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- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- Telehealth Study Recruiting Veterans Now
- USDA Delivers Immediate Relief to Farmers, Ranchers and Rural Communities Impacted by Recent Disasters
- Submit Nominations for Partnership for Quality Measurement (PQM) Committees
- Unleashing Prosperity Through Deregulation of the Medicare Program (Executive Order 14192) - Request for Information
- Dr. Mehmet Oz Shares Vision for CMS
- CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid Partnership
- Social Factors Help Explain Worse Cardiovascular Health among Adults in Rural Vs. Urban Communities
- Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation: Request for Input
- Secretary Kennedy Renews Public Health Emergency Declaration to Address National Opioid Crisis
- Secretary Kennedy Renews Public Health Emergency Declaration to Address National Opioid Crisis
- 2025 Marketplace Integrity and Affordability Proposed Rule
- Rural America Faces Growing Shortage of Eye Surgeons
- Comments Requested on Mobile Crisis Team Services: An Implementation Toolkit Draft
Thriving PA Report Highlights WIC Program Community Feedback
Thriving PA’s newest report, WIC Participants Encourage Improvements to Remove Barriers to Access, highlights community feedback about the Special Supplemental Nutrition Program for Women, Infants, and Children, commonly referred to as WIC. Over the summer, Thriving PA partnered with several community organizations across the state to hold seven focus sessions with current and former WIC clients to hear directly from their experiences on the strengths and barriers of the WIC program.
The WIC program provides eligible pregnant and postpartum women and infants and children up to age 5 with access to nutritious foods, breastfeeding supports, nutritional education, and health referrals. Unfortunately, participation in PA’s WIC program has been declining in recent years, a trend that is happening nationally. From 2018-2022, the PA program saw nearly a 25% decline in participation. The pandemic also impacted these numbers, with Pennsylvania seeing the third largest decrease in participation from February 2020 to February 2022.
To address the declining participation, which impacts the federal funding Pennsylvania receives to administer the program, Thriving PA sought out direct feedback from participants to identify solutions to the WIC program’s challenges. Many of the recommendations in the report highlight opportunities to modernize the program and provide greater flexibility for participants. Some recommendations include technology improvements like moving to an online EBT card system and simplifying the application process through system integration with other state application systems like COMPASS. Others include allowing virtual visits to continue and coordinate care between health professionals, so participants do not need to provide the same information to multiple providers.
Thriving PA hopes the incoming administration and WIC Advisory, a stakeholder group formed earlier this year, will consider the recommendations from WIC clients to help improve the WIC program and increase participation statewide.
Pennsylvania Partnerships for Children Releases Annual Health Care Report
Pennsylvania’s child uninsured rate improved slightly to 4.4% from 4.6% during the COVID-19 pandemic thanks to the federal continuous coverage provision that prevents states from disenrolling children and families from Medicaid during the public health emergency, according to our recently released 2022 State of Children’s Health report.
Even more families turned to Medicaid during the pandemic when child enrollment increased by 20%. More than 1.4 million Pennsylvania children currently have Medicaid as their health insurance.
We are cautiously optimistic about the improvement in our child uninsured rate in Pennsylvania. While we have made progress, Pennsylvania has the 8th highest number of uninsured children in the nation, with 126,000 children who do not have health insurance and don’t have regular access to preventive and primary health care.
And hundreds of thousands of children are at risk of losing Medicaid coverage when the public health emergency ends and the state begins to unwind the disenrollment freeze and resume pre-pandemic operations. According to the latest estimates from DHS, 1 in 4 children enrolled in Medicaid could lose coverage when the public health emergency ends and the process to redetermine eligibility begins.
It will be imperative for DHS to implement an unwinding process that does not disconnect the children most at risk of losing coverage, particularly when Pennsylvania’s uninsured rate is starting to improve.
We recommend DHS:
- Reaffirm its commitment to using a 12-month unwinding period as recommended by the Centers for Medicare and Medicaid, which most other states plan to use. Using the full 12 months permitted will give Pennsylvania the best chance to minimize inappropriate terminations and disruptions in coverage (churn) that often impact children more than the adult population.
- Immediately expand the 12-month continuous eligibility policy to children ages 4 through 21 in Medicaid when the public health emergency ends to make it more equitable—Pennsylvania already provides 12-month continuous eligibility (regardless of changes in circumstances) in Medicaid for children up to age 4. All Pennsylvania children in CHIP have continuous eligibility for a full year.
According to the report, factors such as race and ethnicity, poverty level and geographic region impact children’s access to health insurance. Some additional key findings include the following:
- Hispanic or Latino children, children who identified as Some Other Race, and children who identified as Two or More Races have worse rates now than in 2019, showing they are more likely to be uninsured.
- 5% of children in PA who qualify for no-cost or reduced-cost health insurance through Medicaid, CHIP, or Pennie™ do not have health insurance.
- The uninsured rates improved in 38 counties and worsened in 29 counties over the last two years.
New to this year’s report are fact sheets for each of the 67 counties that show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.
Read the latest coverage:
New OHRC Resource Published on Opioids During Pregnancy
The National Maternal and Child Oral Health Resource Center (OHRC) has released a new resource, “Opioids and Pregnant Women: Information for Oral Health Professionals.” This resource provides guidance for dentists about prescribing opioids to pregnant women, if pain management is needed.
February is National Children’s Dental Health Month
The American Dental Association’s Council on Advocacy for Access and Prevention has materials for 2023 National Children’s Dental Health Month (NCDHM) ready to ship! Free bilingual posters are available to ship. New this year, you can purchase postcards either in English or Spanish. Additional resources, including activity sheets and a planning guide, can be found on the NCDHM website.
Felt for Miles: The Ripple Effect of Rural Hospital Closures
Rural hospitals may be geographically isolated from their urban counterparts, but when they shutter, the effects are felt for miles.
A recent study from the Hershey, Pa.-based Penn State College of Medicine has quantified those impacts. Researchers analyzed the average rate of change for inpatient admissions and emergency department visits at bystander hospitals — those within 30 miles of a selected 53 hospitals that closed between 2005 and 2016 — two years before and two years after the nearby closure.
Researchers found that two years prior to a rural hospital closure, bystander hospitals’ emergency department visits increased an average of 3.59 percent. Two years following a closure, emergency department visits increased an average of 10.22 percent.
Similarly, two years prior to a rural hospital closure, bystander hospitals’ average admissions fell by 5.73 percent. Average admissions rose by 1.17 percent in the two years following a closure.
“We know rural areas, especially regions like Appalachia, are at increased risk for diseases of despair including alcoholism, accidental poisonings and suicide,” Jennifer Kraschnewski, MD, director of Penn State Clinical and Translational Science Institute said in a Dec. 13 Penn State news article. “Increased burden at bystander hospitals and health care institutions may cause these problems to proliferate if other public health interventions aren’t identified and implemented.”
The study results were published in September in the Journal of Hospital Medicine.
HHS Proposes Rule to Strengthen Beneficiary Protections, Improve Access to Behavioral Health Care, and Promote Equity for Millions of Americans with Medicare Advantage and Medicare Part D
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), proposed a rule to strengthen Medicare Advantage and Medicare Part D prescription drug coverage for the tens of millions of people who rely on the programs for health care coverage. The proposed rule improves protections for people with Medicare, expands access to behavioral health care, and promotes equity in coverage. The proposed rule also implements a key provision of the Inflation Reduction Act to make prescriptions drugs more affordable for approximately 300,000 low-income individuals who will benefit in 2024.
“We are taking feedback from thousands of Americans and turning it into concrete action to strengthen Medicare for the millions of Americans who rely on it,” said HHS Secretary Xavier Becerra. “From streamlining prior authorization to cracking down on misleading marketing, we are committed to ensuring that everyone can have peace of mind and get the health care they need.”
“We continue working tirelessly to implement President Biden’s Inflation Reduction Act. Yesterday, thanks to the new law, we are taking action to lower costs and expand access to affordable prescription drug coverage for hundreds of thousands of people with Medicare, including communities of color and those living on fixed incomes,” the Secretary continued. “CMS released a proposed rule today that takes important steps to hold Medicare Advantage plans accountable for providing high quality coverage and care to enrollees,” said CMS Administrator Chiquita Brooks-LaSure. “The rule also strengthens Medicare prescription drug coverage and implements an important provision of the Inflation Reduction Act to help more people with Medicare who have modest incomes afford their prescriptions.”
A July 2022 Request for Information on Medicare Advantage drew almost 4,000 comments regarding improvements to the program. We thank stakeholders for their thoughtful feedback, and the policies in this proposed rule are informed by the feedback received.
In this rule, CMS proposes significant changes to strengthen protections for people enrolled in or seeking coverage from Medicare Advantage plans or Medicare Part D prescription drug plans, including through improvements to prior authorization, coverage guidelines, and plan marketing requirements. The rule proposes clarifications and revisions to regulations governing when and how Medicare Advantage plans develop and use coverage criteria and utilization management policies to ensure Medicare Advantage enrollees receive the same access to medically necessary care they would receive in Traditional Medicare. The rule also proposes policies to streamline prior authorization requirements and reduce disruption for enrollees. It does this by requiring that a granted prior authorization approval remain valid for an enrollee’s full course of treatment, requiring Medicare Advantage plans to annually review utilization management policies, and requiring coverage determinations be reviewed by professionals with relevant expertise. These proposed policies complement proposals in CMS’ recently announced Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P).
Additionally, the proposed rule focuses on protecting people exploring Medicare Advantage and Part D coverage from confusing and potentially misleading marketing while also ensuring access to accurate and necessary information to make coverage choices. The proliferation of certain television advertisements generically promoting Medicare Advantage enrollment has been a topic of concern. To address this, CMS proposes to prohibit ads that do not mention a specific plan name as well as ads that use words and imagery that may be confusing, or use language or logos in a way that is misleading, confusing, or misrepresents the plan. CMS also proposes to codify guidance protecting people with Medicare or exploring Medicare coverage from misleading marketing and ensure they are not pressured into enrolling into plans that may not best meet their needs. Further, CMS is proposing to strengthen the role of plans in monitoring agent and broker activity.
“People exploring Medicare coverage options deserve peace of mind that they are receiving honest, transparent, and accurate information about health coverage options and have access to the care they need. These proposed protections are commonsense and critical to the physical, mental, and financial stability of millions of people who choose a Medicare coverage option each year,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare.
CMS remains committed to emphasizing the invaluable role that access to behavioral health plays in whole person care. In line with CMS’ Behavioral Health Strategy and the Administration’s strategy to address the national mental health crisis, CMS proposes to strengthen behavioral health network adequacy by adding clinical psychologists, licensed clinical social workers, and prescribers of medication for opioid use disorder to the list of evaluated specialties. CMS also proposes new minimum wait time standards for behavioral health and primary care services and more specific notice requirements from plans to patients when these providers are dropped from their networks. Finally, CMS proposes to require most types of Medicare Advantage plans include behavioral health service in care coordination programs, ensuring that behavioral health care is a core part of person-centered care planning.
Additionally, the proposed rule reinforces CMS’ commitment to advancing health equity and driving quality in health coverage. For the first time, CMS proposes establishing a health equity index in the Star Ratings program that would reward excellent care for underserved populations by Medicare Advantage and Medicare Part D plans. The rule also proposes updates to the Medicare Part D medication therapy management (MTM) program to improve access, including a proposed requirement that plans include all 10 core chronic diseases identified by CMS — including HIV/AIDS — in their MTM targeting criteria. Plans would also be required to provide culturally competent care to an expanded list of populations and to improve equitable access to care for those with limited English proficiency, through newly proposed interpreter standards and the requirement that materials be provided in alternate formats and languages. Finally, the proposed rule would balance the emphasis between patient experience, complaints, and access Star Ratings measures and health outcomes Star Ratings measures to more effectively focus both on patient-centric care and on improving clinical outcomes.
In order to implement section 11404 of the Inflation Reduction Act (Pub. L. 117-169), CMS proposes to expand eligibility under the low-income subsidy (LIS) program. Under the IRA provision and proposal, individuals with incomes up to 150% of the federal poverty level and who meet statutory resource requirements will qualify for the full LIS beginning on or after January 1, 2024. This change will provide the full LIS to those who would currently qualify for the partial LIS, improving access to affordable prescription drug coverage and lowering costs. As a result of this change, eligible enrollees will have no deductible, no premiums (if enrolled in a “benchmark” plan), and fixed, lowered copayments for certain medications.
The proposed rule can be accessed at the Federal Register at https://www.federalregister.gov/public-inspection/current. Comments on the proposed rule are due by February 13, 2023.
New CDC Guidelines for Opioid Prescribing Announced
The Centers for Disease Control and Prevention (CDC) recently issued a new Clinical Practice Guideline for Prescribing Opioids for Pain. This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients over 18 years of age. It updates the previous CDC guideline and includes recommendations for managing acute (duration of less than one month), subacute (duration of 1–3 months) and chronic (duration of more than three months) pain.
Rural Hospital CFOs Don’t See Telehealth As a Solution to Financial Challenges
While rural CFOs acknowledge that telehealth has some financial advantages, they do not believe that it has improved their hospitals’ financial situations, according to a Dec. 5 report published in The American Journal of Managed Care.
The report’s authors interviewed 20 rural hospital CFOs and other hospital administrators from 10 states between October 2021 and January 2022. 17 represented critical access hospitals and 3 represented short-term acute care hospitals, according to the report.
Five findings to know:
- The CFOs interviewed reported that limited reimbursement, low volumes, preference for in-person care, and insufficient broadband were key challenges to telehealth’s financial viability.
- Most CFOs interviewed believed that telehealth was a loss leader or had a neutral impact on their finances.
- Of the hospitals featured in the sample, all but one operated multiple telehealth programs. CFOs shared that their motivation to implement telehealth was driven more by improving quality and, in some cases, keeping up with competition, rather than improving their financial position.
- The CFOs said that telehealth requires substantial initial investment in technology and the downstream financial benefits are hard to quantify and not always realized.
- Some CFOs interviewed said that the requirement that critical access hospitals maintain an average length of stay of less than 96 hours was a barrier to the growth of their impatient and ED-based telehealth programs.
Executives Grapple with Decisions on CMS’ Rural Emergency Hospital Designation
The new Rural Emergency Hospital designation is putting providers between a rock and a hard place, offering an infusion of cash from the federal government that is available only if they eliminate inpatient care, The New York Times reported December 9.
CMS released the final rule for the new designation in November. The rule aims to curb rural hospital closures by offering them a chance to shutter infrequently used inpatient beds and focus on providing outpatient and emergency department services. The new designation is set to go into effect in January.
Hospitals that convert will receive monthly payments of $272,866, with annual increases based on inflation, according to the report. They will also receive higher Medicare reimbursements than larger hospitals.
Some rural healthcare providers and health policy analysts said officials behind the rule are “out of touch with the difficulties of transferring rural patients,” according to the Times. Bigger hospitals are dealing with their own set of challenges and are increasingly unwilling to accept transferred patients, especially from small field hospitals that are unaffiliated with their systems.
Katy Kozhimannil, PhD, director of the University of Minnesota Rural Health Research Center, told the Times she is concerned that gambling with transfers could mean “some of the most extremely remote and marginalized communities could end up with no care at all — and that’s what we were trying to avoid in the first place.”
Some hospitals, such as Sturgis (Mich.) Hospital, have said they are planning to convert to a rural emergency hospital. The hospital was on the verge of closing when the Michigan Hospital Association suggested it convert to a rural emergency facility. Sturgis Hospital CFO Bobby Morin said 80 percent of the facility’s revenue comes from outpatient services, and a sizable portion of its expenses comes from the inpatient side.
Others, such as Bucktail Medical Center in Renovo, Pa., have ruled out the conversion because there would be nowhere to transfer patients in the case of another pandemic surge, according to the report. Bucktail’s financial margin for patient services was minus-43 percent in 2021.
“Am I going to lose some revenue? Possibly,” CEO Time Reeves told the Times. “But is it more important to provide the services needed? That’s the position we’re taking.”
Broadband Listening Sessions to Be Held Across Pennsylvania
Pennsylvanians can learn about the new FCC broadband map, and how to challenge its inaccuracies
Pennsylvania Broadband Development Authority (Authority) Executive Director Brandon Carson today announced listening sessions will be held across the commonwealth beginning December 13 to give Pennsylvanians the opportunity to learn about the Authority, federal funding for broadband, and to hear about the important role they have in reviewing the new Federal Communications Commission (FCC) broadband access map. The map’s accuracy is crucial for the commonwealth to receive sufficient federal funding to ensure high-speed internet access for all Pennsylvanians.
“In today’s world, having access to high-speed internet is a necessity,” said Carson. “Pennsylvanians need broadband access for school, work, and to ensure public safety, and it is critical that we close the digital divide across the commonwealth. The more accurate we can make the FCC map, the more we ensure we get a fair allocation of federal funding to expand broadband.”
The FCC’s broadband access map shows all broadband serviceable locations across the United States where fixed broadband internet access 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. Pennsylvanians should visit the map to search for their home address to determine whether the information listed by the FCC is accurate.
Listening Sessions
The Authority will host the following broadband listening sessions across the commonwealth:
- Tuesday, December 13 at 10:00 AM – Beaver County
In-person only listening session will be held at Community College of Beaver County, Library Conference Center 9103, 1 Campus Drive, Monaca, PA 16061
- Tuesday, December 13 at 2:00 PM – Somerset County
In-person only listening session will be held at Glencoe United Church of Christ, 128 Critchfield Street, Fairhope, PA 15538
- Wednesday, December 14 at 10:00 AM – Venango County
Hybrid listening session
- In-person will be held at Venango County Training Center, 737 Elk Street (Corner of Elk & 8th), Franklin, PA 16323
- Click here to register and attend virtually
- Wednesday, December 14 at 2:00 PM – Elk County
Hybrid listening session
- In-person will be held at North Central PA Regional Planning and Development Commission, 49 Ridgmont Drive, Ridgway, PA 1585
- Click here to register and attend virtually
- Thursday, December 15 at 10:00 AM – Luzerne County
Hybrid listening session
- In-person will be held at Greater Wyoming Valley Chamber of Commerce, 7 South Main Street, Wilkes-Barre, PA 18701
- Click here to register and attend virtually
- Thursday, December 15 at 2:00 PM – Tioga County
Hybrid listening session
- In-person will be held at Bradford County Public Safety Center, 29 VanKuren Drive, Towanda, PA 18848
- Click here to register and attend virtually
- Friday, December 16 at 10:00 AM – Union County
Hybrid listening session
- In-person will be held at SEDA-Council of Governments, 201 Furnace Road, Lewisburg, PA 17837
- Click here to register and attend virtually
- Monday, December 19 at 11:00 AM – Chester County
In-person only listening session will be held at Borough of Kennett Square, 600 S. Broad Street, 3rd Floor, Kennett Square, PA 19348
Process to Challenge Inaccuracies in the FCC Broadband Map
Challenges to the map can include:
- A location that meets the FCC’s definition of a broadband serviceable location is missing from the map.
- A location’s broadband serviceability is incorrectly identified.
- Information such as the address or unit count for the location is incorrect.
- The location’s placement (its geographic coordinates) is incorrect.
Pennsylvanians should challenge the map to help improve its accuracy by January 13, 2023. There are two ways to submit a challenge: by a single location, or in bulk. The location challenge can be completed by individual consumers utilizing the map itself. Bulk challengers will be required to use the Broadband Data Collection (BDC) platform to submit information to the FCC.
Additional information about the Consumer Challenge Process can be found here, and additional information on the Bulk Challenge Process can be found here. A consumer may also challenge mobile data coverage through the FCC Speed Test App – a free application that can be downloaded from an Apple or Google Play Store.
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, or the Department of Community and Economic Development, visit the Authority’s website and be sure to stay up-to-date with all of our agency news on Facebook, Twitter, and LinkedIn.