The Senate Finance Committee marked up a Pharmacy Benefit Manager-focused bill on Wednesday, July 26. Thanks to the tireless advocacy of the National Association of Community Health Centers (NACHC), Primary Care Associations like PACHC, and Community Health Centers in affected states, bipartisan momentum is behind a fix to address a health center concern that the bill’s treatment of the 340B contract pharmacy definition was insufficient. NACHC has received assurances from Finance Committee leadership that health center concerns will be addressed in the final bill. Thank you all for your advocacy on this issue. Click here to watch a recording of the hearing.

A road map for regulatory actions being considered by Pennsylvania Governor Shapiro’s administration is published in the Pennsylvania Bulletin. The 44-page document lists regulations being drafted by state agencies covering a wide range of activities under state government oversight. The regulatory agenda establishes a timetable for when the regulations may be proposed but notes that the nature and complexity of regulation will affect that date. An executive order dating to 1996 requires a semi-annual publication of the agenda. The agendas are compiled “to provide members of the regulated community advanced notice of regulatory activity,” according to the notice by the governor’s office. “The agenda represents the Administration’s present intentions regarding future regulations.”

With the prospect that the state’s budget impasse could drag on for another two months appearing increasingly likely, county leaders are bracing for the impact of having to pay their bills when the state isn’t paying its bills. Tens of millions of dollars for county-level services for substance abuse, child welfare, mental health, and the intellectually disabled are expected to be held up in the coming days and weeks unless the state budget impasse is resolved, the Associated Press reports. State Senate Pro Tempore Kim Ward (R-Westmoreland) expressed that the Senate may return in August to pass the budget bill. However, the code bills, which provide the state government with how the state funds are to be allocated and spent, remain in the House. The House is not expected to return until the week of Sept. 26, after a special election on Sept. 19 for the House seat that is currently open due to Rep. Sara Innamorato’s (D-Lawrenceville) resignation.

  The National Conference of State Legislatures (NCSL) describes actions taken by states to address physician shortages in rural and underserved areas through graduate medical education (GME).  The article covers statewide collaborations and appropriations, Medicaid payments, and incentives for rural clinical training.

See which states and rural health projects got funded by the U.S. Department of Agriculture (USDA) Rural Emergency Health program.  This initiative supported 179 new grant recipients that will expand access to health care in 39 states and Puerto Rico.  Part of the American Rescue Plan Act passed by Congress in March 2021, the funding is intended to support rural hospitals and healthcare clinics, improve facilities, purchase new equipment, and help distribute fresh food to families, senior citizens, veterans, and people with disabilities.

The Centers for Medicare & Medicaid Services (CMS) issued a final payment rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration’s priorities to provide support to historically underserved and under-resourced communities and to promote the highest quality outcomes and safest care for all individuals. The fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule updates Medicare payments and policies for hospitals as required by statute; adopts hospital quality measures to foster safety, equity, and reduce preventable harm in the hospital setting; and recognizes homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting. This is consistent with the Administration’s goal of advancing health equity for all, including members of historically underserved and under-resourced communities, as described in the President’s January 20, 2021, Executive Order 13985 on “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.”

For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record users, the final rule will result in an increase in operating payment rates of 3.1%. This reflects an FY 2024 projected hospital market basket update of 3.3%, reduced by a statutorily required productivity adjustment of a 0.2 percentage point. Under the LTCH PPS, CMS expects payments in FY 2024 to increase by approximately 0.2% or $6 million.

“As part of CMS’ health equity goals, we are rewarding hospitals that deliver high-quality care to underserved populations and, for the first time, also recognizing the higher costs that hospitals incur when treating people experiencing homelessness,” said CMS Administrator Chiquita Brooks-LaSure. “With these changes, CMS is laying the foundation for a health system that delivers higher quality, more equitable, and safer care for everyone.”

Supporting Rural and Other Underserved Communities

In this final rule, CMS is finalizing a health equity adjustment in the scoring methodology for the Hospital Value-Based Purchasing (VBP) Program that rewards hospitals that serve higher proportions of dual-eligible patients for providing excellent care. The newly finalized scoring methodology allows the opportunity for hospitals to earn up to ten bonus points depending on their performance on existing quality measures and the proportion of dually eligible patients they treat. The rule is a first step toward promoting health equity in the Hospital VBP Program and as such, CMS received public comments on additional approaches for equity adjustments in the Hospital VBP Program for future years. These suggestions include using other methods of restructuring the scoring methodology and determining the best metric to identify underserved populations, which CMS will consider for future updates.

CMS is also finalizing a policy to recognize the higher costs that hospitals incur when treating people experiencing homelessness when hospitals report social determinants of health codes on claims, meaning that hospitals will generally receive higher payments when a patient is experiencing homelessness. In addition, CMS is finalizing the policy that allows rural emergency hospitals (REHs) to be designated as graduate medical education training sites. This policy will build upon the Biden-Harris Administration’s commitment to supporting care in rural and other underserved communities by enhancing the health care workforce opportunities in these areas.

Additionally, this final rule will codify the requirements for the additional information that eligible facilities are required to submit when applying for enrollment as an REH, as specified in law. The finalized policy is intended to increase access to essential health care services in rural communities and support the enrollment process for eligible facilities seeking the REH designation.

Promoting Patient Safety

CMS is finalizing proposals for the Hospital IQR and Medicare Promoting Interoperability Programs to adopt three electronic clinical quality measures beginning with the CY 2025 reporting period to foster safety and reduce preventable harm in the hospital setting.

Resources

• For a fact sheet on the final payment rule visit: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0
• The FY 2024 IPPS/LTCH PPS final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the

Get CMS news at cms.gov/newsroom, sign up for CMS news via email, and follow CMS on Twitter @CMSgov

On July 28, 2023, the Centers for Medicare & Medicaid Services (CMS) released its first monthly data report on Medicaid and Children’s Health Insurance Program (CHIP) eligibility renewals. These data will inform the Biden-Harris Administration’s critical work to help ensure eligible people stay covered, and to help ensure people no longer eligible for Medicaid or CHIP to transition to a range of other coverage options, including affordable health insurance through HealthCare.gov and state Marketplaces.

The data detail updates from the 18 states that had completed at least one cohort of renewals by April 30, 2023, highlighting how many people kept their Medicaid and CHIP coverage, as well as the number of people who were disenrolled from coverage. CMS is also releasing data on state Medicaid call centers, including average wait times and the number of people who disconnected before speaking to a customer service representative. In addition, CMS is releasing HealthCare.gov Marketplace data on consumers who were previously enrolled in Medicaid or CHIP that came to the HealthCare.gov and applied for coverage and State-based Marketplaces (SBM) data on consumers who transitioned to SBM coverage following a Medicaid or CHIP redetermination. See a national summary of the data at a glance, or read more about the data at Medicaid.gov/unwinding-data.

CMS continues to work closely with states as people renew their Medicaid and CHIP coverage or explore other coverage options. In addition to the new data, Health and Human Services (HHS) Secretary Xavier Becerra sent a letter to Governors encouraging states to do more to adopt strategies to automatically renew coverage for people where states already have data showing the person is eligible for Medicaid or CHIP.

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Immunization Awareness Month during August. Immunizations—also called vaccinations, vaccines, or shots—protect people of all ages against a wide range of diseases and conditions. Throughout August, and the rest of the year, we’re highlighting the importance of immunizations by working to advance equitable access to vaccines and encouraging all individuals served by CMS to get their routine vaccines.

Each year, the CDC recommends vaccinations like flu shots and COVID-19 vaccines as well as important, routine vaccinations based on different age groups. Despite these recommendations, fewer than 1 in 4 adults who are 19 or older got all their routinely recommended vaccines in 2019 and minority populations have even lower immunization rates. Only 15.9% of Black adults and 17.3% of Hispanic adults get their routine immunization compared to 23.7% of their White counterparts. Additionally, Black (39.0%), Hispanic (37.5%), and adults who identify as other or multiple race (41.4%) have persistently lower flu vaccine rates compared with White adults (49.3%). These racial inequities in vaccination are due to significant disparities in access and health coverage as well as a history of discrimination and distrust.

While vaccination rates for most children’s vaccines are significantly higher, kindergartener vaccination coverage has steadily declined for all vaccines over the past two school years and similar gaps in vaccination coverage exist among children in minority communities. Increasing vaccination rates for all Americans means addressing the social and health inequities that contribute to vaccine disparities.

The Inflation Reduction Act improves coverage and lowers out-of-pocket costs for recommended vaccines in Medicare, Medicaid, and the Children’s Health Insurance Program. People with Medicare drug coverage will pay nothing out-of-pocket for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) — including the shingles vaccine and Tetanus-Diphtheria-Whooping Cough vaccine. Learn more about these changes.

Health care professionals and partner organizations can encourage their communities to stay up to date on vaccines by emphasizing why immunizations matter and sharing information to help people get the vaccines they need. These resources can help those you serve learn more about recommended vaccinations and how to access them using their health care coverage.

Resources

• Find immunization resources for health care providers, partners, and patients on our Immunization and Vaccine Resources
• Learn more about the changes to coverage through the Inflation Reduction Act and find social media toolkits to share with patients in your community.
• View the Coverage to Care (C2C) Prevention Resources webpage for newly updated flyers that offer information on covered immunizations for all age groups. These resources are each available in 8 languages.
• Download the Annual Influenza Vaccination Disparities in Medicare Beneficiaries data snapshot to learn more about flu vaccines and disparities among Medicare fee-for-service enrollees.
• Share CDC’s Adult Vaccine Assessment Tool to help those you serve learn more about which immunizations they should receive.
• Visit CDC’s Vaccine Information for Adults webpage and review the Adult Immunization Schedule for details on recommended vaccinations in adulthood. Additionally, view the Vaccines for Your Children webpage and Child & Adolescent Immunization Schedule for details about vaccines for children. Visit the CDC “Back-to-School” Campaign for downloadable resources and additional materials.
• Explore CDC’s Resources to Encourage Routine Childhood Vaccinations webpage to access materials to help both health care providers and parents contribute to efforts to increase routine vaccination coverage.
• Utilize and share the CMS Flu Vaccine Partner Toolkit which provides the most up-to-date information from CMS, CDC, and HHS on the importance of receiving the flu vaccine.
• Find the latest information on the COVID-19 vaccine and guidance on how to get vaccinated on the CDC Vaccines for COVID-19.