The 2020 Rate Notice and Call Letter for the MA and Prescription Drug Programs details what plans and consumers can expect for the upcoming plan benefit year.  In addition to updating payment methodologies and rates, it finalizes policies to address the opioid epidemic and provides guidance on how MA plans can tailor supplemental benefits to improve or maintain the health of an enrollee with a chronic condition or illness, such as by providing meals or transportation for non-medical needs.  In 2017, about 25 percent of rural Medicare beneficiaries were enrolled in a Medicare Advantage plan and about 70 percent enrolled in a Prescription Drug plan, through either their MA plan or a stand-alone drug plan.

 CMS’ latest Health Insurance Exchange Enrollment fact sheet reports that overall enrollment in the 39 states that use the HealthCare.gov and in the 12 State-Based Exchanges (SBEs) that use their own eligibility and enrollment platforms decreased from 11.8 million in 2018 to 11.4 million in 2019. The proportion of enrollments in the Healthcare.gov states by rural residents remained at its 2018 rate of 18 percent in 2019. 

The Office on Women’s Health at the U.S. Department of Health & Human Services recognizes April as the month to raise awareness of sexual assault, and increase understanding of its effects that go well beyond targeted victims.  While prevalence of the consequences of violence is higher among women than among men, decades-old research on children who are exposed to domestic violence shows life-long impact on chronic conditions for physical and mental health.  The New England Journal of Medicine (NEMJ) notes that intimate partner violence is “more prevalent during a woman’s lifetime than conditions such as diabetes, depression, or breast cancer, yet it often remains unrecognized by health professionals.”  In the same editorial, NEMJ refers to a strategic framework to improve the response of health care systems implemented here at the Health Resources and Services Administration (HRSA).  The HRSA Strategy to Address Intimate Partner Violence includes a partnership with the Administration for Children and Families to increase coordination between clinical and social response systems.

The Economic Research Service (ERS) at the U.S. Department of Agriculture released data from its research on the economic, social, and demographic factors affecting rural poverty.  The ERS reports that there are 353 persistently poor counties in the United States, meaning that 20 percent or more of their populations were living in poverty over the course of several decades. Eighty-five percent of these counties are rural.  In 2017, more than one-third of non-metro families headed by a female with no spouse present were poor (33.8 percent), and nearly half of those with related children were poor (44.4 percent).

Experts in health management, sociology, and psychology analyzed responses to the 2017 Health Information National Trends Survey to examine characteristics of patients who do not access electronic medical records and communications from their provider through online portals.  The researchers found that of the sixty-three percent of patients who reported not using a portal during the prior year, the nonusers were more likely to be male, be on Medicaid, lack a regular provider, and have less than a college education compared to those who did access portals.  Though we don’t typically include articles requiring paid access in this space, the findings may have implications on the advancement of telehealth for rural areas

March 2019

The Centers for Medicare & Medicaid Services (CMS) has issued Frequently Asked Questions (FAQs) that provide more information to State Medicaid programs on what settings have the qualities of an institution and are ineligible for Home and Community Based Services (HCBS), which settings qualify for HCBS, and under what circumstances CMS needs to conduct a review with heightened scrutiny to determine if the setting qualifies for HCBS.  The guidance clarifies that while rural settings may appear to meet the criteria to conduct a heightened scrutiny review, States should only request such a review if a setting has the qualities of an institution and if individuals qualifying for HCBS in a rural area do not have the same access to engage in the community as enrollees not receiving Medicaid HCBS in the same area. 

March 2019

The Centers for Medicare & Medicaid Services (CMS) has published information on clinician participation, reporting, and performance in year one (2017) of the Quality Payment Program (QPP). Among the findings, CMS noted that rural clinicians eligible for the Merit-Based Incentive Payment System (MIPS) had a participation rate (94 percent) virtually equal to the overall average, and 93 percent of rural clinicians participating in MIPS received a positive payment adjustment. CMS also reiterated their commitment to alleviating barriers and creating pathways for improvement and success for rural clinicians through the Small, Underserved, and Rural Support initiative.

March 27, 2019
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Harrisburg, PA – Governor Tom Wolf announced today that the departments of Drug and Alcohol Programs (DDAP) and Human Services (DHS) have awarded $15 million in federal Substance Abuse and Mental Health Services Administration (SAMHSA) grants for a new program to provide case management and housing support services for Pennsylvanians with an opioid use disorder (OUD). The pilot programs will support innovative practices that increase access to support services for individuals with OUD, keep people engaged in treatment and recovery, and help prevent overdose-related deaths.

“With these grant announcements we are taking an important step in removing a barrier to recovery and independence for those suffering from opioid use disorder,” Gov. Wolf said. “As we continue to battle this health crisis, being able to address housing as a means to get people into treatment and on the road to recovery is a key component.”

First announced in October, the program will direct the $15 million through 16 grant agreements that will assist urban and rural counties throughout the commonwealth. The pilot programs will assist individuals as they become and remain engaged in evidence-based treatment programs and will provide individuals with support services such as pre-tenancy and tenancy education services to maintain stable housing.

The counties selected for pilot programs under the request for applications were identified via a formula that equally considered the rate of individuals diagnosed with a substance use disorder (SUD) and rate of overdose-related deaths in a county. The selected grant recipient are:

“We know that each individual seeking treatment is just that – an individual,” said DDAP Secretary Jennifer Smith. “They each have different situations and circumstances hindering their recovery. In order to truly combat this crisis, we must build capacity to support individuals by providing necessary, supportive wrap around services like stable housing and case management.”

“The conditions in which a person lives play a substantial role in a person’s health. When a person experiences homelessness in addition to a substance use disorder, the lack of a secure home is often a barrier to staying engaged with treatment and recovery, if they are able to access treatment at all,” said DHS Secretary Teresa Miller. “These programs will soon assist people with housing access and stability and will help more people stay engaged in treatment and reach recovery.”

SAMHSA has distinguished four major dimensions that support a life in recovery: Health, Home, Purpose, and Community. This project aims to support two components of the dimensions – Home and Purpose. By giving an individual a stable, safe place to focus on their recovery, paired with the independence and self-worth that housing provides, an individual’s overall health and wellbeing is greatly improved.

Housing instability, combined with unmet basic needs, makes the road to recovery and independence extremely challenging. According to national data, about one in five people experiencing homelessness has a chronic substance use disorder. This aligns with information gathered from Pennsylvania’s 45 state-sponsored OUD Centers of Excellence, a majority of which identify housing as a major barrier for their clients.

The grants are made possible by the $55.9 million SAMHSA grant secured to bolster the state’s response to the prescription opioid and heroin epidemic. Additional initiatives included in the grant are focused on expanding services to pregnant women and veterans affected by OUD, developing the treatment and recovery workforce, and strengthening criminal justice and law enforcement initiatives with a focus on reentrant supports.

Find more information on the state’s efforts to battle the opioid crisis here.

MEDIA CONTACT:    J.J. Abbott, 717-783-1116