Pennie – Pennsylvania’s official health insurance marketplace – announced that a record nearly 435,000 Pennsylvanians are now covered with affordable, high-quality health coverage through Pennie. This represents a 17% increase compared to this time last year, far exceeding the average annual increase of 1%. Marketplace enrollment has increased by over 150,000 in the four years since Pennsylvania took over ownership and operations from the federal marketplace (healthcare.gov) – a 56% increase.

A House Subcommittee hosted a hearing this week on “Health Care Spending in the United States: Unsustainable for Patients, Employers, and Taxpayers.” Click here to watch a recording of the hearing.

Pennsylvania’s Bureau of Procurement released bid solicitations this week for the PA Department of Human Services’ Community HealthChoices (CHC) program. CHC is Pennsylvania’s mandatory managed care program, implemented in 2018, for dually eligible individuals and individuals with physical disabilities receiving home and community-based waiver services or nursing facility services. DHS is seeking to procure the services of Managed Care Organizations (MCOs) to operate the CHC program in the five CHC zones which cover all 67 counties of the Commonwealth, for a five-year term (with three one-year renewal options). The draft MCO agreement, exhibits (17 in all) and other important dates for compliance are here. Bids are due by March 15, 2024.

The Pennsylvania Supreme Court last Monday issued a 219-page opinion on funding of abortions by Medicaid. While the complex ruling found that the state’s 1982 Abortion Control Act appears to discriminate based on sex, indicating that the ban prohibiting payment for abortions is “presumptively unconstitutional,” the state’s high court sent the case back to Commonwealth Court to resolve that question. The case could be a step on the way to the court recognizing there is a right to abortion under the state constitution. Under the 1982 Abortion Control Act passed by the Pennsylvania legislature, Medicaid prohibits reimbursement for abortions in all instances other than rape or incest, or to prevent the death of the woman. Five years ago, a group of seven abortion providers across Pennsylvania, alleging that the ban discriminates on the basis of sex, filed a petition challenging the prohibition under Pennsylvania’s Equal Rights Amendment.

Pennsylvania Gov. Shapiro and the state Department of Drug and Alcohol Programs (DDAP) announced that $18 million is available through the substance use disorder (SUD) student loan repayment program to assist practitioners within the SUD treatment, prevention, case management and recovery support services workforce. High rates of turnover and shortages of healthcare professionals have placed increased pressure on employee recruitment and retention.

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More information will be available in a Q&A document the administration is composing that will be posted to the DDAP website by Feb. 16 at noon.

Last week, the commonwealth launched PA Navigate, a new website that connects residents to community organizations, government agencies and health care providers for access to resources for basic needs, such as food, housing, and childcare.

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HRSA’s Office of Women’s Health invites you to participate in CERV-Net: A Cervical Cancer ECHO Learning Series for Safety-Net Settings. CERV-Net is a free, virtual, collaborative learning series that prepares and empowers safety-net providers to engage partners, patients, and communities to ultimately improve cervical cancer care across the cancer continuum.  The series consists of 11 sessions on Thursdays from 9:00-10:00 a.m. (ET) covering cervical cancer prevention, screening, management, and quality improvement activities.  Continuing medical education credits are available at no cost to physicians, nurse practitioners, nurses, and physician assistants.  If interested, please complete the interest form by Tuesday, February 13, 2024. For more details, please contact CERVNet@norc.org.  The Centers for Disease Control and Prevention cite lack of access to screening as a reason for higher prevalence of cervical cancer in rural areas.  Download resources from OWH’s page for the Federal Cervical Cancer Care Collaborative.

Read the full article here.

In 2024, two Medicare ACO initiatives will have increased participation by rural providers: the Shared Savings Program (SSP), the permanent ACO program, and the ACO REACH Model, which intends to improve access to and care for underserved populations, including those in rural areas. Accountable care organizations (ACOs) are groups of doctors, hospitals, and other health care professionals that work together to give patients high-quality, coordinated service and health care, improve health outcomes, and manage costs. This year, both SSP and ACO REACH will have over 25 percent more participation from Federally Qualified Health Centers, Rural Health Clinics, and Critical Access Hospitals than in 2023.  The increase in SSP is due, in part, to recent changes in the program intended to encourage participation among providers from rural and underserved areas.  Even though the transition from volume-based payment (i.e., fee-for-service with no connection to value) to value-based payment has been slower in rural America than in urban areas, increased rural provider participation in these initiatives furthers the CMS goal for all beneficiaries with traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030.

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The Centers for Medicare & Medicaid Services (CMS) is required to update Medicare Advantage (MA) payment rates and other policies for calendar year 2025.  The full Advance Notice may be viewed on the CMS website by selecting “2025 Advance Notice.”  For Medicare Advantage, CMS proposes to continue phasing in previously finalized adjustments to plan pay rates as well as make new adjustments for MA plans in Puerto Rico.  They also request input on future quality measures.  For the Part D Prescription Drug program, CMS invites comment on draft guidance implementing parts of the Inflation Reduction Act of 2022 (IRA) that take effect in 2025.  Specifically, the IRA creates a newly defined standard Part D benefit design; lowers the annual out-of-pocket threshold; establishes the Manufacturer Discount Program, under which manufacturers provide discounts on applicable drugs in the initial coverage phase and catastrophic phase of the defined standard drug benefit; and changes the liability of enrollees, sponsors, manufacturers, and CMS.  In recent years, non-metro areas have seen slightly higher growth in the number of MA plans and enrollment than metropolitan counties.

Read the full article here.