Gov. Josh Shapiro praised a bipartisan effort to give medically vulnerable infants in Pennsylvania expanded access to potentially life-saving pasteurized donor human milk. Act 32 of 2023, Owen’s Law, took effect the week of January 15 and increases access to pasteurized donor human milk by expanding the number of health conditions eligible for Medicaid-covered donor human milk. The law will support supplementation of a mother’s milk and provide more options to support healthy growth for infants. Key components of the law include expanding the number of medical conditions that qualify for Medicaid coverage for pasteurized human donor milk; requiring the Department of Health (DOH) in consultation with the Department of Human Services (DHS) to produce a public information campaign on the availability of pasteurized human donor milk; and tasking DHS with creating and updating guidance about the usage of donor milk. Click here to learn more. Click here for the Medical Assistance Bulletin.

Multi-state compacts make licensing easier to navigate by streamlining the application process. Visit this page at Telehealth.HHS.gov to learn how multi-state licensing compacts work and specifics on the compact for your discipline, including physicians and nurses, allied and auxiliary health care workers, and emergency medical services personnel.  Get more telehealth resources, including funding opportunities, from HRSA’s Office for the Advancement of Telehealth.

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Along with the Office of Personnel Management, the Internal Revenue Service, and the Departments of Labor and Treasury, HHS seeks comments on proposed rules related to the Federal independent dispute resolution process established under the No Surprises Act. The proposal includes new requirements for disclosing information along with the initial payment or notice of denial of payment for certain items and services subject to surprise billing protections.  Initially opened in the Federal Register on November 3, 2023, the proposal was republished on Monday of this week; comments will be accepted until February 5.

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Last week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that advances federal efforts toward interoperability.  Through this rule, “impacted payers” of health plans designed by CMS – including, but not limited to, state issuers of Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service programs, Medicare Advantage organizations, and Qualified Health Plan issuers on Federally Facilitated Exchanges – are required to implement and maintain application programming interfaces.  Also known as APIs, these interfaces are relied on by the federal government to uphold global standards for the electronic exchange of health care information.  Beginning in 2026, impacted payers will also be required to streamline their processes for prior authorization (PA), a common practice of insurance organizations that requires providers to get advanced approval before delivering a service to patients.  They must send authorization to providers within 72 hours for urgent requests, and within seven calendar days for non-urgent requests.  Beginning in 2027, impacted payers must implement an approved application programming interface for prior authorization, where providers can access the list of covered items and services and get support with their requests. Additionally in 2027, hospitals, including Critical Access Hospitals, and Merit-based Incentive Payment System (MIPS) eligible clinicians will have to attest to using this electronic interface to submit PA requests as part of their Medicare Promoting Interoperability Program reporting requirements. While the use of various electronic exchange methods among hospitals and physicians has increased in recent years, the Government Accountability Office (GAO) recently found that use among small and rural hospitals is lower than that of other hospitals.  Federal officials and other stakeholders told GAO that these and other federal provisions could be helpful for small and rural providers because it could make the exchange of data less costly.

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced a new state-based model that focuses on community-based behavioral health practices for Medicaid and Medicare beneficiaries.  In Spring 2024, CMS will open the application process for the IBH Model; up to eight states will receive funding for activities and capacity building. The project period is expected to begin in Fall 2024 and run for eight years to implement an approach to community health that integrates mental treatment with primary and specialty care.  By the start of year 4, states may be selected to implement a Medicaid payment model that includes a per-beneficiary-per-month payment, and additional performance-based payments for model years 4-8.

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The Pennsylvania Department of Health is seeking feedback from providers across the state to guide the development of educational materials for communities at-risk of mpox transmission, as well as for providers. The Mpox Outreach & Education (O&E) Materials Questionnaire gives providers and team members the opportunity to provide insight into the types of materials that would be most beneficial for services providers and the communities your teams serve. Additionally, if you feel like materials should include messaging about both mpox and other STIs or HIV, please elaborate on that in the questionnaire as well.

At a 2022 White House conference, the American College of Lifestyle Medicine (ACLM) made a $24.1 Million commitment to improving nutrition training for medical professionals. Their upcoming National Training Initiative is part of that effort. It offers scholarships for one primary care physician at every FQHC to become certified in lifestyle medicine. Learn more or express interest on ACLM’s site. ACLM also offers a free CME/CE-accredited course on prescribing nutrition — using food as medicine — and other lifestyle modalities. Visit ACLM’s site for information or to register. Up to 5.5 CME/CE available.

Vaccination is one of the most highly effective public health interventions, responsible for saving millions of lives each year. Despite the care taken in the development and deployment of vaccines and their clear and compelling benefit of saving individual lives and improving population health outcomes, an increasing number of people in the US are now declining vaccination for a variety of reasons, ranging from safety concerns to religious beliefs. The situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths are likely to occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines. Read more in this Feb. 15 JAMA article.