According to a new federal report, U.S. life expectancy estimates have fallen to the worst levels since 1996, marking the second straight year of plummeting estimates in the wake of the COVID-19 pandemic. The drop in life expectancy from 2019 to 2021 has fallen by 2.7 years to 76.1 – the country’s worst two-year decline on record since 1923.

Amazon, CVS, Alphabet (Google’s parent company) are all making major moves in the primary care market. These big players are all experimenting with how to be successful in primary health care and they have the data to make informed decisions and the money to make mistakes. Amazon is in the midst of a $3.9 billion acquisition of One Medical. CVS is buying Signify Health in an $8 billion deal and executives have shared that the company is eyeing a major play in the primary care market by the end of this year. Alphabet’s subsidiary Cityblock has a mission statement that reads much like that of Community Health Centers. All have a motivation to make money.

The Pennsylvania Department of Human Services (DHS), to reduce the burden on Community Health Centers when there is a PPS rate change, has added language to the Physical HealthChoices managed care organization (MC0) agreements requiring timely processing. The agreements contain a 90-day MCO processing requirement for rate changes that DHS hopes will help all providers receive timely payments and reduce the burden of fighting for retroactive adjustments with MCOs. The 2022 Physical HealthChoices MCO agreement is available on the DHS website. The first test of the new provision will be when DHS notifies MCOs of the Medicare Economic Index (MEI) adjustment to PPS rates in October.

HRSA issued a Federal Tort Claims Act (FTCA) particularized determination permitting health centers to prescribe and dispense naloxone to individuals who are not patients of the health center. The determination allows health centers that have been deemed as Public Health Service employees for purposes of liability protections and any officer, governing board member, employee, qualified contractor, or VHP of such an entity (“eligible individuals”), to have liability protections under section 224 of the Public Health Service Act for the provision of health services within the health center’s scope of the project to individuals who are not patients of the health center for prescribing and dispensing naloxone at a health center service site or at offsite locations within the community served by the health center and where the health center is providing care.

The Centers for Medicare & Medicaid Services (CMS) announced on Aug. 31, 2022, a proposed rule that would standardize Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment procedures by limiting renewals to once every 12 months, allowing applicants 30 days to respond to information requests, and requiring prepopulated renewal forms. The proposed rule would also end lifetime benefit limits in CHIP, eliminate pre-enrollment waiting periods, and allow states to transfer children’s eligibility directly from Medicaid to CHIP. Finally, the rule proposes automatic consideration of older adults for Medicare Shared Savings Programs and standardization of state recordkeeping requirements. Public comments will be accepted through Nov. 7. Read More.

Due to the recent Physical HealthChoices reprocurement, more than 470,000 Medicaid eligibles were transferred to new Managed Care Organizations (MCOs). These consumers needed to voluntarily select a new health plan by August 16 to avoid being auto-assigned as of Sept. 1. The Department of Human Services reported only 26% actively selected a plan, with the remaining 348,000 consumers auto-assigned to a new plan. Those who were auto-assigned and desired to switch to a different plan had until Sept. 8 to do so for an Oct. 1 start date. With Aetna Better Health leaving the HealthChoices program entirely and changes to the UnitedHealth Care and Highmark Wholecare (formerly Gateway) network, new MCOs are required to maintain continuity of care for transitioning consumers. Continuity of care includes open prior authorizations, PCP assignment changes, and special needs. DHS also reported that 1,057,441 consumers are enrolled in the Adult Benefit Package under the Affordable Care Act Medicaid Expansion for a total of 3,541,516 Medicaid consumers statewide.

Absent congressional action, the FTCA Volunteer Health Professionals Program (VHP) will sunset on Saturday, Oct. 1. While there have been discussions of including an extension for the VHP in the continuing resolution (CR) being negotiated, it remains unclear whether it will make it into the final package. HRSA is monitoring updates. If Congress decides to continue the program, HRSA will issue guidance on how to apply for coverage. If the program is not extended, health centers will need to ensure that you make alternate medical malpractice coverage plans for anyone volunteering after Friday, September 30.

As September begins, Members of Congress are returning to work following a month-long break. While the House has another week off, the Senate is back in session and will be voting on a wide range of items. Senate leadership is expected to focus on the FY23 budget, which must be passed by the end of the month to avoid a government shutdown. A continuing resolution (CR), which will extend the FY22 funding levels for several months, is likely to occur as FY23 negotiations continue in both the House and the Senate. As Congress seeks to pass a CR, the Biden administration wants to add several emergency funding requests into the package. This includes $22.4 billion to fund the COVID-19 response and $4.5 billion to address monkeypox, in addition to other issues.