Rural Health Information Hub Latest News

Comments Requested on Medicare Advantage, Medicare Part D Updates 

CMS recently displayed a proposed rule that includes revisions to Medicare Advantage, also known as Medicare Part C, as well as changes to the Medicare prescription drug benefit, Medicare Part D, that are part of Inflation Reduction Act (IRA) requirements passed earlier this year. As part of updates to promote health equity, CMS is proposing to update its current regulations that require MA organizations to ensure that services are provided in a culturally competent manner to list populations for consideration including rural residents. The rule also makes updates to Programs of All-Inclusive Care for the Elderly (PACE) and to all 4 parts of Medicare regarding the standard for an identified overpayment. According to a recent brief from the RUPRI Center, while rural counties had a lower rate of MA participation than urban counties (34.6 percent and 44.6 percent, respectively), the rate of enrollment growth was higher in rural areas between 2020 and 2021 (14.2 percent and 6.2 percent, respectively). Comments are due by  February 13

Comments Requested on the Proposed Updates to Health Insurance Marketplaces

CMS seeks public comment on the Notice of Benefit and Payment Parameters for 2024, which proposes updates to the standards for issuers and Marketplaces offering qualified health plans through  Proposals include adding Mental Health Facilities and Substance Disorder Treatment Centers as Essential Community Provider (ECP) categories, including Rural Emergency Hospitals as a provider type in the Other ECP Providers category, adding a special enrollment period for consumers who lose Medicaid/CHIP coverage during the year and allowing assisters to conduct door-to-door enrollment.  The number of Marketplace plans offered in rural areas has been increasing, although there are still fewer plans available compared to urban areas. Comments are due January 30.

HHS and DoD Created the National Emergency Tele-Critical Care Network

 A joint program of the U.S. Department of Health & Human Services (HHS) and the U.S. Department of Defense (DoD) is available at no cost to hospitals caring for COVID-19 patients. Teams of critical care clinicians – critical care physicians, nurses, respiratory therapists, and other specialized clinical experts – are available to deliver virtual care through telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians, and email to learn more and sign up.

The Provider Relief Fund (PRF) Reporting Portal Opens in January

The Provider Relief Fund (PRF) Reporting Portal will be open from January 1, 2023 to March 31, 2023 for Reporting Period 4 (RP4). Providers who received one or more PRF (General or Targeted) and/or American Rescue Plan Rural payments exceeding $10,000, in the aggregate, from July 1, 2021 to December 31, 2021 must report on their use of funds during RP4.  Resources are available to assist providers with completing their reports. For a quick glance at all our reporting-related resources, visit the PRF Reporting Resources Page.

Thriving PA Report Highlights WIC Program Community Feedback

Thriving PA’s newest report, WIC Participants Encourage Improvements to Remove Barriers to Access, highlights community feedback about the Special Supplemental Nutrition Program for Women, Infants, and Children, commonly referred to as WIC. Over the summer, Thriving PA partnered with several community organizations across the state to hold seven focus sessions with current and former WIC clients to hear directly from their experiences on the strengths and barriers of the WIC program.

The WIC program provides eligible pregnant and postpartum women and infants and children up to age 5 with access to nutritious foods, breastfeeding supports, nutritional education, and health referrals. Unfortunately, participation in PA’s WIC program has been declining in recent years, a trend that is happening nationally. From 2018-2022, the PA program saw nearly a 25% decline in participation. The pandemic also impacted these numbers, with Pennsylvania seeing the third largest decrease in participation from February 2020 to February 2022.

To address the declining participation, which impacts the federal funding Pennsylvania receives to administer the program, Thriving PA sought out direct feedback from participants to identify solutions to the WIC program’s challenges. Many of the recommendations in the report highlight opportunities to modernize the program and provide greater flexibility for participants. Some recommendations include technology improvements like moving to an online EBT card system and simplifying the application process through system integration with other state application systems like COMPASS. Others include allowing virtual visits to continue and coordinate care between health professionals, so participants do not need to provide the same information to multiple providers.

Thriving PA hopes the incoming administration and WIC Advisory, a stakeholder group formed earlier this year, will consider the recommendations from WIC clients to help improve the WIC program and increase participation statewide.

Pennsylvania Partnerships for Children Releases Annual Health Care Report

Pennsylvania’s child uninsured rate improved slightly to 4.4% from 4.6% during the COVID-19 pandemic thanks to the federal continuous coverage provision that prevents states from disenrolling children and families from Medicaid during the public health emergency, according to our recently released 2022 State of Children’s Health report.

Even more families turned to Medicaid during the pandemic when child enrollment increased by 20%. More than 1.4 million Pennsylvania children currently have Medicaid as their health insurance.

We are cautiously optimistic about the improvement in our child uninsured rate in Pennsylvania. While we have made progress, Pennsylvania has the 8th highest number of uninsured children in the nation, with 126,000 children who do not have health insurance and don’t have regular access to preventive and primary health care.

And hundreds of thousands of children are at risk of losing Medicaid coverage when the public health emergency ends and the state begins to unwind the disenrollment freeze and resume pre-pandemic operations. According to the latest estimates from DHS, 1 in 4 children enrolled in Medicaid could lose coverage when the public health emergency ends and the process to redetermine eligibility begins.

It will be imperative for DHS to implement an unwinding process that does not disconnect the children most at risk of losing coverage, particularly when Pennsylvania’s uninsured rate is starting to improve.

We recommend DHS:

  • Reaffirm its commitment to using a 12-month unwinding period as recommended by the Centers for Medicare and Medicaid, which most other states plan to use. Using the full 12 months permitted will give Pennsylvania the best chance to minimize inappropriate terminations and disruptions in coverage (churn) that often impact children more than the adult population.
  • Immediately expand the 12-month continuous eligibility policy to children ages 4 through 21 in Medicaid when the public health emergency ends to make it more equitable—Pennsylvania already provides 12-month continuous eligibility (regardless of changes in circumstances) in Medicaid for children up to age 4. All Pennsylvania children in CHIP have continuous eligibility for a full year.

According to the report, factors such as race and ethnicity, poverty level and geographic region impact children’s access to health insurance. Some additional key findings include the following:

  • Hispanic or Latino children, children who identified as Some Other Race, and children who identified as Two or More Races have worse rates now than in 2019, showing they are more likely to be uninsured.
  • 5% of children in PA who qualify for no-cost or reduced-cost health insurance through Medicaid, CHIP, or Pennie™ do not have health insurance.
  • The uninsured rates improved in 38 counties and worsened in 29 counties over the last two years.

New to this year’s report are fact sheets for each of the 67 counties that show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.

Read the latest coverage:

Seeking Draft Recommendation Statement for Pre-exposure Prophylaxis (PrEP) for HIV Prevention 

The U.S. Preventive Services Task Force seeks comments on a draft recommendation statement and draft evidence review on pre-exposure prophylaxis (PrEP) for the prevention of HIV infection. Based on its review of the evidence, the Task Force recommends that healthcare professionals prescribe PrEP to people at increased risk for HIV to help prevent HIV infection. The draft recommendation statement and draft evidence review are available for review and public comment from Dec. 13, 2022, to Jan. 17, 2023.

COVID-19 Vaccine Ordering and Testing Supplies

HRSA released their Health Center COVID-19 Holiday Ordering Schedule on Dec. 13. All ordering will be disabled and no deliveries will be made during the weeks of Dec. 18 and Dec. 25. Regular ordering cadence will resume the week of Jan. 1. Additionally, BD Veritor Point-of-Care (POC) products have been exhausted at this time. Other distributors for these test strips can be found on the website Ordering & Reimbursement | BD Veritor™ Plus System.

Clinicians Urged to Consider Measles with Recent Outbreak

Currently, there is an ongoing outbreak of measles in Columbus, Ohio. As of Dec. 12, there were 73 confirmed cases with the growing concern of spreading to neighboring states, including Pennsylvania. Providers are encouraged to consider measles in patients presenting with clinically compatible symptoms. Providers who order testing must obtain samples from the following sites: throat/nasopharyngeal swab, urine, and serum. Timely measles testing is available through the PA Department of Health (DOH) Bureau of Laboratories after consultation with the local or state department of health. Measles is a reportable condition and providers should immediately report suspected cases to local health authorities or DOH. See Dec. 14 PAHAN 676 for more information.