CMS posted several updates for the Global and Professional Direct Contracting (GPDC) / ACO REACH Model on innovation.cms.gov. This includes a list of the 110 provisionally accepted ACOs in the ACO REACH model and DCEs participating in the third Implementation Period (IP3) of the ACO REACH model. It also includes quarterly updates to a document with GPDC’s financial and quality performance results. The ACO REACH’s Application Fact Sheet and FAQs also received minor updates to ensure consistency with the newly released documents. We kindly ask that you please share this information with your partners.

Please review the below links for further information.

Web links/Materials:

• Press Release: https://www.cms.gov/newsroom/press-releases/cms-announces-increase-2023-organizations-and-beneficiaries-benefiting-coordinated-care-accountable
• ACO Reach Model Fact Sheet: https://innovation.cms.gov/media/document/aco-reach-model-fs-jan2023
• Kidney Care Choices (KCC) Model Fact Sheet: https://innovation.cms.gov/media/document/kcc-model-fs-jan2023
• MSSP Fact Sheet: https://www.cms.gov/files/document/2023-shared-savings-program-fast-facts.pdf
• Public Use Files (PUFs): ): https://data.cms.gov/medicare-shared-savings-program/accountable-care-organizations & https://data.cms.gov/medicare-shared-savings-program/accountable-care-organization-participants

Any technical questions should be directed to the model team at ACOREACH@cms.hhs.gov​.

Approximately 35,000 locations identified with inaccuracies related to broadband service availability

Pennsylvania Broadband Development Authority (Authority) Executive Director Brandon Carson announced today that approximately 35,000 locations have been submitted as part of a bulk challenge to the Federal Communications Commission’s (FCC) National Broadband Map. This action will prompt the FCC to work directly with internet service providers to verify the information submitted.

“Submitting these challenges to the FCC is the next step in the federal funding allocation process,” said Carson. “In addition to the Authority’s efforts to prepare a bulk challenge, we have also been urging all Pennsylvanians to review their information on the map. Submitting these inaccuracies will help ensure Pennsylvania receives adequate federal funding for highspeed internet access to unserved and underserved areas of the commonwealth.”

The FCC’s National Broadband Map displays broadband serviceable locations across the United States where fixed internet service is or can be installed. The commonwealth’s allocation of funding for broadband deployment under the federal infrastructure law is dependent upon the map being accurate. The 35,000 locations submitted as part of the bulk challenge will be reviewed by the FCC and internet service providers and the map will be updated accordingly.

Updates to the National Broadband Map will be a continual process, but this bulk challenge submission is the best opportunity for Pennsylvania’s data to be considered as part of the National Telecommunications and Information Administration’s state broadband funding allocations, anticipated in summer 2023.

The Authority plans to continue to partner with internet service providers and local communities to verify and update information to ensure that the FCC’s map has the most up-to-date information for Pennsylvania. The data will help to inform investments in broadband infrastructure across the commonwealth.

Former Pennsylvania Governor Tom Wolf announced the creation of the Authority in February 2022 to manage at least $100 million in federal aid to coordinate the rollout of broadband across Pennsylvania. The Authority was charged with creating a statewide broadband plan and distributing federal and state monies for broadband expansion projects in unserved and underserved areas of the commonwealth.

For more information about the Pennsylvania Broadband Development Authority, visit the Authority’s page on the Department of Community and Economic Development’s website and be sure to stay up-to-date with all of our agency news on Facebook, Twitter, and LinkedIn.

MEDIA CONTACT: Penny Ickes, dcedpress@pa.gov

The Centers for Medicare and Medicaid Services (CMS) has released corrected clarificaitions to recently-published rules for hospitals and “primary roads” for determination of Critical Access Hospital (CAH) eligibility.

• Medicare Program; Updates to Face-to Face Encounter and Written Order Prior to Delivery List – Final Rule published 1/17/23; effective 4/17/23
• Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; etc.; Correction – Rule published 1/4/2023; Effective date 1/1/2023
  
• Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules; Correction – Rule published 12/30/2022; Effective 12/30/2022
  
• Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices Model; Correction – Rule published 12/30/22; Effective 1/1/2023
  
• Medicare Program:  Hospital Inpatient Prospective Payment Systems; Correction – Final Rule published 12/13/2022; effective date 12/12/2022
  

In December, our Board of Directors approved our biennial policy roadmap that aligns with our organizational mission to improve the health, education and well-being of children and youth in the commonwealth.

Learn more about our five policy areas, including data points, policy priorities, and legislative or other significant actions:

• Child Welfare: Ensure each child in Pennsylvania lives in a home where they are safe and protected from abuse and neglect.
• Early Care and Education: Ensure each child in Pennsylvania can participate in affordable and accessible high-quality early care and education, including infant and toddler child care and pre-kindergarten education.
• Home Visiting: Ensure each child in Pennsylvania can grow up in a stable and healthy home environment.
• K-12 Education: Ensure each child in Pennsylvania has the opportunity for an adequate and equitable high-quality public education.
• Perinatal and Child Health: Ensure each birthing person and child in Pennsylvania can access affordable, quality health care.

PPC is committed to policy choices that improve maternal and child well-being, advance racial equity and support economically disadvantaged families.

Our work to advance equitable policy solutions is critical in our long-term vision because we can’t achieve our goals if any child is left behind.

Explore the policies we work on to build better futures within the 2023-24 Policy Roadmap.

Also new this year is our revamped State of the Child, which serves as a data companion to the roadmap. View a variety of data points pertaining to Pennsylvania’s children and their well-being

In late December, President Biden signed a sprawling appropriations package (HR 2617) which sets the federal budget for Fiscal Year 2023. Many elements of the omnibus budget prioritized kids and families including reauthorizing the MIECHV program, increasing child care funding, and enhancing CHIP and Medicaid programs across the country.

The omnibus contained language from the Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022, which passed the House in November and included:

1. Reauthorization of the MIECHV program through 2027
2. An initial increase in funding of $100 million, bringing the program’s full appropriation to $500 million
3. Subsequent funding increases of $50 million annually (except for a $150 million increase in 2027)
4. Establishing a publicly available dashboard that reports program outcomes
5. Requiring activities to reduce unnecessary data collection, reporting, and other administrative requirements of the program
6. Allowing for virtual home visits

In a victory for the child care sector, the budget contained a 30.1% increase for the Child Care Development Block Grant (CCDBG) to over $8 billion. Pennsylvania will get about $56.3 million more in 2023 compared to 2022. It also contained increases for Head Start and the Individuals with Disabilities in Education Act (IDEA).

The omnibus also contained multiple provisions related to Medicaid and CHIP. First, it delinked the Medicaid continuous coverage requirement from the COVID-19 public health emergency and set the gradual decrease of the federal match for Medicaid to begin on March 31, 2023. In an exciting win for advocates, the law now requires all states to provide 12 months of continuous eligibility for children in both Medicaid and CHIP (previously only available for children up to age 4 in Medicaid, but all children in CHIP). Funding and authorization for the CHIP program extended two years to 2029, and the 12-month postpartum coverage option for CHIP and Medicaid was made permanent (this provision was initially supposed to sunset after five years). If you’d like to read more about the health care provisions of the omnibus, please check out SayAhhh!, the blog by our partners at the Georgetown University Center for Children and Families.

From The American Prospect, December 27, 2022

Insurer UPMC and its new pharmacy benefit manager Express Scripts are squeezing local independent pharmacies, with residents caught in the crossfire.

In late November, at a strip mall in the rural Pennsylvania town of Bedford, Stephanie Over worked behind the Fisher’s Pharmacy counter, filling prescriptions into translucent orange pill bottles and administering shots. As strip mall pharmacies go, Fisher’s stands out. A recently restored art deco facade juts out, and the store’s name runs down vertically in Broadway font. The store is a local fixture in Bedford, population under 3,000, and has been around for almost 100 years, of which Stephanie has worked nearly 30.

Stephanie was about to check out for her lunch break when the letters flooded in. Regulars at Fisher’s began marching up to the counter, clutching notices from the University of Pittsburgh Medical Center (UPMC), a leading health insurer in Western Pennsylvania, and Express Scripts, the pharmacy benefit manager for UPMC.

The letter told them that under a new policy, UPMC’s insurance plan would not cover prescriptions at Fisher’s anymore. Instead, UPMC’s beneficiaries would be encouraged to go to other pharmacies in the health plan network for their own “convenience,” which meant national chains like Rite Aid, Walmart, or Giant Eagle, a regional grocery chain. Bedford is a remote town, 100 miles from both Harrisburg and Pittsburgh. Residents, many of whom had gone to Fisher’s for decades, would have to drive several towns over, maybe 30 or 40 minutes, just to get their prescriptions filled. Fisher’s knew them, their families, and medical history, a personal touch that would be lost at a chain.

“Why should our people have to drive through 20 signal lights to get a prescription filled when they could just call us and we’d have it ready,” said Over.

The letter offered no explanation for the policy change. Stephanie called the owner, Jennifer Leibfreid, who had not been notified by UPMC. Fisher’s tried calling other local pharmacies and associations to piece together whether other independents were receiving the same letters from customers.

Most had. In an overnight purge, UPMC, the third-largest insurer in the state and the most powerful hospital network, dropped over 1,200 pharmacies from its health plan, around half of the stores it previously carried. Most were independents. The decision impacted tens of thousands of individuals who bought their insurance on the state health insurance exchange, known as Pennie, as well as company plans for businesses with fewer than 50 employees. Patients covered by Medicare and Medicaid are not affected by the change.

The UPMC kill-off will have devastating consequences for pharmacies and patients across rural Pennsylvania. Fisher’s estimates that it might lose 20 percent of its customers, some of whom need prescriptions filled every other day. They’ll have to decide whether to drive several towns over or pay out of pocket at Fisher’s for generic drugs.

Thirty miles south of Bedford, Potomac Valley Pharmacy in Hyndman was another retailer cut out from UPMC’s plan. Pharmacist Dan Iseminger doesn’t know how much business he’ll lose because “frankly, I’ve been too scared to look.” In that area, as in many other rural parts of the state, UPMC is often the only health plan locals can afford.

Read the full article here.