On Tuesday, Senators Catherine Cortez Masto (D-NV) and Pat Roberts (R-KS) introduced the Rural ACO Improvement Act. The National Rural Health Association’s Government Affairs team strongly supports this legislation because it would fix a glitch in Medicare’s reimbursement formula that inadvertently punishes rural health care providers when they reduce costs.

A series of serious obstacles stand in the way of FY20 appropriations bills in the Senate, and during the week of October 21, 2019, the Coalition for Health Funding reports that Chairman of the Senate Appropriations Committee Richard Shelby has floated the possibility that the next Continuing Resolution (CR) might stretch into 2020.

In a powerful piece titled “What if You Call 911 and No One Comes?”, NBC shined a spotlight on the growing shortage of EMS personnel in rural areas across the country. The story focuses its narrative on the challenges to maintaining reliable EMS services in Hebron and Marmarth, North Dakota, but it explains that their stories are not isolated incidents. The situations in Hebron and Marmarth aren’t isolated; they come at a time when demand for health care in rural America far exceeds the supply of people necessary to provide that care. Fewer rural hospitals mean ambulances need to travel even farther distances, often in rough terrain or on unmarked roads, causing even more challenges in emergency situations.

Research from a recent American Academy of Pediatrics, Agency for Health Research & Quality (AHRQ) Improvement Innovation Network, showed that diagnoses for pediatric elevated blood pressure and adolescent depression improved and sustained with interventions developed during the project. It showed that missed or delayed actions for laboratory tests with abnormal results improved during the maintenance phase and after the intervention. The results were used to develop AHRQ’s Reducing Diagnostic Errors in Primary Care Pediatrics Toolkit.

After receiving approval earlier this month from the Federal Aviation Administration to operate a commercial drone fleet that will carry small metal boxes, UPS announced this week that it’s expanding drone-delivery services to include CVS Pharmacy, Kaiser Permanente, wholesale pharmaceutical distributor AmerisourceBergen and the University of Utah health system.  UPS is hitting the healthcare business on all sides, from patients to providers and suppliers, for faster deliveries of lab testing, prescriptions and medical supplies. UPS expects the unmanned aircraft to cut down a 30-minute truck drive to 3 minutes and 15 seconds.

The opioid crisis cost the U.S. economy $631 billion from 2015 through last year, according to a study by the Society of Actuaries. The biggest driver of the cost over the four-year period is unrealized lifetime earnings of those who died from the drugs, followed by healthcare costs. While more than 2,000 state and local governments have sued the drug industry over the crisis, the report finds that governments bear less than one-third of the financial costs. The rest are borne by individuals and the private sector.

An analysis of new census data shows the number of children in the United States without any kind of insurance rose by more than 400,000 between 2016 and 2018 after decades of progress, the N.Y. Times reports. The article indicates that there is growing evidence that administrative changes and rising fears of deportation in immigrant communities are pushing large numbers of children out of coverage under federal programs.

Pennsylvania and three other states have reached an $8 billion deal with five companies over their roles in fueling the deadly opioid epidemic, Pennsylvania Attorney General Josh Shapiro announced this week. An agreement in principle was reached with Cardinal Health, McKesson, AmerisourceBergen, Johnson & Johnson and Teva that will provide $22.25 billion in cash and another $26 billion for medication-assisted treatment drug provision and distribution over 10 years. The deal also includes North Carolina, Tennessee and Texas. The $26 billion in generic suboxone product, product distribution, and data-tracking measures will be distributed to the four states over a 10-year period.  The states chose the settlements as a way to get the resources necessary to combat the opioid crisis rather than endure the delays of a lengthy court process and post-trial settlements. Still pending is a lawsuit filed last month by Shapiro against the Sackler Family, whose Purdue Pharma has been sued by states and local governments across the country for the role of OxyContin in the opioid epidemic.

On October 15, 2019,the Pennsylvaia Department of Human Services (DHS) released the Pennsylvania HealthChoices Physical Health Medicaid Managed Care request for applications (RFA). Reflecting the current framework, Medicaid managed care organizations (MCOs) will serve the five HealthChoices zones covering all 67 counties: Southeast, Southwest, LehighCapital, Northwest, and Northeast. Contracts are worth nearly $13 billion. Pennsylvania failed to implement new contracts and negated awards from 2016 as well as the awards from the 2017 rebid. As a result, the HealthChoices program is currently operating under extensions of contracts originally awarded in 2012. The most recent awards in early 2017, which would have been for a three-year, $12 billion contract, were protested by Aetna, UnitedHealthcare, and AmeriHealth Caritas, leading the state to cancel the RFA and reissue the procurement. Applications are due December 17, 2019, and contracts are expected to begin January 2021, running for five years, with an option to extend for an additional period of three years. An award date was not announced.

Pennsylvania Insurance Commissioner Jessica Altman announced Pennsylvania’s approved 2020 individual and small group ACA health insurance rates, highlighted increased marketplace competition within several counties and noted a decrease in counties with only one carrier. Click here to see the press release. Pennsylvania will have seven insurers in the health insurance market offering individual plans for 2020.

• Ambetter
• Capital Blue Cross
• Geisinger Health Plan
• Highmark
• Independence Blue Cross
• Oscar
• UPMC