Announced at the Sept ember 9 Pennie Community Workgroup, new system enhancements will be available beginning October 2022. Pennie plans to pilot a Live Chat feature and add organ donor and voter registration information to the end of the Pennie enrollment application. The Pennie system will also use current monthly income when assessing potential eligibility for Medicaid and CHIP. On previous applications, yearly income was used to determine eligibility. This change will result in a more accurate assessment of likely eligibility due to fluctuating income. To listen to the recording or view slides, click here.

In a new issue brief, the Commonwealth Fund explores how changing the benchmark plan might affect consumers’ deductibles and out-of-pocket limits and how those costs would compare to those in employer health plans. The benchmark plan refers to the second lowest-cost silver plan in the marketplace in each area or in the individual/family insurance market to define essential health benefits within that state for individual/family and small group plans. According to the researchers, “Modest changes like these could encourage more people to get the care they need and keep them from incurring medical debt.” Read more here.

FamiliesUSA published a white paper discussing the importance of Community Health Workers (CHW) and the need for sustainable funding to address health disparities. Community Health Centers employ CHWs to address enabling services, including disease-specific education, translation issues, transportation coordination, language services, enrollment assistance and other non-clinical services.

Congressional negotiators released the full text of the CR on September 27. After several weeks of debate, Congress decided to permanently extend the Federal Tort Claims Act (FTCA) coverage for Volunteer Health Professionals. This is a big victory and will ensure that qualified Volunteer Health Professionals can continue providing critical primary and preventative care at health centers in communities impacted by natural disasters or provider shortages.

Acting Secretary of Health and Physician General Dr. Denise Johnson joined representatives from Feeding Pennsylvania and the Second Harvest Food Bank of Northwest Pennsylvania to showcase the Pennsylvania Healthy Pantry Initiative (PA HPI) program in action. This program has supported tens of thousands of pantry clients to increase their consumption of healthy foods by highlighting the healthy food choices within the food pantries, equipping clients with reliable and helpful information, and providing displays and storage equipment to showcase healthier options. Program materials include shelf talkers, signage, produce information, and recipe cards that are instrumental in food demonstrations, tastings, and nutrition classes hosted through local food pantries. In April 2022, PA HPI was added as a nationally recognized program offering a practice-tested intervention in the U.S. Department of Agriculture’s SNAP-Ed toolkit. Click here to learn more.

From the National Rural Health Association

Alongside the White House Conference on Hunger, Nutrition, and Health this past Wednesday, the Biden Administration released its National Strategy on Hunger, Nutrition, and Health. Please see below for a summary highlighting the most rural-relevant proposals.

The National Strategy is made up of five pillars, each with corresponding goals and action items to achieve the listed goals:

Pillar 1: Improve Food Access and Affordability

Help more individuals experiencing food insecurity benefit from federal assistance programs.

• The Administration will work with Congress increase funding for Older Americans Act nutrition programs. This will help address rural seniors’ unique health, social, and nutritional challenges associated with shopping and cooking.
• The Administration will make it easier for eligible individuals to access federal food and health services. The Department of Agriculture (USDA) will partner with other agencies to increase outreach and awareness for SNAP to older adults and other populations.
• USDA, through American Rescue Plan funds, will expand online shopping for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). NRHA is hopeful that this will expand access for rural residents that travel longer distances to grocery stores.
• The Administration will support Congress in removing unnecessary barriers for SNAP recipients, like the inability to purchase hot and prepared foods with SNAP dollars.

Invest in community and economic development to increase access to food. Almost 40 million Americans live in areas where no grocery stores are nearby, including rural areas.

• The Federal Trade Commission will publish a report summarizing how supply chain distributions have affected grocery stores, including independent grocery stores that often serve rural communities.
• The Federal Emergency Management Agency and USDA will partner to integrate food security as a priority area when conducting outreach with state, local, and Tribal leaders for disaster planning and messaging. This is especially important for rural areas when there are natural disasters and other emergencies.

Pillar 2: Integrate Nutrition and Health

Provide greater access to nutrition services to better prevent, manage, and treat diet-related diseases.

• Expand Medicare and Medicaid beneficiaries’ access to food as medicine by supporting legislation to create a pilot program for Medicare coverage of medically tailored meals for beneficiaries with diet-related health conditions.
• The Centers for Medicare and Medicaid Services (CMS) will use its 1115 demonstration authority to pilot innovative coverage options for diet-related interventions. For example, CMS just announced that it approved Oregon and Massachusetts’ Medicaid state plans for nutritional assistance and medically tailored meals.
• The Administration will support legislation to expand nutrition and obesity counseling to more Medicaid beneficiaries, specifically in states that have not expanded Medicaid and have large rural populations. The Administration also supports expanding nutrition and obesity counseling to Medicare beneficiaries who currently may only seek counseling in a primary care setting with a primary care practitioner. CMS will examine its authority to increase access to such counseling.
• Indian Health Services (IHS) will implement a National Produce Prescription Pilot Program. Produce prescriptions provide fresh fruits and vegetables as a medical treatment or preventative service for patients who are eligible due to diet-related health risk or condition or food insecurity.
• The Department of Veterans’ Affairs (VA) will implement produce prescription programs and mobile food pantries that will aid our rural veteran population.
• CMS will develop a strategy to increase access to diabetes prevention and treatment for Medicare and Medicaid beneficiaries. NRHA looks forward to this work as rural residents are at a greater risk for diabetes.
• CMS will support efforts to develop the data infrastructure needed for food insecurity and other social determinants of health (SDOH) elements to be captured in electronic health records. NRHA is hopeful that CMS will support rural providers in this endeavor.

Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices

Create healthier food environments and a healthier food supply.

• The Administration will work with Congress to expand incentives for purchasing fruits and vegetables with SNAP.
• USDA will make investments to support local and regional food and farm businesses.
• USDA will establish Regional Food Business Centers to support local food business growth, particularly in rural and underserved areas like Appalachia, Colonias, the Mississippi Delta, and in Tribal communities.

Pillar 4: Support Physical Activity for All

 Build environments that promote physical activity.

• Expand the Centers for Disease Control (CDC) State Physical Activity and Nutrition Programs to all states and territories. The Administration will work with Congress to expand the Program from 16 states to nationwide.

Pillar 5: Enhance Nutrition and Food Security Research

• HHS and USDA will create a 2025 Dietary Guidelines Advisory Committee with a diverse membership, including geographic diversity. The committee will review dietary guidelines with a health equity lens.
• USDA will conduct research to better understand nutritional needs of Native Americans and Native Alaskans.
• USDA will leverage its partnership with the University of North Dakota to better understand Native diets and Indigenous foods.
• CMS will measure SDOHs, including food insecurity, for at-risk Medicare Advantage beneficiaries.

Medicare Open Enrollment is approaching, October 15.  In preparation, materials are being released to be shared with consumers, colleagues and others who may assist Medicare consumers.

• The attached Press Releases announce the Medicare Advantage landscape.
• The Medicare Health & Drug Plan Finder  will be updated with the 2023 Medicare health and prescription drug plan information on October 1, 2022. 1-800-MEDICARE is also available 24 hours a day, seven days a week to provide help in English and Spanish as well as language support in over 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll.
• To help with their Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). The MSPs help pay Medicare premiums and may also pay Medicare deductibles, coinsurance and copayments if people meet the conditions of eligibility. Enrolling in an MSP offers relief from these Medicare costs, allowing people to spend that money on other necessities like food, housing or transportation. Individuals interested in learning more can visit here. 
• To view the premiums and costs of 2023 Medicare Advantage and Part D plans, please visit: https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin

Select the various 2023 landscape source files in the downloads section of the webpage.

• For state-by-state information, important dates and enrollment resources for Medicare Advantage and Part D in 2023, please visit: https://www.cms.gov/files/document/2023-medicare-advantage-and-part-d-state-state-fact-sheets.pdf
• For more information on the Medicare Advantage Value-Based Insurance Design Model, including plan participation, please visit: https://innovation.cms.gov/innovation-models/vbid.
• During Open Enrollment, people with Medicare who take insulin are encouraged to call 1-800-MEDICARE or contact their State Health Insurance Assistance Programs (https://www.shiphelp.org/) for help comparing plans and costs this year.

Shareable Social Media, Videos, TV & Radio Ads will be placed in the CMS Medicare Open Enrollment website located  HERE. 

Naloxone, originally approved by the FDA under the brand name Narcan, is an anti-overdose, therapeutic medication

Pennsylvania has one of the highest rates of opioid overdose in the nation, and, according to Penn State researchers, one’s chances of surviving that overdose can depend on where the person lives.

Using data from the Pennsylvania Overdose Information Network from the years 2018-20 and American Community Survey data from 2015-19, Penn State geography researchers looked at the prevalence of overdoses in the state and found the availability of the anti-overdose therapeutic Naloxone to be a key factor in overdose survival. The findings were reported in the Journal of Drug and Alcohol Dependence.

Data showed individuals who received at least one dose of Naloxone were nine times as likely to survive an overdose. Naloxone was administered in about 75% of the survival cases and just 29% of fatal overdose cases.

Yet, the availability of the drug at the time of overdose ranged between 41%-47% in the lowest counties such as nearby Clinton and Huntingdon Counties to 92% in Philadelphia County, the highest. In broad strokes, lesser populated counties had less access to the life-saving treatment, with exceptions for Centre and Mercer Counties, which fared better than similarly populated counties.

“One of the main goals of this research is to inform public health practitioners and policymakers who have the capacity to do something about the distribution of Naloxone, which is clearly effective,” said Louisa Holmes, assistant professor of geography at Penn State, member of Penn State Social Science Research Institute’s Consortium on Substance Use and Addiction (CSUA) and lead author of the study. “It gives leaders a target for combating the opioid epidemic by saving lives.”

Data showed 82% of Pennsylvania adults survived opioid overdoses. In 2020, there were 4,314 opioid related deaths in the state, a 16% increase over 2019, according to the Pennsylvania Department of Health.

According to the Centers for Disease Control and Prevention, opioid overdose deaths have increased steadily from 1999 to 2018, before ballooning in 2020 after a dip in 2019, resulting in the first multi-year decrease in life expectancy in more than 50 years.

The increase in overdose deaths coupled with the effectiveness of Naloxone prompted the Office of the Surgeon General in 2018 to call for its increased distribution. Similarly, Pennsylvania issued standing orders in 2015 and updated in 2022 authorizing anyone to obtain Naloxone, although it leaves decisions to stock the drug up to pharmacists. A recent survey of Pennsylvania pharmacies found 55% did not stock Naloxone, and the majority of pharmacists were unclear on policies related to the standing order. The survey also found out-of-pocket Naloxone prices in 2017 to range from $50 to $400.

Using data for 16,673 unique overdose incidents occurring in Pennsylvania, researchers found 13,724 people survived, while 2,949 did not. About 70% of the deaths were male, 53.5% were ages 25-39 and 90% were white. About 33% of the victims lived in the most rural portions of the state, versus 28% who lived in the most populated areas.

Researchers say the data point to a need for more comprehensive and consistent access to Naloxone for emergency responders, agencies, opioid use disorder patients and their families, citing the effectiveness of programs such as community distribution of Naloxone kits, which cut overdose deaths by 42%. Measures such as expanding take-home Naloxone programs, overdose response training and pharmacist education could also save lives, researchers said.

Although Pennsylvania law allows first responders such as EMTs and police officers to administer Naloxone, researchers said such training is scarcer in rural areas.

This research is related to more broad efforts by the CSUA, which is a large collective of substance-based addiction researchers, practitioners and educators across all of Penn State’s campuses that work on everything from opioids to e-cigarettes to alcohol. Holmes was hired in 2019 among a team of researchers tasked with addressing addiction research.

“The expanding research being done by the CSUA on these topics further positions Penn State as a leader both regionally and nationally,” said Brian King, head of the Department of Geography and co-author of the research. “It is a testament to how research at this institution directly impacts residents in the Commonwealth of Pennsylvania.”