The Rothman Opioid Foundation for Opioid Research & Education is offering a free online curriculum that will aid current and future prescribers to fight opioid addiction across the Commonwealth of Pennsylvania and the Appalachian region. Launched in 2019, the Philadelphia nonprofit is dedicated to raising awareness of the risks and benefits of opioids, while educating physicians, other providers, patients, and policymakers on safe opioid use. The organization also supports research and education to use alternative pain strategies to decrease opioid use. Click here to access additional details on the Opioids & Pain Management course and to take it.

The Pennsylvania Department of Human Services, Office of Medical Assistance Programs has issued MA Bulletin 99-22-11, Reinstatement of Provider Enrollment Requirements. In response to the COVID-19 pandemic, DHS requested provider enrollment flexibilities under Section 1135 of the Social Security Act. CMS approved DHS’ Section 1135 request for provider enrollment flexibilities on March 27, 2020. Providers were advised of these flexibilities in Provider Quick Tip 240, which was issued on April 9, 2020. Effective Feb. 27, 2023, this Bulletin reinstates the requirements for provider payment for enrollment application fees, fingerprint-based backgrounds, and site visits for providers. Providers temporarily enrolled in the MA Program during the Public Health Emergency who did not satisfy the enrollment requirements that were suspended under the Section 1135 flexibilities must satisfy the enrollment requirements as described in the Bulletin.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) released a proposed rule that would permanently allow providers to prescribe buprenorphine using telehealth for opioid use disorder treatment without requiring an in-person physical evaluation. With comments due on or before Feb. 14, 2023, the proposed rule also includes a change to the consent process required for telehealth visits, among other proposed changes.

The Childhood Blood Lead Test Act was signed into law in November. 3, 2022, took effect January 2, 2023. The Act provides for blood lead assessment and testing of specific children and pregnant women by healthcare providers; imposes duties on the Department of Health; and requires particular health insurance policies to cover blood lead tests. The purposes of the Act are to substantially reduce and eventually eliminate the incidence of childhood lead poisoning in the Commonwealth, to improve public awareness of lead safety issues in housing, to educate property owners and tenants about practices that can reduce the incidences of lead poisoning and encourage testing of all children in Pennsylvania by two years of age so that prompt diagnosis and treatment, as well as prevention of harm, are possible. The state Health Department gave notice in the Pennsylvania Bulletin regarding how Act 150 of 2022 is to be implemented by healthcare providers.

On Dec. 22, the Pennsylvania Department of Human Services (DHS),Office of Medical Assistance Programs issued MA Bulletin 01-22-78: 340B Drug Pricing Program – Dispensing 340B Purchased Drugs. According to DHS, “This bulletin does not reflect any change to the Department’s policy. As per the 2013 MA Bulletin (link added), and as reflected in the current bulletin, authorized 340B entities are still able to dispense and bill 340B eligible drugs in both FFS and Managed Care.” The Bulletin notes that “contract pharmacies must dispense non-340B-purchased drugs to beneficiaries in the FFS and managed care delivery systems.”

The federal COVID-related Public Health Emergency (PHE), currently set to expire on Jan. 11, 2023, is expected to be extended once more, to April 2023. During the PHE, Pennsylvania has allowed continued Medicaid (Medical Assistance (MA)) coverage for most individuals enrolled in MA as required by the federal Families First Coronavirus Response Act (FFCRA) in exchange for increased federal Medicaid funding. However, the previous continuous coverage requirement tie to the PHE was severed with passage of the omnibus spending bill by Congress last week sets March 31, 2023, as the last day of the requirement, regardless of the status of the PHE. The bill allows states to continue to receive enhanced federal funding, in gradually decreasing amounts, throughout 2023. When the continuous Medicaid coverage requirement ends, the PA Department of Human Services (DHS) will review Medicaid eligibility for everyone on MA. While DHS originally planned to conduct the “unwinding” of continuous Medicaid coverage over a six-month time period, DHS in November shared its intention to take a full 12 months to review eligibility for all Pennsylvanians on Medicaid. For most, this means Medicaid will be reviewed when their Medicaid renewal would normally occur. Please remind your patients who are currently covered by MA that it is critical to ensure their contact information with the County Assistance Office (CAO) is up to date so they can receive Medicaid-related correspondence, including the renewal packet. Contact information can be updated on the COMPASS website, on the myCOMPASS PA mobile app, or by calling the Statewide Customer Service Center at 1-877-395-8930 (in Philadelphia, call 215-560-7226). MA-insured individuals also have the option to sign up for text alerts related to their benefits renewal.

When mapmakers reimagined the boundaries of Pennsylvania’s 253 legislative districts, they did it with an eye on the state’s growing racial and ethnic minorities, and officials say that has helped yield the most diverse incoming class of lawmakers yet, the Associated Press reported. The number of state lawmakers who are Black, Latino or of South Asian descent will rise as part of what House Democrats call the “most diverse class of freshmen legislators” in Pennsylvania history after candidates ran in this year’s election in the newly drawn map of districts. The proportion of Black lawmakers is now slightly outpacing that of Black residents in Pennsylvania, with both around 11%, even after the departure for higher offices of two Black lawmakers, Summer Lee (elected to Congress) and Austin Davis (elected lieutenant governor). The election, however, was mixed for Latinos: Their rapid population growth over the past decade in Pennsylvania and several new districts designed to boost their electoral strength did not translate into significant electoral gains in the Legislature. There, the number of Latinos will rise from four to five, or just 2% in a state where Latinos make up 8% of Pennsylvania’s 13 million residents. Proportional representation would be more like 20 seats.

The National Academy for State Health Policy provides this interactive map summarizing state Medicaid reimbursement policies for all types of midwives.  Midwives still have an important role to play in providing care in rural areas, where there are currently more midwives than physicians in practice.

CMS recently displayed a proposed rule that includes revisions to Medicare Advantage, also known as Medicare Part C, as well as changes to the Medicare prescription drug benefit, Medicare Part D, that are part of Inflation Reduction Act (IRA) requirements passed earlier this year. As part of updates to promote health equity, CMS is proposing to update its current regulations that require MA organizations to ensure that services are provided in a culturally competent manner to list populations for consideration including rural residents. The rule also makes updates to Programs of All-Inclusive Care for the Elderly (PACE) and to all 4 parts of Medicare regarding the standard for an identified overpayment. According to a recent brief from the RUPRI Center, while rural counties had a lower rate of MA participation than urban counties (34.6 percent and 44.6 percent, respectively), the rate of enrollment growth was higher in rural areas between 2020 and 2021 (14.2 percent and 6.2 percent, respectively). Comments are due by  February 13

CMS seeks public comment on the Notice of Benefit and Payment Parameters for 2024, which proposes updates to the standards for issuers and Marketplaces offering qualified health plans through Healthcare.gov.  Proposals include adding Mental Health Facilities and Substance Disorder Treatment Centers as Essential Community Provider (ECP) categories, including Rural Emergency Hospitals as a provider type in the Other ECP Providers category, adding a special enrollment period for consumers who lose Medicaid/CHIP coverage during the year and allowing assisters to conduct door-to-door enrollment.  The number of Marketplace plans offered in rural areas has been increasing, although there are still fewer plans available compared to urban areas. Comments are due January 30.