FCC Approves $20 Billion Rural Broadband Funding Plan

Published by Route Fifty, January 30, 2020

The Federal Communications Commission voted January 30, 2020 to approve a $20.4 billion plan to subsidize the construction of high-speed broadband networks in rural America.  FCC Chairman Ajit Pai called the vote the “biggest step the FCC has ever taken to close the rural digital divide.”

The Rural Digital Opportunity Fund will help internet service providers deploy broadband over 10 years to areas currently lacking service of at least 25 megabits per second download and 3 Mbps upload speeds. The federal agency estimates about six million rural homes and businesses are located in areas that could benefit from the initiative. Internet service providers, including telecoms and government utilities, would bid to provide broadband and voice services to the locations.  Read more.

CMS Rolls Out Guidance to Help States Convert Medicaid Funding into Block Grant

Published in FierceHealthcare, January 30, 2020

The Trump administration has rolled out new guidance to enable states to convert Medicaid funding into a block grant, but only for a limited population.

The Centers for Medicare & Medicaid Services (CMS) released Thursday the Healthy Adult Opportunity Initiative that would enable states to voluntarily apply for a waiver to get a fixed amount to pay for services for adults who aren’t disabled, pregnant or elderly. The initiative is already getting severe pushback from patient advocacy groups, signaling a potential new legal fight for the agency.

“We’ve built in strong protections for our most vulnerable beneficiaries, and included opportunities for states to earn savings that have to be reinvested in strengthening the program so that it can remain a lifeline for our most vulnerable,” said CMS Administrator Seema Verma in a statement.

The initiative will only apply to a limited population: adults under 65 not eligible for Medicaid because of a disability or need for long-term care services. Very low-income parents, children, pregnant women, elderly adults and the disabled are not affected.

A state that gets a waiver from CMS under the initiative can adjust benefits for the limited population or “align benefits more closely to what is available through a commercial insurance benefit package,” according to a fact sheet on the proposal.  The states would get a “defined budget target” that is adjusted to either a flat amount or on a per-enrollee basis.  “The targets will be negotiated based on the state’s own historic costs and other factors like national and regional trends,” CMS said.

A state has to maintain spending on health services at a “level at least 80% of the target amount,” the fact sheet said. “To the extent they achieve savings and demonstrate no declines in access or quality, CMS will share back a portion of the federal savings for reinvestment in Medicaid.”  The state could get a share of between 25-50% of the savings similar to value-based care payment models, Verma said during a briefing on Thursday.

States would also get the power to design a formulary under the initiative similar to those used in commercial insurance markets. The goal is to give states more negotiating power over drugs.  However, such formularies can implement tools such as prior authorization or step therapy to steer patients into cost-effective treatments but generate complaints about access to products.

A state that gets a waiver can use any combination of fee-for-service or managed care delivery systems and “will have the flexibility to alter these arrangements over the course of the demonstration, as long as certain guidelines are met,” CMS said in its fact sheet of the demonstration.

Verma said that the states must meet minimum benefit requirements and cannot cap benefits.

However, some physician and patient advocacy groups have long complained that block grants will lead to states cutting eligibility and benefits and warned of the administration’s latest approach.

A transition to block grants could transform Medicaid into a “program with funding limits that drive care rationing for the most vulnerable,” said Howard Burris, president of the American Society of Clinical Oncology, in a statement before the guidance’s release.

Burris added that reducing access to care such as recommended cancer screenings could eventually lead to higher costs for states when patients present a “complex, late-stage illness.”

The American Medical Association charged in a statement that any cap on Medicaid funding will “increase the number of uninsured and undermine Medicaid’s role as an indispensable safety net program.”

The Federation of American Hospitals also lambasted the proposal.  “Medicaid block grants have rightly been rejected by Congress,” said President and CEO Chip Kahn. “Rebranding them under the thin veil of a demonstration doesn’t change the fact they would lead to arbitrary cuts that will weaken Medicaid for those most in need.”

Tennessee so far is the only state to apply for a waiver to get a block grant, but it may not be the last. The state’s proposal said it would base the block grant on the historical Medicaid spending through state fiscal years 2016 and 2018.

However, some services would still be covered by the federal-state match. Those services include prescription drugs and uncompensated care to hospitals, some of the sources of higher costs for Medicaid.

Tennessee’s proposal stressed that it won’t lower benefits or eligibility to get savings from the block grant. However, the state does want to be exempt from any new federal mandates on eligibility or covered benefits from Congress or the federal government.

It won’t be the only state. Oklahoma Republican Gov. Kevin Stitt said at an event on Thursday announcing the initiative that the state is considering getting a waiver under the initiative in addition to work requirements.

Block grants have been a popular healthcare policy fixture among conservatives. A 2017 Affordable Care Act (ACA) repeal bill sponsored by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would convert all ACA funding into a block grant.

The bill would also have converted Medicaid funding into a per-capita cap system, which would give states a fixed amount per beneficiary for Medicaid.

Graham and Cassidy’s bill was scuttled in the fall of 2017 after insufficient GOP support in the Senate, but the idea of a block grant for Medicaid continues to retain popularity among conservatives eager to cut entitlement spending.

APHA Healthiest Cities & Counties Challenge

The American Public Health Association (APHA) announces a new Healthiest Cities & Counties Challenge. APHA, in partnership with the Aetna Foundation—a private foundation affiliated with CVS Health—and National Association of Counties, will provide $100,000 in funding and nonfinancial support to selected communities to address access to foods that support healthy eating patterns and access to health services through systems-level approaches and resident engagement over a two-year period.

The Challenge invites applications from cities, counties and federally recognized tribes with a population of up to 600,000 in California, Florida, Georgia, Kentucky, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, and West Virginia that are prepared to work across silos in order to advance health equity and prevent chronic diseases. The deadline is end of February!

Rural Research Brief: Strategic Choice in Developing Telemedicine – Observations from Three Organizations

Thomas Vaughn, PhD; Fred Ullrich, BA; Muska Nataliansyah, MPH and Keith J. Mueller, PhD

Advances in technology have made it easier to provide telemedicine services, but the actual value of telemedicine programs for health systems providing those services or for patients has not been firmly established. This paper from the RUPRI Center for Rural Health Policy Analysis explores organizational motivations of three large health systems for incorporating telemedicine patient care services.

Click to download a copy: Strategic Choice in Developing Telemedicine – Observations from Three Organizations

 ************************************************
RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
145 Riverside Drive, N200 – CPHB
Iowa City, IA 52242
Phone: (319) 384-3831
Fax: (319) 384-4371

Web site: www.public-health.uiowa.edu/rupri

Follow us on Twitter! @RUPRIhealth

Wrapping Up Human Trafficking Awareness Month with Resources

Human trafficking can happen anywhere and to anyone. Sometimes it takes place at the hands of someone the victim knows.

In Pennsylvania, state agencies and organizations are working together to put an end to human trafficking within the state and nationally.

Human Trafficking is the most rapidly growing organized crime in the world. In 2016, 40 million people were victims of human trafficking. The National Human Trafficking Hotline reported 10,949 cases called in in 2018.In Pennsylvania, The Hotline receive 630 contacts regarding human trafficking in 2018, with 275 cases reported. These numbers are not indicative of the full scope of victims, since not all cases are identified or reported.

What is Human Trafficking?

Adults and children can be trafficked or enslaved and forced to sell their bodies for sex. People are also trafficked or enslaved for labor exploitation, for example to work on a farm or factory or in a house as a servant, maid, or nanny and receive little to no money for their work 10-16 hours every day of the week. The crime of human trafficking must involve the use of force, fraud, or coercion.

PennDOT Response

PennDOT is one of the first transportation agencies in the country to train employees to recognize the signs of a potential trafficking situation and how to report it to the authorities. To date, PennDOT has trained 564 driver license and welcome center employees, as well as almost 15,000 transit agency employees in human trafficking awareness. In 2018, PennDOT took the USDOT pledge to “Put the Brakes on Human Trafficking” and became a member of the National Transportation Leaders Against Human Trafficking initiative.

Visit PennDOT’s human trafficking landing page for more information on the initiative and helpful links.

Get the Facts & Spot the Signs

Polaris provides resources for human trafficking prevention and tracks data that can be used for targeted systems-level strategies to disrupt and prevent human trafficking. They provide myths, facts, and statistics to help better explain what human trafficking is and dispel common misconceptions.

Keep Kids Safe provides additional information on human trafficking in Pennsylvania, as well as how to spot the signs of human trafficking for sexual exploitation.

Report It

If you witness or are a victim of human trafficking, get in touch with the U.S. National Human Trafficking Hotline.

Call 888-373-7888, or text “BeFree” to 233733. 

The Pennsylvania Office of Victim Services provides help for victims of human trafficking who need to find local service programs, financial assistance, or visa assistance.

Download and print human trafficking awareness posters from the Pennsylvania State Police

Poster Size Version (17×11)
Letter Size Version (8.5×11)

2021 Proposed Payment Notice Posted and Letter to Issuers Posted

On January 31, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the proposed annual Notice of Benefit and Payment Parameters Rule for 2021, also known as the Proposed 2021 Payment Notice. This proposed rule would update regulatory and financial standards applied to issuers and Exchanges, as well as set parameters for the risk adjustment program. Similar to Payment Notices issued in prior years, the Proposed 2021 Payment Notice contains a number of other provisions that support the Trump Administration’s ongoing commitment to lowering premiums, protecting taxpayer dollars and strengthening the health insurance markets to deliver more competition and choice for consumers.

In conjunction with the proposed rule issued today, we are also issuing several guidance documents.  Links to those documents are below.

To view the proposed rule, click here:  https://www.federalregister.gov/public-inspection/current or the direct link at https://www.federalregister.gov/documents/2020/02/06/2020-02021/benefit-and-payment-parameters-notice-requirement-for-non-federal-governmental-plans

To view the proposed Key Dates for Calendar Year 2020 for QHP Certification, Rate Review, and Risk Adjustment, click here https://www.cms.gov/files/document/proposed-key-dates-tables-cy2020.pdf

To view the Draft ICD-10 Crosswalk for Potential Updates to HHS-HCC Risk Adjustment Model for the 2021 Benefit Year, click here https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/index.html#Premium-Stabilization-Programs

To view the proposed 2021 Letter to Issuers, click here: https://www.cms.gov/files/document/2021-draft-letter-issuers-clearance-version-final-13120.pdf

To view the request from Alabama to decrease the volume of transfers for Risk Adjustment, click here

https://www.cms.gov/files/document/state-flexibility-requests-relating-risk-adjustment-transfer-reductions-2021-benefit-year.pdf

 

Innovation is Widespread in Rural Areas, Not Just Cities

Conventional measures of innovation suggest that only big cities foster new ideas, but a more comprehensive measure developed at Penn State shows that innovation is widespread even in rural places not typically thought of as innovative. This “hidden” innovation brings economic benefits to businesses and communities, according to researchers, whose findings will help decision makers think in new ways about innovation and how they can support it.  Full story

CLOUD (Curated Library about Opioid Use for Decision-makers) Partnership Activities

In a partnership that includes the National Governor’s Association and the Milbank Memorial Fund, the Center for Evidence-based Policy at Oregon Health & Science University created this searchable library of resources on opioids and the opioid crisis.  A search on rural resources includes promising practices for medication-assisted treatment in primary care and a spotlight on Project ECHO, the initiative that connects addiction medicine experts with clinicians in remote areas.  The information can be accessed here.

Reach Out PA New Online Feedback Form Seeks Public Input on Mental Health Resource Needs

On January 23, 2020, Governor Tom Wolf today introduced an online form<https://www.governor.pa.gov/reach-out-pa-feedback-form/> for Pennsylvanians to provide feedback on mental health barriers, services and how the state can better support people’s mental health needs. The creation of the form is on the heels of the governor’s Jan. 2 announcement of Reach Out PA: Your Mental Health Matters<https://www.governor.pa.gov/newsroom/pennsylvania-launches-reach-out-pa-your-mental-health-matters/> initiative to reduce stigma and increase access to mental health and well-being services and supports.

“Having a way for all voices to be heard is critical to our goal of increasing access to mental health services, breaking down barriers, and detailing the ways we can meet the mental health needs of all,” Gov. Wolf said. “I encourage every Pennsylvanian to reach out via this online form to let us know their thoughts and suggestions.”

Of note is the first message on the form, which advises site visitors, “If you are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255, or text PA to 741741.”

“It’s critical that people in crisis have a way to get immediate help, which is why we included the suicide prevention lifeline first,” Gov. Wolf said. “Our form is intended for feedback and suggestions for the commonwealth as we move forward with breaking down barriers, improving services and reducing mental health stigmas.”

The commonwealth will not share any identifying information without permission of those who submit information. Comments and suggestions will be compiled and reviewed to determine next steps in program and service development or redesign, as well to convey pertinent information to state agencies involved in the initiative. Forms may be submitted anonymously.

“You can help improve the state of mental health in Pennsylvania,” Gov. Wolf said. “Completing this form and sharing your thoughts and ideas is another step in the right direction to make mental health a priority for all.”

The online form<https://www.governor.pa.gov/reach-out-pa-feedback-form/> is available now.

https://www.governor.pa.gov/reach-out-pa-feedback-form/