Rural Health Information Hub Latest News

CMS Begins “Good Faith Estimate” Enforcement

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) issued its first fines against hospitals for failure to comply with the price transparency regulation. While the rule went into effect on January 1, 2021, it is widely believed that compliance is low. This month’s fines are the first sign that CMS is getting serious about enforcement.

Pennsylvania Clarifies the Duration of TeleMAT Waiver

The Pennsylvania Department of State (DOS) has issued additional guidance on the September 2020 TeleMAT Waiver, which waived the requirement for an initial physical examination of a patient prior to prescribing buprenorphine for the treatment of opioid use disorder (OUD). DOS has determined that this waiver “relates to Federal exemptions granted under the Federal public health emergency declaration,” specifically the exemptions granted by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Agency (DEA).Therefore, in accordance with section 2102-F(a.3) of the Pennsylvania Administrative Code of 1929 (amended by Act 14 of 2022), the DOS waiver will continue until the last day of the federal public health emergency declaration and will no longer expire on June 30, 2022, as originally indicated. DOS also noted that to be considered within the acceptable and prevailing standard of care, the physician/prescriber must be following the applicable SAMHSA guidelines and DEA guidelines. Pennsylvania has not received notification that the public health emergency (PHE) will be terminated on July 15 and expects the PHE to be extended again. If this occurs, this waiver and others tied or related to the PHE will be extended until mid-October 2022. Visit the DOS COVID-19 Suspensions webpage for additional information on waivers.

Pennsylvania Medicaid Consumer Notices Have Been Sent

The Department of Human Services started issuing notices and guides to those enrolled in HealthChoices, Pennsylvania’s mandatory Medicaid managed care program, informing consumers of their health plan choices. The initial mailing went to patients currently covered by a managed care organization (MCO) that will no longer cover the zone where the patient resides. The deadline to choose a new health plan is August 16, 2022, and consumers who fail to choose an MCO by the deadline will be auto-enrolled into an MCO plan, with coverage in the new plan effective September 1, 2022. Consumers should contact PA Enrollment Services at 1-800-440-3989 or online at www.enrollnow.net. It is important for consumers to review the notices and guides as there are changes to the network with Aetna no longer operating in the state, Gateway no longer operating in the Northwest Zone, and UnitedHealthcare no longer operating in the Southwest or Lehigh/Capital zones.

Am Executive Order Has Been Issued to Block Federal Funding for LGBT Conversion Therapy and Curb Discrimination Against Transgender Youth

 

President Biden signed an executive order aimed at curbing discrimination against transgender youth and drying up federal funding for the discredited practice of “conversion therapy.” The executive order asks the federal health and education departments to expand access to gender-affirming medical care and find new ways to counter a flurry of bills passed in states by conservative lawmakers this year that ban these treatments for transgender youth. The order asks federal agencies to ensure that federally funded programs do not offer conversion therapy, which tries to force LGBTQ+ youth to change their sexual orientation, and the Federal Trade Commission to consider policing such practices that seek to change a patient’s sexual orientation or gender identity as deceptive businesses.

The Federal Trade Commission Puts Pharmacy Benefit Managers on Notice Regarding Rebate Practices

The Federal Trade Commission (FTC) issued an enforcement policy statement aimed at illegal rebate practices by pharmacy benefit managers (PBMs) and other intermediaries. The FTC may issue fines or penalties to PBMs who are found to be engaging in these practices. The agency issued an enforcement policy statement that targets rebates and fees that can prohibit competitors from targeting lower-cost drug alternatives. The FTC outlined what rebates or fees could spark a move against a PBM or other intermediary, which could potentially result in fines or penalties. “Today’s action should put the entire prescription drug industry on notice: when we see illegal rebate practices that foreclose competition and raise prescription drug costs for families, we won’t hesitate to bring out full authorities to bear,” said FTC Chair Lina Khan in a statement. Read more.

The Supreme Court Strikes Down Roe v. Wade

The Supreme Court has struck down Roe v. Wade, eliminating the nearly 50-year-old constitutional right to abortion and handing states authority to drastically limit or ban the procedure. The decision, announced today, is certain to ignite a firestorm and yield a complex patchwork of state laws that will effectively block large swathes of the population from terminating unwanted pregnancies. The ruling upholds Mississippi’s 15-week abortion ban, which directly clashed with Roe’s requirement that states permit abortion up to the point of fetal viability, around 24 weeks. More than two dozen states, primarily in the South and Midwest, are expected to tighten abortion access as a result of the ruling, including 13 states with “trigger bans” set to take effect automatically or through a minimal effort by state officials. The decision comes after a stunning breach of Supreme Court secrecy last month led to the public release of a draft version of the opinion. Experts expect the far-reaching implications of the decision on health, economics, child welfare, and many other issues to reverberate greatly across the nation.

Pennsylvania Launches a New Resource for Drug & Alcohol Treatment

The Pennsylvania Department of Drug & Alcohol Programs (DDAP) announced a new resource available to Pennsylvanians looking for drug and alcohol addiction treatment. DDAP partnered with the national nonprofit Shatterproof to launch the free Addiction Treatment Locator, Assessment and Standards (ATLAS) platform, available online at treatmentatlas.org. The site explains various treatment types and what to expect when going through each treatment. A 10-minute assessment, structured like popular social media quizzes, leads those seeking treatment to options that meet their unique needs. ATLAS rates addiction facilities based on Shatterproof’s standards and patient reviews. People seeking treatment (or their family and friends) can search facilities based on reviews and other criteria, including location, insurance accepted substance focus, and age-specific programs. The online tool can be viewed on any web browser in both English and Spanish. ATLAS is free and anonymous. To date, the tool has been launched in nine states and reaches more than a quarter of U.S. residents. DDAP’s 24/7 Get Help Now Hotline—(800) 662-4357—remains an option for those in need of immediate assistance.

CMS Proposes ESRD Policies and Payment Updates for 2023

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS).  Once finalized, the new rule would affect renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023. CMS projects that the updates would increase the total payments to all ESRD facilities by 3.1% over payments for the calendar year 2022. For rural ESRD facilities, CMS projects an increase in total payments of 2.3 percent, and for urban facilities, CMS projects an increase in total payments of 3.2 percent. Comments due by August 27

Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers have been Released

 For this brief, HRSA provided historical data for community mental health centers (CMHCs) and community health centers (CHCs) – two types of federally funded sites that provide mental health care. Researchers at the Rural and Underserved Research Center found that the supply of CMHCs decreased substantially from 2000 to 2019 in non-metropolitan counties. However, the supply of CHCs offering mental health services increased substantially over the same time period.