Rural Health Information Hub Latest News

340B Program and Medicaid MCOs Update

PA Department of Human Services (DHS) 340B Workgroup members received the following communication from DHS this week regarding the 340B Program and Medicaid MCOs:

“We wanted to provide an update on the Department’s work surrounding the 340B program. We appreciate the time everyone has taken to participate in the workgroup meetings, and individual meetings, as well as sharing information and feedback between meetings.

 “CMS is currently considering a method for identifying 340B purchased drugs within the Medicare Program. As we often mirror Medicare, and to avoid duplicate work, we have decided to hold on to any decision until CMS announces the Medicare method. At that time, we will review the applicability of that process and decide how to proceed.

 “Thank you again for your engagement and feedback.”

New Toolkit for School-Based Outreach on Medicaid and CHIP Renewals

The Centers for Medicare and Medicaid Services (CMS) released a toolkit (PDF) to support school-based outreach to families about renewing Medicaid or Children’s Health Insurance Program (CHIP) coverage. It includes ready-to-use resources, like email and text message scripts, to spread the word about Medicaid/CHIP coverage renewal in schools and early education or care settings. The back-to-school toolkit (PDF) from the HHS Insure Kids Now campaign also supports these efforts.

Pennie Announces Health Equity Report, Taking Strides to Reduce Health Inequities

Pennie released its inaugural 2022-2023 Health Equity Data Report. The Data Report examines Pennie enrollments across the diverse race and ethnicities represented in the Health Insurance Marketplace in Pennsylvania. The report begins with a broad focus on enrollments at the Commonwealth level, moving next to a section examining enrollment in urban and rural geographic areas. The goal of this report was to examine racial and ethnic enrollment data in the Pennie Marketplace through a health equity lens.

Understanding the IDD Healthcare Disparity Through Legislation

A recent article in Helen: The Journal of Human Exceptionality, focuses on the health disparities for individuals with intellectual and developmental disabilities. The article, “Underserved & Unrecognized: Understanding the IDD Healthcare Disparity Through Legislation,” also focuses on the need for individuals with disabilities to be recognized as a Medically Underserved Population (MUP).

Click here to read the article.

You Might Need an Ambulance, But Your State Might Not See It as ‘Essential’

From Stateline

When someone with a medical emergency calls 911, they expect an ambulance to show up.  But sometimes, there simply isn’t one available.

Most states don’t declare emergency medical services (EMS) to be an “essential service,” meaning the state government isn’t required to provide or fund them.

Now, though, a growing number of states are taking interest in recognizing ambulance services as essential — a long-awaited move for EMS agencies and professionals in the field, who say they hope to see more states follow through. Experts say the momentum might be driven by the pandemic, a decline in volunteerism and the rural health care shortage.

EMS professionals have been advocating for essential designation and more sustainable funding “for longer than I’ve been around — longer than I’ve been a paramedic,” said Mark McCulloch, 42, who is deputy chief of emergency medical services for West Des Moines, Iowa, and who has been a paramedic for more than two decades.

Currently, 13 states and the District of Columbia have passed laws designating or allowing local governments to deem EMS as an essential service, according to the National Conference of State Legislatures, a think tank that has been tracking legislation around the issue.  Those include Connecticut, Hawaii, Indiana, Iowa, Louisiana, Maine, Nebraska, Nevada, Oregon, Pennsylvania, South Carolina, Virginia and West Virginia.  And at least two states — Massachusetts and New York — have pending legislation.  Idaho passed a resolution in March requiring the state’s health department to draft legislation for next year’s legislative session.  Meanwhile, lawmakers in Wyoming this summer rejected a bill that would have deemed EMS essential, according to local media.

“States have the authority to determine which services are essential, required to be provided to all citizens,” said Kelsie George, a policy specialist with the National Conference of State Legislatures’ health program.  Among those states deeming EMS as essential services, laws vary widely in how they provide funding. They might provide money to EMS services, establish minimum requirements for the agencies or offer guidance on organizing and paying for EMS services at the local level, George said.

The lack of EMS services is acute in rural America, where EMS agencies and rural hospitals continue to shutter at record rates, meaning longer distances to life-saving care.

“The fact that people expect it, but yet it’s not listed as an essential service in many states, and it’s not supported as such really, is where that dissonance occurs,” said longtime paramedic Brenden Hayden, chairperson of the National EMS Advisory Council, a governmental advisory group within the U.S. Department of Transportation.

More financial support

There isn’t a sole federal agency dedicated to overseeing or funding EMS, with multiple agencies handling different regulations, and some federal dollars in the form of grants and highway safety funds from the Department of Transportation. Medicaid and Medicare offer some reimbursements, but EMS advocates argue it isn’t nearly enough.

“It forces it as a state question, because the federal government has not taken on the authority to require it,” said Dia Gainor, executive director for the National Association of State EMS Officials and a former Idaho state EMS director. “It’s the prerogative of the state to make the choice” to mandate and fund EMS.

In states that don’t provide funding, EMS agencies often must rely on Medicaid and Medicare reimbursements and money they get from local governments.

Many of the latter don’t have the budgets to pay EMS workers, forcing poorer communities to turn to volunteers. But the firefighter and EMS volunteer pool is shrinking nationally as the volunteer force ages and fewer young people sign up.

Overhead for EMS agencies is expensive: A basic new ambulance can cost $200,000 to $300,000. Then there are the medicine and equipment costs, as well as staff wages and farther driving distances to medical centers in rural areas. The fact that people expect it, but yet it’s not listed as an essential service in many states, and it’s not supported as such really, is where that dissonance occurs.

By contrast, police departments are supported and receive funds from the U.S. Department of Justice along with local tax dollars, and fire departments are supported by the U.S. Fire Administration, although many underserved areas also rely on volunteer firefighters to fill gaps.  “We need more if we’re going to save this industry and [if] we’re going to be available to treat patients,” Hayden said. “EMS in general represents a rounding error in the federal budget.”  What’s more, reimbursements only occur if a patient is taken to an emergency room. Agencies may not receive compensation if they stabilize a patient without transporting them to a hospital.

Gary Wingrove, president of the Paramedic Foundation, an advocacy group, has co-authored studies on the lack of ambulance service and on ambulance costs in rural areas. The former Minnesota EMS state director argues that reimbursements should be adjusted on a cost-based basis, like critical-access medical centers that serve high rates of uninsured patients and underresourced communities.

A rural crisis

About 4.5 million people across the United States live in an “ambulance desert,” and more than half of those are residents of rural counties, according to a recent national study by the Maine Rural Health Research Center and the Rural Health Research & Policy Centers. The researchers define an ambulance desert as a community 25 minutes or more from an ambulance station.

Some regions are more underserved than others: States in the South and the West have the most rural residents living in ambulance deserts, according to the researchers, who studied 41 states using data from 2021 and last year.  State Rep. Eric Emery, a Democrat, is a paramedic and EMS director of the tribe’s sole ambulance station, providing services to 11,400 residents.

Emery and his colleagues respond to a variety of critical calls, from heart attacks to overdoses. They also provide care that people living on the reservation would otherwise get in the doctor’s office — if it didn’t take the whole day to travel to one. Those services might include taking blood pressure measurements, checking vital signs or making sure that a diabetic patient is taking their medicine properly.  Nevertheless, South Dakota is one of 37 states that doesn’t designate emergency medical services as essential, so the state isn’t required to provide or fund them.

While he and his staff are paid, remote parts of the reservation are often served by their respective county volunteer EMS agencies. It would simply take Emery’s crew too long — up to an hour — to arrive to a call.  “Something I wanted to tackle this year is to really look into making EMS an essential service here in South Dakota,” Emery said. “Being from such a conservative state that’s very conservative when it comes to their pocketbook, I know that’s probably going to be a really hard hill to climb.” Ultimately, Wingrove said, officials need to value a profession that relies on volunteers to fill funding and staffing gaps.  “We’re looking for volunteers to make decisions about whether you live or die,” he said.  “Somehow, we have placed ourselves in a situation where the people that actually make those decisions are just not valued in the way they should be valued,” he said. “They’re not valued in the city budget, the county budget, the state budget, the federal budget system. They’re just not valued at all.”

5.6 Million Disenrolled Nationwide from Medicaid

At least 5.6 Million people in 48 states and DC have been disenrolled from Medicaid since April 1, 2023, according to the Kaiser Family Foundation Medicaid Enrollment and Unwinding Tracker. Overall, 37% of people with a completed renewal were disenrolled in reporting states while 63%, or 9.2 million enrollees, had their coverage renewed (three of the reporting states do not provide data on renewed enrollees). Across all states with available data, 73% of all people disenrolled had their coverage terminated for procedural reasons. Of the people whose coverage has been renewed as of Sept. 5, 2023, 53% were renewed on an ex parte basis while 47% were renewed through a renewal form. Pennsylvania is reporting 185,000 Medicaid disenrollments due to the unwinding, with 44% of those for procedural reasons and 56% determined ineligible; 25% of those disenrolled are children and 75% are adults. Pennsylvania has a very low ex-parte renewal rate of 12% and an 88% renewal rate via the form. The Department of Human Services is processing some ex-parte renewals manually.

Pennsylvania Governor’s Administration Launches Overdose Prevention Program

The Pennsylvania Commission on Crime and Delinquency (PCCD) and the Department of Drug and Alcohol Programs (DDAP) has announced a new program, building on the impact of the Naloxone for First Responders Program (NFRP). The new program—the PA Overdose Prevention Program—will serve as a “one-stop-shop” for individuals and organizations seeking multiple formulations of naloxone and related harm reduction supplies, including fentanyl and xylazine test strips. It will also serve as a clearinghouse for information, training, and technical assistance to help groups involved in harm reduction work and others on the front lines of Pennsylvania’s evolving overdose crisis. Like the NFRP, the PA Overdose Prevention Program will focus on getting naloxone and harm reduction supplies into the hands of people who use drugs and those who serve and support them. Read more about the initiative.

Pennsylvania State Budget, Pennsylvania Primary Care Practitioner Program Updates

The Senate returned to Harrisburg to pass Fiscal Code legislation providing authorization for several appropriations in the enacted 2023-24 Fiscal Year budget, as well as program implementation language across numerous state agencies. Notably, the Senate passed two separate Fiscal Code bills: HB 1300 and SB 757. The text of HB 1300 largely follows the standard format and content of previous Fiscal Code legislation, with program implementation and authorization language across a broad swath of agencies, including those in the health and human services space. Notable aspects of the bill include the Pennsylvania Primary Care Practitioner Program. In the budget bill signed by Governor Shapiro, HB 611, there is $8,350,000 allocated for the Pennsylvania Primary Care Practitioner Program, an 18% increase over last year’s allocation. HB 1300 provides details on how the funds are to be allocated and is awaiting passage in the state House of Representatives. Per the drafted code bill, the funds are to be distributed as follows: a minimum of $3.45 million for loan repayments, $1.5 million for the PA Academy of Family Physicians Residency Program, $1.3 million for the PA Academy of Family Physicians Family Medicine Residency Community Health Impact Grants, and $2.1 million to be shared by the other existing grantees. With passage in the Senate, both bills move to the House for consideration and action. It is unlikely that the House will return to session before September 26 to act on these or any other legislative items with the chamber deadlocked at 101-101, pending the outcome of a special election. As stated above, the Fiscal Code legislation passed by the Senate has significant disparities and omissions in policy that will need to be rectified with the House.

Pennsylvania Broadband Authority’s Broadband Equity, Access, and Deployment (BEAD) Program Open for Public Comment

The Pennsylvania Broadband Development Authority (PBDA) has drafted its Volume I of the Broadband Equity, Access, and Deployment (BEAD) Program, as required through the National Telecommunication and Information Administration’s BEAD Notice of Funding Opportunity and supplemental guidance. Volume I includes critical components of PBDA’s plans for implementing BEAD grant funding, to ensure that all Pennsylvanians have access to high-speed internet. To draft the document, PBDA complied with NTIA requirements and guidance on elements such as the application process, scoring criteria, labor standards, and other requirements, as well as Commonwealth policies.

Volume I will be available for public review and comment for the required 30 days, from September 11, 2023 through October 10, 2023. The draft document can be accessed here. Upon receipt and consideration of comments to this document, PBDA will seek approval from its Board of Directors and submit the Volume for consideration to NTIA. Public viewers are asked to share comments through this form by 11:59 PM on October 10, 2023. Please note that Volume II will be available to view and comment on later this fall and prior to the NTIA submission deadline of December 27, 2023.