Thanks to a 2022 law, consumers across the commonwealth have a new option if a healthcare claim is denied. Consumers can now file an online appeal of insurer denials of healthcare coverage to the Pennsylvania Insurance Department (PID) using PID’s new appeal website. Pennsylvania took over the independent external review process from the federal government under Act 46 of 2022, which took effect January 1, 2024. According to PID, only a small number of individuals challenged claim denials in the past three years and a significant number of those appeals resulted in decision reversals. PID encourages individuals who believe that they were inappropriately denied coverage for a service to utilize the new process and appeal the decision.

The Health Resources and Services Administration (HRSA) has approved a request from drug maker Eli Lilly to audit a rural, multi-site community health center regarding how it prevents duplicate discounts on 340B drugs reimbursed under Medicaid managed care. This approval is notable as it is the first time that either a HRSA or manufacturer 340B audit will look at Medicaid managed care drugs. (Previous audits around Medicaid have been limited to fee for service drugs.) The rationale behind HRSA’s change in policy is unclear.

Nationally, over 15 million people have been disenrolled from Medicaid since April 1, 2023 and over 28 million have had their coverage renewed. Kaiser Family Foundation (KFF) has published a Medicaid Unwinding Brief that summarizes information gathered from stakeholder interviews to highlight key observations and themes from the field, including perspectives from Pennsylvania. With the growing concern over such large disenrollment numbers, the federal government issued additional guidance with strategies to help states protect coverage and prevent additional procedural terminations.  Pennsylvania has disenrolled more than 575,000 recipients from coverage since April 1, renewed coverage for 1.3 million, and terminated 44% for procedural issues.

Join Administrator Chiquita Brooks-LaSure of the Centers for Medicare & Medicaid Services (CMS) as she highlights CMS’ key 2023 accomplishments and reviews the 2024 priorities to advance CMS’ Strategic Plan. CMS’s focus for the coming year includes advancing health equity, expanding coverage, and improving health outcomes while engaging communities for input and feedback during the process.  RSVP for the January 23, 1:00 – 2:00 pm call here.

The PA Departments of Human Services (DHS) and Education will operate the Summer Electronic Benefits Transfer (Summer-EBT) program in the summer 2024, allowing children to access nutritious meals during the summer months when school is not in session.  An increase in the state’s budget will provide universal free breakfast to Pennsylvania’s public school students. Every public school student regardless of income will be eligible to receive free breakfast. The funding also provides free lunch to all 22,000 Pennsylvania students who are eligible for reduced-price lunches through the National School Lunch Program.

Congressmen David Trone (D-MD), Jamie Raskin (D-MD), and Brian Fitzpatrick (R-PA) reintroduced the Continuity in Necessary Evaluative Crisis Treatment (CONNECT) Act to connect individuals experiencing a behavioral or mental health crisis with follow-up services. The bill authorizes $30 million to create a new grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) to support these activities.

Advocates and dentists are hopeful a state House bill will restore dental services for adults with Medicaid coverage in Pennsylvania. The legislation passed the Democratic-controlled state House last month in a bipartisan 153-50 vote. Coverage for many adult dental services was cut in 2011 under the administration of former Gov. Tom Corbett as part of a cost-saving move; the change was estimated to save about $18 million in state funds at the time. Since that time, adults in the state’s Medicaid program have had a very limited set of dental benefits that don’t cover much beyond routine exams, cleanings, and basic fillings. The bill is now in the state Senate before the Human Services Committee. There is also a similar Senate bill, sponsored by Minority Leader Sen. Jay Costa, a Democrat.

Among fourteen categories that can be searched by state, topic, keyword, and year, the resource includes legislative topics on newborn screening, women’s health, childhood obesity and nutrition, maternal and infant mortality, maternal and child mental health and the impacts of substance use on the MCH population. The database goes back to 2017 and is kept up to date by the National Conference of State Legislatures (NCSL).

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HRSA relies on grant reviewers to select the best programs from a competitive group of applicants. Over the coming months, the Federal Office of Rural Health Policy will be competing a number of programs, including among other things: substance use disorders and opioid use disorder, rural workforce, and rural hospitals. Having reviewers with expertise in rural health greatly benefits the review process and is also an opportunity to learn about the review process itself. Reviews are typically held remotely over a period of a few days and reviewers who participate and complete their assigned duties receive an honorarium. Registration is easy and does not commit you to serving as a reviewer. Please consider lending your expertise to these important initiatives.

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