from their current issuer with important information about premiums, coverage and benefit changes, and plan availability for 2020.
To see examples of consumer notices, visit: https://marketplace.cms.gov/applications-and-forms/notices.html
Automatic Re-enrollment Process
Similar to previous years, current enrollees who don’t update their application and enroll in a plan by the December 15, 2019 deadline generally will be automatically enrolled in the same plan or another plan offered by the same issuer that is intended to be similar, and if that is not available, another plan with a different insurance company. Consumers who are currently enrolled are strongly encouraged to come back and update their information, shop, and pick a plan that best suits their health care needs before the deadline. Consumers who miss the deadline to actively re-enroll in a plan of their choice during Open Enrollment will not be able to make any plan changes until the next coverage year unless they qualify for certain Special Enrollment Periods.
The Exchange sends a notice alerting consumers who were automatically re-enrolled.
Consumers whose 2019 issuer doesn’t have a plan available to them for 2020 will receive a discontinuation notice from their current issuer by the start of Open Enrollment. Those consumers may also receive a letter from the Exchange notifying them that they have been matched with an alternate plan from a different issuer to help avoid a gap in coverage. These consumers generally will need to pay their premium for January in order for their 2020 coverage to begin. Consumers are not under any obligation to stay with the new plan and are encouraged to take action and choose a plan by December 15. Consumers whose issuer isn’t offering their plan in 2020 are eligible for a Special Enrollment Period due to losing coverage and have the opportunity to choose a different plan.
Marketing and Outreach
CMS plans to spend $10 million on marketing and outreach for the upcoming Open Enrollment Period, matching the same level of spending for the past two years. CMS will continue to use similar marketing tactics that focus funding and attention on the most strategic and efficient ways to reach consumers. This year’s outreach and education campaign will target people who are uninsured as well as those planning to reenroll in health plans, with a special focus on young and healthy consumers. CMS has committed resources to proven high impact, low cost digital outreach efforts including short YouTube videos, social media, and mobile and search advertising.
CMS will also continue to use direct response methods including email, text messaging and autodial messages. Targeted email has proven to be the most cost efficient and effective way to reach consumers. As part of this effort, CMS will send most consumers emails throughout each week, with increasing frequency as the December 15 deadline approaches. CMS will also reinforce educational messaging through ongoing text messages and provide reminder calls encouraging consumers to take action before the deadline.
HealthCare.gov Scheduled MaintenanceWindows
Every year, CMS establishes scheduled maintenance windows that provide periods of time when CMS and its partners can make updates or resolve issues. Maintenance will only occur within these windows when deemed necessary to provide consumers with a better shopping experience. Consumer access to HealthCare.gov may be limited or restricted when this maintenance is required. Regularly scheduled maintenance will continue to be planned for the lowest-traffic time periods on HealthCare.gov, which are Sunday mornings.
The purpose in scheduling these times is to minimize any consumer disruption. Like other IT systems, these scheduled maintenance windows are how CMS updates and improves our system to run optimally and are the normal course of business.
For more information on the scheduled maintenance times, visit: https://marketplace.cms.gov/technical-assistance-resources/healthcaregov-maintenance-windows.pdf
HealthCare.gov Waiting Rooms
Similar to previous years, CMS may deploy a “waiting room” for some consumers who are logging in or creating an account on HealthCare.gov if website traffic becomes high enough to impact the consumer experience.
The waiting room is one tool CMS utilizes to optimize a consumers’ experience because it allows CMS to control the volume of users on HealthCare.gov resulting in better performance of the website. If they are in a waiting room, consumers will see a message asking them to stay on the page. The waiting room will refresh when a consumer can continue to apply and enroll with a smooth experience.
Weekly Enrollment Snapshots Similar to previous years, CMS plans to release weekly enrollment snapshots throughout the Open Enrollment Period.
2020 Health Insurance Exchange Premium Landscape Issue Brief
To view the 2020 Health Insurance Exchange Premium Landscape Issue Brief, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/QHP-Choice-Premiums.html
2020 Plan Landscape Data
For more information on 2020 individual and family health plans available in the Federal Health Insurance Exchange, visit: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/
2020 Health Insurance Exchange Public Use Files
To see the 2020 Health Insurance Exchange Public Use Files, visit: https://www.cms.gov/cciio/resources/data-resources/marketplace-puf.html
2020 Quality Rating System Public Use Files
To see the Plan Year 2020 Quality Rating System Public Use Files, visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/ACA-MQI-Landing-Page.html
2020 Issuer Participation County Map
To see the 2020 Issuer Participation County Map, visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Health-Insurance-Exchange-Coverage-Maps.html
On October 24, 2019, members of the Oral Health Progress and Equity Network (OPEN) from across the nation met with Congressional offices to talk about the importance of oral health. Advocates presented each office they met with three policy asks to improve oral health outcomes; include oral health coverage under Medicare Part B, include oral health as a mandatory component of pregnancy-related benefits in Medicaid, and increase funding for the CDC Division of Oral Health to support an oral health program in every state.