- CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- Public Inspection: CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Public Inspection: HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Increased Risk of Cyber Threats Against Healthcare and Public Health Sector
- HRSA Announces Action to Lower Out-of-Pocket Costs for Life-Saving Medications at Health Centers Nationwide
- Announcing the 2030 Census Disclosure Avoidance Research Program
- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
Report Released on Health Care Access for Rural Pennsylvanians with Disabilities
From the Pennsylvania Health Action Network and the Pennsylvania Developmental Disabilities Council
Navigating the Pennsylvania health care system is frequently challenging. Long wait lists, unexpected costs, and lack of coverage for needed services affect many health care consumers in Pennsylvania. These issues are especially acute in the rural parts of the state where many live in poverty, distances are longer, transportation infrastructure is limited, and there may be fewer options for treatment.
People with disabilities living in rural areas encounter all of these problems as well as prejudice, ignorance, and various barriers that impact their ability to access health care services, facilities, and equipment. This report features stories from people with disabilities, their family members and caregivers about barriers to health care access. We collected these stories through surveys, face-to-face meetings, phone conversations, and public listening sessions during 2019 and 2020.
The goal of this report is to document barriers, better understand the perspectives and needs of those facing them, and raise awareness of the need for improved accessibility.
The report can be accessed at https://pahealthaccess.org/wp-content/uploads/2020/09/rural-access-report.pdf
Ending Hunger in Pennsylvania One Helping at a Time
September is Hunger Action Month and the Pennsylvania Department of Human Services (DHS) is drawing awareness to the charitable food organizations that work tirelessly to fill the hunger gaps in our communities that the Supplemental Nutrition Assistance Program (SNAP) cannot do on its own. Food insecurity is at an all time high in Pennsylvania. In 2020, as a result of the coronavirus pandemic, Feeding America estimates the number of Pennsylvanians facing food insecurity will grow to 15.9 percent – an increase of 45.2 percent in just two years.
DHS administers SNAP, the nation’s most important anti-hunger program. SNAP helps more than 1.8 million Pennsylvanians expand their purchasing power and put food on their tables. On average, children whose families utilize SNAP are healthier than kids whose families qualify for SNAP but are not enrolled in the program. These kids go on to have higher graduation rates, increased earnings in adulthood, and improved health outcomes throughout their life. Older adults who are enrolled in SNAP are healthier, hospitalized less often, and are less likely to go into a nursing home. More than 1.8 million people use SNAP, but SNAP’s positive impact has an even broader reach. The food bought from local grocery stores and farmers markets supports our local economies to the tune of over $25 billion respectively.
Feeding Pennsylvania
Feeding Pennsylvania oversees member food banks which serve nearly 2 million people annually by distributing more than 164 million pounds of food throughout Pennsylvania to more than 2,700 agencies and feeding programs.
On average, Feeding Pennsylvania’s food banks serve nearly 2.2 million Pennsylvanians annually. During the first three months of their COVID-19 response, these food banks have had 5.5 million visitors.
Organizations like Feeding Pennsylvania rely on support to operate and help those in need. You can find out how you can support their mission on the Feeding Pennsylvania website.
Find Food Assistance
Pennsylvanians can get help with food costs through the Supplemental Nutrition Assistance Program (SNAP.) If you’re new to the program, applying is easy and can be done online via COMPASS.
If you are in need of local food resources, Feeding Pennsylvania has a Find Assistance page that can connect you to help.
For a list of local food banks and pantries visit Ending Hunger in PA.
CMS Advancing Seniors’ Access to Cutting-edge Therapies and Technology in Medicare Hospital Rule
Finalized policy changes expand new technology add-on payment pathway for certain antimicrobials
On September 2, CMS issued the FY 2021 Medicare Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital (LTCH) final rule, which includes important provisions designed to ensure access to potentially life-saving diagnostics and therapies for hospitalized Medicare beneficiaries. The changes will affect approximately 3,200 acute care hospitals and approximately 360 LTCHs. CMS estimates that total Medicare spending on acute care inpatient hospital services will increase by about $3.5 billion in FY 2021, or 2.7 percent.
“President Trump is committed to ensuring that seniors on Medicare have access to the latest life-saving diagnostics and therapies,” said CMS Administrator Seema Verma. “This rule is another critical step in our effort to modernize the program and strip away bureaucratic barriers between our seniors and the latest innovative treatments.”
CMS’ rule creates a new Medicare Severity Diagnostic Related Group (MS-DRG) that provides a predictable payment to help adequately compensate hospitals for administering Chimeric Antigen Receptor (CAR) T-cell therapies. The current FDA-approved CAR-T-cell cancer therapies use a patient’s genetically modified immune cells to treat specific types of cancer.
Also in the final rule, CMS approved a record number of 24 New Technology Add-on Payments (NTAPs), which is an additional payment to hospitals for cases involving eligible new and relatively high cost technologies. Last year, to remove barriers to innovation, CMS established alternative streamlined pathways for FDA Breakthrough Devices and FDA Qualified Infectious Disease Products (QIDPs) to qualify for NTAPs. Among CMS’ approval of these 24 additional NTAPs are two technologies for new medical devices that are part of the FDA’s Breakthrough Devices Program and six technologies that received FDA QIDP designation. This will provide additional Medicare payment for these technologies while real-world evidence is emerging, giving Medicare beneficiaries timely access to the latest innovations.
CMS is also expanding the add-on payment alternative pathway for antimicrobial products approved under FDA’s Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD pathway), which encourages the development of safe and effective drug products that address unmet needs of patients with serious bacterial and fungal infections. Specifically, an antibacterial or antifungal drug approved under the LPAD pathway is used to treat a serious or life-threatening infection in a limited population of patients with unmet needs.
CMS is also taking steps to ensure that the Medicare Fee-for-Service (FFS) program adopts pricing strategies based on real world market forces. Medicare generally pays hospitals a rate that is weighted by the relative cost of providing certain services based on a patient’s diagnosis. These weights are currently based in large part on the charges that hospitals report to the federal government, which often have little relevancy to the actual rates paid by insurance companies. Hospitals are already required to report these negotiated rates as part of the Trump Administration’s efforts to promote price transparency, and CMS is now finalizing a requirement for hospitals to report to CMS the median rate negotiated with Medicare Advantage Organizations for inpatient services to use instead of the charge based data. CMS will begin to collect this data in 2021 and will use it in the methodology for calculating inpatient hospital payments beginning in 2024. These provisions will introduce the influences of market competition into hospital payment and help advance CMS’s goal of utilizing market- based pricing strategies in the Medicare FFS program.
For More Information:
COVID-19 & Oral Health: Resource for School Nurses
During the current pandemic, school nurses may be the only avenue for assuring that children receive dental screenings/referrals. The Association and State and Territorial Dental Directors (ASTDD) and the National Association of School Nurses have collaborated to develop a resource to assist with doing so. Please share the below resource with any school nurses you may work with or know.
Report Focuses on Networks for Oral Health Integration
The National Maternal and Child Oral Health Resource Center (OHRC) produced a report that provides information about the “Networks for Oral Health Integration Within the Maternal and Child Health Safety Net” projects funded by the Maternal and Child Health Bureau (MCHB). The goal of the 5-year initiative is to improve access to and utilization of comprehensive, high-quality oral health care in community health centers for target populations (i.e., pregnant women, infants and children from birth to age 40 months, children ages 6–11) at high risk for oral disease.
CMS Hasn’t Started Garnishing Medicare Pay to Recoup $100 Billion in Loans
Hospitals that received COVID-19 relief loans from Medicare expected that CMS would cut off their fee-for-service reimbursement after four months, but as deadlines have passed the agency apparently hasn’t started garnishing payments. State and national hospital associations, providers and consultants that work with providers said their reimbursements remain the same although CMS said it would begin recouping Medicare Accelerated and Advance Payment Program funds. In March and April, hospitals received more than 80% of the $100.3 billion in relief loans from CMS.
Pennsylvania Governor Renews Coronavirus Disaster Declaration
Pennsylvania Governor Tom Wolf announced on September 1 that he has renewed a 90-day disaster declaration, now for a second time, after he originally signed it in early March following the confirmation of the first positive cases of the coronavirus in Pennsylvania.
The original declaration was set to expire Tuesday, and the new declaration will last through late November, unless Wolf ends it.
“We are going to continue to combat the health and economic effects of COVID-19, and the renewal of my disaster declaration will provide us with resources and support needed for this effort,” Wolf said in a statement.
Under state law, an emergency disaster declaration gives governors the authority to issue or rescind executive orders and regulations, access stockpiles of emergency supplies and equipment and suspend laws or regulations that govern state agencies.
Executive orders have the force of law, under emergency disaster law. As part of it, the Pennsylvania Emergency Management Agency has been able to assign missions to the National Guard, and it could in the future allow PEMA to rapidly deploy a vaccine, Wolf’s office said.
HHS Providing Up to 125M Face Masks to Schools
HHS is working to support safe school reopening for students, teachers and staff. In support of this, HHS is providing up to 125 million cloth face masks to states and territories for distribution to schools. The Administration intends for these masks to support students, teachers and staff in public and private schools that are reopening – with an emphasis on students who are low-income (or otherwise with high needs) and schools providing in-person instruction.
These masks will be allocated according to the share of students from low-income families in each state. The cloth face masks will be distributed in two shipments, starting in early September 2020.
Additional information on Cloth Face Masks in Schools and State Allocations: Cloth Face Masks in Schools can be found on ASPR’s public facing website.
Pennsylvania Census 2020 Updates
Pennsylvania Census Completion Map for August 2020
- A recent article by NPR highlights how changes to operational timelines may limit the ability for the U.S. Census Bureau to adequately review the data, possibly affecting the data’s accuracy.
- The U.S. Census Bureau announced a new survey, the 2020 Census User Experience Survey, which will measure how satisfied respondents were with their experience using the online questionnaire.
- According to the U.S. Census Bureau’s daily 2020 Census housing unit completion rates, over 73% of housing units have been accounted for in the 2020 Census.
- The U.S. Census Bureau recently released a presentation providing updates for their operational planning and how the Bureau is adapting operations to ensure a complete and accurate count by December 31, 2020.
- Follow response rates to the 2020 Census with the U.S. Census Bureau’s Response Rates page. Or check out the Hard To Count 2020 tool created by SUNY’s Center for Urban Research which has a variety of other useful data in addition to response rates.
- Avoid fraud and scams related to the 2020 Census by reviewing these tips from the U.S. Census Bureau.
New Flex Monitoring Team Website Launched
The Medicare Rural Hospital Flexibility Program (Flex) Monitoring Team (FMT) is pleased to announce the launch of its newly redesigned website. While the web address remains the same—flexmonitoring.org—the site has been completely updated and reorganized to focus on easing user experience and making the site accessible to all audiences.
On the new site, users can search through over fifteen years of evaluation of the Flex Program. The “Our Work” section of the navigation bar houses all current and past research on Critical Access Hospitals (CAHs) and rural health. The “Publications” page organizes all products by date, including national reports produced annually on quality improvement, community benefit, and financial performance data. Users can search and filter results to find more information on other topics ranging from EMS and hospital services to financial distress and evidence-based best practices. The homepage also highlights the most recent reports, briefs, and papers.
State-level analyses can be found through the new State Profiles section of the website, which includes a map that leads to individual state profiles, making it easier to find publications relating to a specific state in the Flex Program. For example, the Alabama state profile contains all HCAHPS, Hospital Compare, community benefit, and financial indicators reports produced for the state since 2004. The page also lists any other publications that mention Alabama.
Other new features include an interactive map of CAH locations and a sortable list of current CAH location data that is also available for download.
CAHMPAS remains a priority of the FMT, and now, on the new site, every page links to the data query tool for quick access to financial, quality, and community benefit data.
Over time, the FMT plans to add more resources to the website, including a news page to showcase the exciting work being done in the Flex Program. Stay tuned!
To learn more about the FMT and its staff, users can explore a detailed “About Us” section. If you have any questions or concerns about the new site, please feel free to contact the FMT’s communications staffer, Nichole Barnes.