The Centers for Medicare & Medicaid Services (CMS) issued the 2025 Marketplace Integrity and Affordability Proposed Rule on March 10, 2025. The proposed rule outlined several provisions with the goal to address waste, fraud, and abuse centered around enrollments considered to be improper, and asserts that current eligibility and enrollment rules have led to adverse selection. The proposed rule directly mentions that several policies would decrease enrollment and thus reduce federal costs.

After a bipartisan, unanimous vote in the PA General Assembly in 2019, Pennie, Pennsylvania’s Health Insurance Exchange, was created. Pennie’s comments to the proposed rule focused on all the ways provisions as well as highlighted three major points: Pennie’s enrollment trends were expected, Pennie’s system already deters unauthorized enrollment by brokers, and that Pennsylvania’s insurance market is stable and robust. Specific proposed provisions of additional concern are limiting open enrollment to 45 days, requiring a $5 premium payment for those current enrollees who are reenrolled in a plan with a $0 net premium, and amending the premium adjustment percentage methodology and de minimis range for plans subject to actuarial value requirements. These particular proposals would significantly raise the costs to purchase and use coverage. Pennie’s current open enrollment period is from Nov. 1 to Jan. 15. For the 2025 Open Enrollment Period, 496,661 Pennsylvanians enrolled in coverage with roughly 36,000 new enrollments between Dec.16 and Jan. 15 of the total new enrollments. View the 2025 Marketplace Integrity and Affordability Proposed Rule (CMS-9884-P) in its entirety.

This is a fascinating look at the cutting-edge artificial intelligence that is transforming the dental landscape, with innovation expert Shawn Kanungo. This Dental Soundbite from ADA gives the latest AI-driven tools and technologies that can revolutionize efficiency and outcomes in dental practices.

A federal effort has been proposed to eliminate the recommendation and use of fluoride in community water systems. The AAPD and over 250 organizations have signed a coalition letter to Congress and the Administration, strongly reaffirming the safety of community water fluoridation and its importance in ensuring oral health across the US. Read the coalition letter here.

Recognizing the critical role health care teams play in preventing overdose, the Department of Health (DOH) launched the Comprehensive Approaches to Pain Management, Opioid Prescribing, and Substance Use Care education modules to assist providers and care teams. DOH offers live and online education sessions at no cost to participants. Participants are eligible to receive continuing education credits and certain modules may meet additional Pennsylvania licensing and relicensing requirements.

The Pennsylvania Department of Health (PA DOH) conducted a statewide, voluntary survey of mobile units between July and August 2024. Results indicate the majority of mobile units deployed were launched in the last seven years, and many operate less than five days per week. Preventive care was the service most often provided by mobile units. Lastly, the funding that most often supported mobile units was federal, philanthropy, and state funding.

IMPORTANT REMINDER: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every five years. Providers should log into PROMISe to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Use this link for enrollment revalidation applications.

The Modern Medicaid Alliance (MMA) released new polling data on Medicaid. The polling highlights the program’s overall popularity, the favorability of specific parts of it, and the number of voters who have a personal or family connection to Medicaid. Click here for more information about the report.

The House Appropriations Committee recently announced the beginning of the Fiscal Year 2026 appropriations process. As of Monday, April 14, House Members may begin submitting programmatic and language requests and Community Project Funding requests for the upcoming year. Deadlines for all the different subcommittees are available. The Senate Appropriations Committee also released guidance to the Senators for Fiscal Year (FY) 2026 Congressionally Directed Spending (CDS) requests. The earmark requests to the Committee are May 16, so individual senators will set even earlier deadlines for their own consideration. Visit the website of your Member of Congress and/or Senator to find out if they are accepting requests and their deadline.

Legislation recently introduced in Pennsylvania would address the state’s dental workforce shortage while ensuring patient safety. HB 787, the Interstate Dental & Dental Hygiene Licensure Compact, is backed by the American Association of Dental Boards and would allow dental professionals with Compact privileges to seek licensure in Pennsylvania while maintaining high standards, including hand skills examinations. The bill is currently in the House Professional Licensure Committee.

On April 11, the Centers for Medicare & Medicaid Services issued a proposed rule for the Fiscal Year (FY) 2026 Inpatient Psychiatric Facility Payment System (IPF PPS) and IPF Quality Reporting Program (QRP). The proposed rule includes a 2.6 percent increase to the prospective payment rates, updates to the outlier threshold, the case-mix-group relative weights and average length of stay values and the wage index. Under the IPF QRP, CMS proposes to remove two quality measures, and is seeking feedback with four Requests for Information (RFIs). Once finalized, updates will be effective October 1, 2025.