The Centers for Medicare and Medicaid Services (CMS) has issued a request for information (RFI) on the coverage of benefits in health plans that are subject to the Essential Health Benefit (EHB) requirements, as part of the Affordable Care Act. CMS wants public input on topics such as the description of the EHB, the scope of benefits covered in typical employer plans, the review of EHB, coverage of prescription drugs, and substitution of EHB. NACHC will review and provide a comment letter template; comments are due Jan. 30, 2023. 

These proposed rules focus on expanding access to healthcare options under the Affordable Care Act’s health insurance marketplaces. The Centers for Medicare and Medicaid Services (CMS) proposes that beginning January 1, 2024, Marketplaces have the option to implement a new special rule for consumers losing Medicaid or Children’s Health Insurance Program coverage. Of special note, CMS also proposes to permit assisters to conduct door-to-door enrollment to increase consumer engagement and advance health equity. Included in the proposed rule is to revise network adequacy and essential community provider (ECP) standards and expand access to care for low-income and medically underserved consumers by establishing two additional major ECP categories for Plan Year 2024 and beyond: Mental Health Facilities and Substance Use Disorder (SUD) Treatment Centers. Beginning in 2024, this rule would allow marketplaces the ability to modify auto re-enrollment for those eligible for cost-sharing reductions who would normally be auto-enrolled into a bronze plan but instead be automatically re-enrolled into a silver plan in the same product with a lower or equivalent premium. In addition, CMS proposes minor updates to standardized plans, including placing all covered generic drugs in a cost-sharing tier.

The Senate recently released a request for information to understand challenges related to serving individuals dually eligible for both Medicaid and Medicare. NACHC needs your help describing the barriers to care for dually eligible for health center patients and how federal legislation can create change on a national level. Challenges can include care coordination, service integration, addressing social determinants of health and adequate reimbursement. To inform NACHC’s comment letter, please review and share feedback by Dec. 23 using the submission form.

State physician general Dr. Denise Johnson issued a standing order asking pharmacies to dispense naloxone without a prescription, including a new injectable form. Dr. Johnson is encouraging pharmacies to carry different forms of naloxone, including the “epi-pen like” form as well as a nasal spray.

  This 27-minute episode features Abigail Barker and Timothy McBride, co-investigators at the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, a rural health research center whose work is published on the FORHP-supported Rural Health Research Gateway. They discuss their findings about rural health insurance coverage shared in the recently published chartbook, An Insurance Profile of Rural America.

The Centers for Medicare & Medicaid Services (CMS) seeks public comment on a proposed rule to formally withdraw the December 2020 CMS interoperability and prior authorization proposed rule and to incorporate feedback received from the previous public comment period. This new proposed rule has five key provisions including those related to interoperability, improving prior authorization (PA) processes, and a new electronic PA measure for Merit-Based Incentive Payments System (MIPS)-eligible hospitals and critical access hospitals and MIPS-eligible physicians. Five requests for information are also included in the rule, among them those concerned with the exchange of information related to behavioral health and maternal health and accelerating adoption of standards for social risk factor data. As of 2019, 63 percent of rural physicians electronically exchanged patient health information in some manner (either sending, receiving, or querying). Comments due by March 13. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking public comment on its proposal to modify regulations regarding medications for the treatment of opioid use disorder. In addition to updating definitions and standards for Opioid Treatment Programs (OTP), these changes – such as allowing for methadone treatment through audio-visual telehealth – would make flexibilities made during the Public Health Emergency permanent.  Telehealth access to OTPs can help address barriers for rural patients, such as long travel times for treatment. Comments due by February 14.

Recently, HRSA issued a proposed rule that would revise the current 340B administrative dispute resolution (ADR) final rule (Dec. 14, 2020) with a new process. The ADR process is an administrative process designed to assist covered entities and manufacturers in resolving disputes regarding overcharging, duplicate discounts, or diversion, as outlined in the statute. Eligible entities for the 340B Drug Pricing Program include a number of rural healthcare facility types. Comments due January 30