A majority of the Supreme Court appeared inclined Monday to reject a conservative challenge to the Affordable Care Act (ACA), leaving in place the federal government’s authority to require insurers to cover everything from depression screenings to HIV prevention drugs at no cost to patients. Source: Politico

Pennsylvania health officials are facing down a potential $500 million loss of federal funding but are tight-lipped about which programs and how many people might be affected by the Trump administration’s decision. The funding helps Pennsylvania purchase and administer vaccines, monitor the spread of infectious diseases like measles and influenza, and contact people who might have been exposed to dangerous pathogens. Source: Spotlight PA

Tick-bite-related emergency department visits have increased recently in Pennsylvania. Healthcare providers should have a heightened clinical suspicion for tickborne diseases in persons with clinically compatible symptoms. Rare tickborne diseases, including hard tick relapsing fever and Powassan virus, continue to be found in ticks in multiple Pennsylvania counties, and human cases have been reported. Alpha gal allergy syndrome has been reported in Pennsylvania residents; health care providers should consider alpha gal allergy syndrome in persons presenting with mammalian meat allergies. The full HAN is available.

CMS issued a request for information on regulatory relief in the Medicare program. CMS seeks public input on approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries, Medicare Advantage and Part D plans, and other stakeholders participating in the Medicare program. Responses are due June 10, 2025, via this form.

U.S. Senator Bill Cassidy, M.D. (R-LA), chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a report detailing findings from his years’ long investigation into how covered entities use and generate revenue from the 340B Drug Pricing Program. Cassidy also outlined potential reforms needed to improve the program to better serve patients. “This investigation underscores that there are transparency and oversight concerns that prevent 340B discounts from translating to better access or lower costs for patients. Congress needs to act to bring much-needed reform to the 340B Program,” said Dr. Cassidy. “I look forward to continuing my efforts to bring transparency and improvements to the 340B Program.” As part of his investigation into the 340B Program, Cassidy requested information from hospitals, Federally Qualified Health Centers (FQHCs), contract pharmacies, and drug manufacturers to better understand how revenue flows throughout the 340B Program and how covered entities use 340B revenue to benefit patients. Cassidy laid out potential reforms for Congress to improve transparency in the 340B Program and ensure vulnerable patients directly benefit from revenue created by discounted drugs:

·    Require covered entities to provide detailed annual reporting on how 340B revenue is used to ensure direct savings for patients, providing a more transparent link between program savings and patient benefit.

·    Address potential logistical challenges caused by increased administrative complexity, leading to burdens that may impede patient benefit from the program.

·    Investigate the types of financial benefits contract pharmacies and TPAs receive for administering the 340B Program to ensure that increasing fees do not disadvantage covered entities and patients.

·    Require transparency and data reporting for entities supporting participants in the 340B Program (i.e., contract pharmacies and TPAs).

·    Provide clear guidelines to ensure that manufacturer discounts actually benefit 340B-eligible patients, including examining legislative changes to the definition of eligible patient and contract pharmacies’ use of the inventory replenishment model.

Read the full report here.

The Centers for Medicare & Medicaid Services (CMS) issued the 2025 Marketplace Integrity and Affordability Proposed Rule on March 10, 2025. The proposed rule outlined several provisions with the goal to address waste, fraud, and abuse centered around enrollments considered to be improper, and asserts that current eligibility and enrollment rules have led to adverse selection. The proposed rule directly mentions that several policies would decrease enrollment and thus reduce federal costs.

After a bipartisan, unanimous vote in the PA General Assembly in 2019, Pennie, Pennsylvania’s Health Insurance Exchange, was created. Pennie’s comments to the proposed rule focused on all the ways provisions as well as highlighted three major points: Pennie’s enrollment trends were expected, Pennie’s system already deters unauthorized enrollment by brokers, and that Pennsylvania’s insurance market is stable and robust. Specific proposed provisions of additional concern are limiting open enrollment to 45 days, requiring a $5 premium payment for those current enrollees who are reenrolled in a plan with a $0 net premium, and amending the premium adjustment percentage methodology and de minimis range for plans subject to actuarial value requirements. These particular proposals would significantly raise the costs to purchase and use coverage. Pennie’s current open enrollment period is from Nov. 1 to Jan. 15. For the 2025 Open Enrollment Period, 496,661 Pennsylvanians enrolled in coverage with roughly 36,000 new enrollments between Dec.16 and Jan. 15 of the total new enrollments. View the 2025 Marketplace Integrity and Affordability Proposed Rule (CMS-9884-P) in its entirety.

This is a fascinating look at the cutting-edge artificial intelligence that is transforming the dental landscape, with innovation expert Shawn Kanungo. This Dental Soundbite from ADA gives the latest AI-driven tools and technologies that can revolutionize efficiency and outcomes in dental practices.

A federal effort has been proposed to eliminate the recommendation and use of fluoride in community water systems. The AAPD and over 250 organizations have signed a coalition letter to Congress and the Administration, strongly reaffirming the safety of community water fluoridation and its importance in ensuring oral health across the US. Read the coalition letter here.

Recognizing the critical role health care teams play in preventing overdose, the Department of Health (DOH) launched the Comprehensive Approaches to Pain Management, Opioid Prescribing, and Substance Use Care education modules to assist providers and care teams. DOH offers live and online education sessions at no cost to participants. Participants are eligible to receive continuing education credits and certain modules may meet additional Pennsylvania licensing and relicensing requirements.