- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- CMS: Request for Information; Health Technology Ecosystem
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- State: 60-Day Notice of Proposed Information Collection: J-1 Visa Waiver Recommendation Application
- HHS: Request for Information (RFI): Ensuring Lawful Regulation and Unleashing Innovation To Make American Healthy Again
- Public Inspection: CMS: Request for Information: Health Technology Ecosystem
Fed Survey Shows Conditions Worsen in Low- to Moderate-Income Communities
As COVID-19 continues to have profound effects on people’s lives, the Federal Reserve Bank of Philadelphia, in partnership with the 11 other Reserve Banks and the Board of Governors of the Federal Reserve System, is surveying representatives of nonprofits, financial institutions, government agencies, and other community organizations to determine the pandemic’s impact on low- to moderate-income (LMI) communities.
Our latest Perspectives from Main Street report summarizes findings from our October survey. The majority of organizations said COVID-19’s impacts on a range of issues — from employment and education to basic consumer needs and health — got modestly or significantly worse since August.
While the Third District state data are not a representative sample, there are several areas where the results vary from or are more pronounced than national indicators in the full report:
- The majority of respondents in the nation (59 percent) and larger majorities of respondents in Pennsylvania (60 percent), New Jersey (69 percent), Delaware (67 percent), report that LMI communities are experiencing significant disruption and expect recovery to be difficult.
- Income and job loss were cited as the top impacts for respondents in the nation (38 percent) and in Pennsylvania (34 percent), New Jersey (45 percent), and Delaware (58 percent).
- The majority of respondents in the nation (56 percent) and in Pennsylvania (60 percent), New Jersey (79 percent), and Delaware (50 percent) report that it will take 12 months for community conditions to return to pre-pandemic levels.
Year-round, the Philadelphia Fed and the the Federal Reserve System work to foster economically resilient communities. Gathering actionable information is especially important during this unprecedented time. We’ll continue to seek and share ongoing perspectives from Main Street.
To learn about Philadelphia Fed’s Community Development and Regional Outreach Department, visit our website.
2021 Medicare Part B Premiums Remain Steady
The Centers for Medicare & Medicaid Services (CMS) announced the 2021 monthly Medicare Parts A and B premiums, deductibles, and coinsurance amounts in which the Medicare Part B monthly premium remains steady. This news comes as Medicare Open Enrollment started on October 15, 2020 running through December 7, 2020, and follows the announcement that Medicare Advantage (or private Medicare health plans) and Part D prescription drug plan premiums are at historic lows, with hundreds of Medicare Advantage and Part D plans now offering $35 monthly co-pays for insulin starting in January 2021.
“With the 2021 Medicare Part B premium information now available, I encourage everyone with Medicare to take time over the next four weeks to review their options during Medicare Open Enrollment,” said CMS Administrator Seema Verma. “Thanks to President Trump’s leadership, Medicare Part B premiums remain steady and seniors have more plans than ever to choose from, many new benefits, and historically low Medicare Advantage and Part D premiums.”
Medicare Part B Premiums/Deductibles
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
The standard monthly premium for Medicare Part B enrollees will be $148.50 in 2021, an increase of $3.90 from $144.60 in 2020. Recent legislation signed by President Trump significantly dampens the 2021 Medicare Part B premium increase that would have occurred given the estimated growth in Medicare spending next year. Medicare spending is estimated to grow due to people seeking care they may have delayed during the COVID-19 public health emergency, availability of more COVID-19 treatments, and availability of COVID-19 vaccines (for which CMS recently announced that there would be no out-of-pocket costs for seniors).
CMS also announced that the annual deductible for Medicare Part B beneficiaries is $203 in 2021, an increase of $5 from $198 in 2020.
Medicare Part A Premiums/Deductibles
Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.
The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,484 in 2021, an increase of $76 from $1,408 in 2020.
Medicare Open Enrollment
Medicare beneficiaries can choose to enroll in fee-for-service Original Medicare (Parts A and B) or can select a private Medicare Advantage plan to receive their Medicare benefits. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans (Medicare Part D) are already finalized and are unaffected by this announcement.
During the ongoing Medicare Open Enrollment – which began on October 15, 2020 and ends December 7, 2020, more than 60 million Medicare beneficiaries can compare coverage options like Original Medicare (Part A and Part B) and Medicare Advantage, and choose health and prescription drug plans for 2021. Medicare health and drug plan costs and covered benefits can change from year-to-year. CMS urges Medicare beneficiaries to review their coverage choices and decide on the options that best meet their health needs. Over the past three years, CMS has made it easier for seniors to compare and enroll in Medicare coverage. The redesigned Medicare Plan Finder makes it easier for beneficiaries to:
- Compare pricing between Original Medicare, Medicare Advantage plans, Medicare prescription drug plans (Medicare Part D), and Medicare Supplemental Insurance (Medigap) policies;
- Compare coverage options on their smartphones and tablets;
- Compare up to three Medicare Part D drug plans or three Medicare Advantage plans side-by-side;
- Get plan costs and benefits, including which Medicare Advantage plans offer extra benefits;
- Build a personal drug list and find Medicare Part D prescription drug coverage that best meets their needs.
Highlights for 2021 Open Enrollment include:
- A 34 percent decrease in average monthly premiums for Medicare Advantage plans since 2017. This is the lowest average monthly premium since 2007. Beneficiaries in some states, including Alabama, Nevada, Michigan, and Kentucky, will see decreases of over 50 percent in average Medicare Advantage premiums.
- More than 4,800 Medicare Advantage plans are offered for 2021, compared to about 2,700 in 2017. Similarly, more Medicare Part D plans are available, and the average basic Part D premium has dropped 12 percent since 2017.
- Medicare beneficiaries can join a prescription drug plan that will offer many types of insulin at a maximum copayment of $35 for a 30-day supply. More than 1,600 Medicare Advantage and Part D prescription drug plans are participating in the Part D Senior Savings Model for 2021. People who enroll in a participating plan could save up to an estimated $446 a year in out-of-pocket costs on insulin. CMS has added a new “Insulin Savings” filter on Medicare Plan Finder to display plans that will offer the capped out-of-pocket costs for insulin. Beneficiaries can use the Medicare Plan Finder to view plan options and look for a participating plan in their area that covers their insulin at no more than a $35 monthly copay.
- Free, personalized counseling on Medicare options is also available through the nonprofit State Health Insurance Assistance Program, or by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
For a fact sheet on the 2021 Medicare Parts A & B premiums and deductibles, please visit: https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles
For more information on the 2021 Medicare Parts A and B premiums and deductibles (CMS-8074-N, CMS-8075-N, CMS-8076-N), please visit:
- (CMS-8074-N)- https://www.federalregister.gov/public-inspection/2020-25024/medicare-program-cy-2021-inpatient-hospital-deductible-and-hospital-and-extended-care-services
- (CMS-8075-N): https://www.federalregister.gov/public-inspection/2020-25028/medicare-program-cy-2021-part-a-premiums-for-the-uninsured-aged-and-for-certain-disabled-individuals
New Simulation Finds Max Cost for Cost-effective Health Treatments
As health care costs balloon in the U.S., experts say it may be important to analyze whether those costs translate into better population health. A new study led by a Penn State researcher analyzed existing data to find a dividing line — or “threshold — for what makes a treatment cost-effective or not.
David Vanness, professor of health policy and administration, led a team of researchers that created a simulation to consider health care treatment costs, insurance premiums, quality of life, and life expectancy to explore whether a treatment delivers enough value for its costs to be considered beneficial for population health.
According to Vanness, the term “treatment cost” in this research incorporates all the costs and savings related to a treatment. For example, the cost of a treatment to lower blood cholesterol would include how much it costs but also take into account potential savings for preventing a heart attack and its subsequent treatment.
“We know that we are spending more and more on health care in the U.S. and that we’re getting less and less for it,” Vanness said. “We do a good job of developing new treatments in this country, but we don’t do a good job of covering everybody or making sure that people have access to basic health care. We’re spending a lot on our medical treatments, but many of those treatments just don’t have a lot of value.”
Vanness added that in order to improve a population’s health without spending too much, it’s important to be able to tell whether the prices drug and device manufacturers are charging are justified by what they deliver in health improvements.
The researchers found that in their simulation, for every $10 million increase in health care expenditures, 1860 people became uninsured. This led to five deaths, 81 quality-adjusted life-years lost due to death, and 15 quality-adjusted life-years lost due to illness. In health care economics, one quality-adjusted life-year (QALY) is equal to one year of perfect health.
Vanness said these results — recently published in the Annals of Internal Medicine — suggests a cost effectiveness threshold of $104,000 per QALY.
“If a treatment is beneficial but it costs more than about $100,000 to gain one quality-adjusted life-year using that treatment, then it may not be a good deal,” Vanness said. “Because our simulation was using data estimates, we wanted to come up with a range of plausible values. So anything over a range of $100,000 to $150,000 per QALY gained is likely to actually make our population’s health fall.”
To create the simulation, Vanness said he and the other researchers used a variety of data, starting with estimates about how likely people are to drop their insurance when their premiums go up.
“We also used evidence from the public health literature on what happens to people’s health and mortality when they gain or lose health insurance,” Vanness said.
The simulation then compiled that data and estimated how much the health of a population goes down when costs increase. According to Vanness, that relationship determines the cost-effectiveness threshold — how much a treatment can cost relative to the health benefits it gives before it causes more harm than good.
The researchers said the findings could be especially important to organizations like the Institute for Clinical and Economic Review, which provides analysis to several private and public insurers to help negotiate prices with manufacturers. These organizations could use the findings as empirical evidence for what makes a treatment a good value in the United States.
“Moving forward, I think some changes could be made to national policy to make cost effectiveness analysis more commonly used,” Vanness said. “Our goal is to get that information out there with the hope that somebody is going to use it to help guide coverage or maybe get manufacturers to reduce their prices on some of these drugs.”
James Lomas at the University of York, and Hannah Ahn, a Penn State graduate student, also participated in this work.
Detailed Population Estimates Dashboard Released
The Pennsylvania State Data Center has released their Detailed Population Estimates Dashboard. Now with the latest estimates for 2019, users can access state and county level data on the total population, the change in population since 2010, and detailed characteristics like sex, age, race, and Hispanic origin.
Click here to visit the dashboard.
COVID-19 Oral Health Resources for School Nurses Available
During the current COVID-19 pandemic, school nurses may be the only avenue for assuring that children receive oral health screenings and referrals. The Association of State and Territorial Dental Directors (ASTDD) and the National Association of School Nurses have collaborated to develop resources for school nurses: “Considerations for School Nurses in Return to School: Dental Screenings” and “School Nurses: The Key to Good Oral Health During COVID-19 Infographic.” Please share with any school nurses you know.
Click here to download “Considerations” document.
Click here to download the infographic.
Parent Handouts on COVID-19 and Oral Health Available
The National Maternal and Child Oral Health Resource Center (OHRC) released two new resources for parents of young children from the Office of Head Start’s National Center on Early Childhood Health and Wellness (NCECHW). The handouts provide clear messages with photos about healthy eating and oral hygiene practices at home and about changes to dental offices to promote the safety of staff and patients during COVID-19. The colorful handouts are available in English and Spanish.
Click here to download the English version.
Click here to download the Spanish Version.
A Three Domain Framework to Innovating Oral Health Care Announced
Change in oral health is long overdue and COVID-19 has brought the system’s issues to the forefront. Now is the time for change. PCOH joins more than 110 oral health leaders in support of a new approach developed by the DentaQuest Partnership for Oral Health Advancement. “A Three Domain Framework to Innovating Oral Health Care” emphasizes overall health as an outcome and is more cost-effective, efficient, and equitable.
Nicotine Dependence and Oral Health Professionals
Have you taken the “Nicotine Dependence Treatment Strategies for Oral Health Professionals” course? PCOH’s newly updated course portal makes it easier than ever! Free CEUs are available. Also, if you would like to get connected to the tobacco coalition in your county/region, please reach out to Paula Di Gregory of Nicotine Free Northwest PA for an introduction. You can also look up your regional tobacco use and prevention cessation primary contractor for the Department of Health below.
Click here to take the course.
Click here to contact Paula Di Gregory.
Click here to look up your regional primary contractor.
Updated Pennsylvania Oral Health Coalition Website Launched
PCOH is excited to share our updated website! While parts of the site may look familiar, there are cool improvements. The new resource page is searchable and has advanced filters so that you can find exactly what you are looking for. The updated course portal provides a more user-friendly continuing education experience. Don’t just take our word for it, check it out!
Regional Response Health Collaboratives in Pennsylvania Strengthen Support for Long-Term Care Facilities
As Pennsylvania Governor Wolf’s administration continues to focus on keeping Pennsylvanians safe, programs have been put in place to protect those most vulnerable including the Regional Response Health Collaborative (RRHC) program. RRHC is a statewide program providing clinical, operational, and educational support to long-term care facilities preparing for or facing outbreaks of COVID-19 at their facility.
COVID-19 can be dangerous in congregate care settings, particularly in settings that serve people who are medically fragile or have other health vulnerabilities that make them more likely to experience additional complications from COVID-19, as often is the case for residents of long-term care facilities. The RRHC Program is a crucial part of catching and responding to outbreaks when they occur, saving lives.
The RRHCs work to assist in ensuring facilities have the resources they need to respond to COVID-19 in these vulnerable settings. As we are in the midst of a fall resurgence, the RRHCs will become even more important.
Pennsylvania’s long-term care system serves more than 127,000 people living in nursing homes, personal care homes, assisted living residences, and private intermediate care facilities. Due to the congregate nature and because they often serve individuals who are older or have co-occurring medical conditions that make them more vulnerable to an acute case of or complications from COVID-19, constant vigilance is necessary to avoid a serious outbreak at these facilities.
RRHC Program Structure
Launched in late July, the RRHC program was established to provide clinical support, technical assistance, and education to long-term care facilities as they work to prevent and mitigate spread of COVID-19. The RRHCs are available 24/7 to support the nearly 2,000 nursing facilities, personal care homes, assisted living residences, and private intermediate care facilities in Pennsylvania and the residents they serve. Eleven health systems were selected to serve six regions across Pennsylvania. Southcentral Pennsylvania’s RRHC is Penn State Health.
Each RRHC is required to make a minimum of two on-site visits to each facility in their region, including an initial on-site assessment that will help the RRHC evaluate a facility’s COVID-19 prevention and mitigation strategies and their preparedness to respond to an outbreak if that were to occur. Based on this assessment, the RRHCs will help those facilities implement best practices in infection control, implement contact tracing programs in facilities, support clinical care through on-site and telemedicine services, and provide remote monitoring and consultation with physicians. RRHCs are in regular communication with DHS, the Department of Health (DOH), and the Pennsylvania Emergency Management Agency (PEMA)to report on experiences interacting with facilities, trends experienced by facilities, and potential challenges.
When a RRHC engages with a facility or is called in to help with a concern identified from collaboration between DHS, DOH and PEMA daily calls, these efforts are classified as missions. A mission could be anything from assistance with testing, assessing a facility’s preparedness, staffing support, rapid response deployment to facilities, PPE support, testing to ensure PPE is properly fitted, and questions or concerns requiring consultation. Since launching, the RRHCs have been assigned more than 6,200 missions, primarily covering testing, consultations, facility assessments, and support with PPE. The RRHCs are also working with the Jewish Healthcare Foundation to operate a statewide learning network available to all long-term care facilities. This network holds regular webinars on topics related to infection control and the latest guidance for responding to and mitigating spread of COVID-19. These webinars have reached more than 1,800 participants since the start of the RRHC program.
The administration can also deploy rapid response teams staffed by the RRHCs when an outbreak is suspected or confirmed at a long-term care facility. These rapid response teams consist of clinical and infection control professionals from the RRHCs to evaluate the situation, ensure proper cohorting of patients based off COVID status, facilitate resident transfers and additional staffing if necessary, and coordinate safe continued care for residents who are not COVID-positive. The rapid response teams can also provide emotional support to both residents or staff to help with the stress and fear associated with an outbreak. Rapid response teams are designed to stabilize potential or confirmed outbreaks, and assistance from RRHCs is not withdrawn until the situation is stabilized and there is no immediate risk to staff and residents.
The RRHC is funded through Pennsylvania’s Coronavirus Aid, Relief, and Economic Security (CARES) Act award, the program is currently scheduled to end on December 1. The Wolf administration recently sent a letter to President Trump requesting funding to extend the program so it may continue to be a resource throughout the winter. Governor Wolf urged President Trump to work with Congress on a new stimulus package that would support the RRHC program and other resources crucial to protecting the lives, health and safety of Pennsylvanians.
“The last eight months have been a period of great learning. We’re now at a point where we have a system that is working and helping to stabilize and prevent outbreaks. As the country works to get a vaccine that is effective in market and available, we need to do all we can to protect people who are most vulnerable to this virus,” said Secretary Miller. “The RRHC program cannot stop COVID altogether, but it is undoubtedly making us better at fighting it. We cannot lose this resource.”