The Department of Health and Human Services (HHS) Office for Civil Rights released guidance clarifying when state Medicaid agencies may use an applicant’s or beneficiary’s substance use disorder (SUD) patient records to verify an exclusion from the community engagement requirement. Agencies may rely on either existing treatment, payment, and health care operations consent or separate written patient consent.

The Health Resources and Services Administration (HRSA) has published the approved manufacturer plans for the 340B Rebate Model Pilot program, covering 21 drugs from 10 manufacturers. Novo Nordisk has opted not to participate in the pilot, and AstraZeneca has excluded Calquence from its approved plan. FQHC 340B Compliance has developed a Rebate Drug Cost & Interest Impact Calculator to estimate the financial impacts of the rebate model.

From Becker’s Health IT

The Pennsylvania House of Representatives passed a bill that would require hospitals, clinicians and payers to disclose how they use AI and would keep humans responsible for final patient care decisions.

The bill passed 144-59, with 41 Republicans joining all Democrats in support, The Center Square reported.

Under the legislation, payers, hospitals and clinicians would have to tell patients and the public how AI is used in their organizations or practice settings. When AI is used, a human decision-maker would have to make the final decision on a patient’s care based on an individualized assessment.

Hospitals and other healthcare facilities would also have to attest to the Pennsylvania Department of Health that their required internal AI governance and AI use comply with existing privacy, safety and antidiscrimination laws. Insurers would make similar attestations to the state Insurance Department or Department of Human Services.

The bill has five coprime sponsors: state Reps. Arvind Venkat, MD, D-Allegheny; Joe Hogan, R-Bucks; Tarik Khan, PhD, CRNP, D-Philadelphia; Bridget Kosierowski, D-Lackawanna; and Greg Scott, D-Montgomery.

House Bill 1925 now moves to the Pennsylvania Senate for consideration.

As states prepare to implement Medicaid community engagement requirements by January 1, 2027, recent federal guidance provides additional direction on medical-frailty exclusions and the use of sensitive health information. Building on previous PARC discussions, these developments highlight important considerations for rural health as states finalize their implementation approaches.

New CMS Guidance on Medical Frailty

On September 8, 2026, the Centers for Medicare and Medicaid Services (CMS) released guidance on implementing medical-frailty exclusions. States must establish and regularly review lists of conditions used to identify individuals who may qualify as medically frail, while maintaining processes for evaluating individuals whose conditions are not listed.

CMS outlined an illustrative three-tier approach: using existing diagnosis data to identify clear cases, obtaining additional information for conditions requiring further evaluation, and conducting individualized reviews when available information is insufficient. The three-tier framework is optional, but states must satisfy federal exclusion and verification requirements.

CMS also emphasizes using existing administrative and clinical information, including Medicaid claims and managed care encounter data, before requesting additional documentation from individuals. A June 29 Federal Register correctionclarified aspects of the verification procedures.

New Guidance on Substance Use Disorder Records

On September 29, the HHS Office for Civil Rights issued guidance on using substance use disorder (SUD) treatment records protected under 42 CFR Part 2 to verify community engagement exclusions.

The guidance explains that existing written consent authorizing the use or disclosure of protected records for treatment, payment, and healthcare operations may also permit certain community engagement verification activities, depending on the scope of that consent. It also addresses obtaining specific written consent when necessary.

This clarification may help states incorporate relevant behavioral health information into eligibility processes while maintaining federal confidentiality protections.

Implications for Rural Health

State decisions about medical-frailty criteria, automated verification, and individualized review may affect how readily qualifying individuals are identified.

Rural patients may receive care across multiple health systems, with clinical information held by local providers, regional hospitals, and distant specialists. Incomplete data sharing could complicate automated verification. Limited broadband, transportation barriers, and access to documentation may create additional challenges when individuals are asked to supply information.

The federal guidance creates an opportunity to examine whether states’ eligibility processes adequately reflect rural healthcare delivery patterns and make effective use of existing information.

As states implement community engagement requirements, coordination between Medicaid agencies, workforce development programs, and community partners may help connect individuals with qualifying employment, education, training, and volunteer opportunities. Existing state workforce systems could offer useful infrastructure for these efforts, particularly in rural communities.

What to Watch

The January 1, 2027, Medicaid eligibility implementation deadline is approaching. Areas to monitor include state medical-frailty methodologies, verification and consent procedures, workforce partnerships, and additional CMS guidance.

Litigation challenging aspects of the federal requirements also remains relevant, and subsequent court decisions may affect implementation.

Federal Resources

• CMS: Community Engagement Resources
• CMS: Implementing Medical Frailty Under Community Engagement – September 8, 2026
• HHS OCR: Part 2-Protected SUD Records and Medicaid Community Engagement
• Medicaid Community Engagement Interim Final Rule – June 3, 2026
• Federal Register Correction – June 29, 2026

The Health Resources and Services Administration (HRSA) today announced more than $525 million in fiscal year (FY) 2026 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program awards to 56 state and jurisdiction recipients — the largest federal investment in the program’s history.

Pennsylvania’s Department of Human Services received a base amount of $15,626,327, with $3,134,909 in federal match, for a total of $18,761,236.

The awards will expand access to evidence-based home visiting services that improve maternal and child health, promote healthy child development, and connect families with the support they need during pregnancy and early childhood.

The MIECHV program reaches families where services are needed most, including those who are rural, low-income, and at greater risk of poor health outcomes. Trained home visitors meet regularly with expecting mothers and families with young children. Decades of gold-standard scientific research show that voluntary home visits during pregnancy and early childhood can help prevent chronic disease and child abuse and neglect, promote school readiness, and boost families’ economic self-sufficiency.

These awards include both base and matching grants. Base grants provide foundational support for evidence-based home visiting programs in every eligible state and jurisdiction, while matching grants help recipients expand services and reach more eligible families. In FY 2026, 55 of the 56 award recipients applied for and received matching grant awards, reflecting the continued commitment of our state partners to expand evidence-based home visiting services in communities across the country.

Since its reauthorization in 2022, the MIECHV program has served 15 percent more parents and children and delivered 23 percent more home visits. In FY 2025, the program provided more than 1 million home visits to more than 158,000 parents and children across one-third of all U.S. counties, helping connect families with services that support healthy pregnancies, positive parenting, child development, and family economic well-being.

As home visiting services expand, a strong and well-supported workforce is essential to meeting the needs of more families. To meet this goal, HRSA released a National Strategy for the Home Visiting Workforce in April 2026, which provides a roadmap to recruiting and retaining a skilled and supported home visiting workforce.

• See the list of FY 2026 MIECHV Program award recipients.
• Learn more about the Maternal, Infant, and Early Childhood Home Visiting Program.
• Explore national, state, and local MIECHV data through the MIECHV Data Dashboard.
• Access the updated MIECHV Program Brief

The Pennsylvania Insurance Department (PID) approved 2027 Affordable Care Act (ACA) insurance rates for individuals and small group health insurance markets through the Pennsylvania Health Insurance Exchange Authority (Pennie).

Pennsylvanians shopping on Pennie for 2027 coverage will see an average increase of 15.97%, while small businesses will see an average increase of 10.28%. Insurers saw a 13% increase in medical claims from 2024 to 2025 further underscoring their request to increase rates overall. Health Insurance Affordability has been the number one reason customers pinpoint as their barrier to purchasing and staying enrolled in health insurance coverage.

When congress failed to reauthorize enhanced premium tax credits for the 2026 plan year, this caused many individuals to drop coverage. As of September 1, 2026, total Pennie enrollment was 417,158. In total, including Open Enrollment 2026, Pennie has seen nearly 202,000 individuals cancel coverage.