Family First Health, a federally qualified health center in Central Pennsylvania has partnered with Bro2Go to create the “Get Healthy” initiative to provide health and social services to formerly incarcerated citizens. Health services will include assistance with enrolling in and navigating insurance, free blood pressure screenings, rapid HIV testing, and education on health and nutrition. Read more.

You can improve staff satisfaction, retention, and resilience by executing a customized workforce well-being strategy. Join the Bureau of Primary Health Care for this webinar to learn about a practical tool that can hone your strategy. The speakers will also explore a real-life scenario that illustrates how to use the tool. Wednesday, July 24, 2:00-3:00 pm.

On June 13, 2024, the Centers for Disease Control and Prevention (CDC) released a Health Alert Network (HAN) regarding the U.S. Department of Justice announcement of a federal health care fraud indictment against a large subscription-based telehealth company that provides attention-deficit/hyperactivity disorder (ADHD) treatment to patients ages 18 years and older across the United States. Patients whose care or access to prescription stimulant medications is disrupted, and who seek medication outside of the regulated healthcare system, might significantly increase their risk of overdose due to the prevalence of counterfeit pills in the illegal drug market that could contain unexpected substances, including fentanyl. In addition to concerns about using illegally acquired stimulant medications, untreated ADHD is associated with adverse outcomes, including social and emotional impairment, increased risk of drug or alcohol use disorder, unintentional injuries, such as motor vehicle crashes, and suicide. Health officials and healthcare providers may need to assist affected patients seeking treatment for ADHD and should communicate overdose risks associated with the current illegal drug market as well as provide overdose prevention education and mental health support. More information is available.

The DHS (Department of Human Services) Medicaid team recently updated the MCOs by region and which PH MCOs contract with which Dental and Vision MCOs. DHS also updated the contact information for the HealthChoices/Community HealthChoices/Behavioral MCOs as of July 2024. Click here for additional HealthChoices general information. Click here for additional Behavioral HealthChoices general information.

The Centers for Medicare and Medicaid Services (CMS) have issued a proposed rule, or Notice of Public Rulemaking, that could create exceptions to the existing four walls requirement for Indian Health Service (IHS)/Tribal clinics, behavioral health clinics, and clinics located in rural areas. The official language posted to the federal register can be found on page 15 and is below.

“This proposed rule includes a proposal to create exceptions to the Medicaid clinic services benefit four walls requirement, to authorize Medicaid payment for services provided outside the four walls of the clinic for IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas. Our current regulation at 42 CFR § 440.90(b) includes an exception to the four walls requirement under the Medicaid clinic services benefit only for certain clinic services furnished to individuals who are unhoused. We believe these proposed exceptions would help maintain and improve access for the populations served by IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas.”

As a reminder, this is a proposed rule intended to announce and explain CMS’ plan to address the problem. As such, all proposed rules must be published in the Federal Register to notify the public and to give them an opportunity to submit comments. The proposed rule and the public comments received on it form the basis of a final rule. Interested parties should provide public comment on this proposed rule to the addresses listed in the federal register by Sept.9, 2024. While CMS works through this process, the Office of Mental Health and Substance Abuse Services (OMHSAS) continues to work toward a more immediate solution for Pennsylvania providers. Reminder, FQHCs are not required to comply with the four walls requirement.

The Centers for Medicare & Medicaid Services’ (CMS) CY2025 Physician Fee Schedule (PFS) Proposed Rule, released in preview form on July 10, 2024, contains various provisions that will impact federally qualified health centers’ (FQHC) service offering and payment under Medicare. The rule contains provisions that will, if finalized, allow for various service expansions and enhancement in payments for FQHCs in Medicare, as well as building on the trend of greater recognition of technology-based services in Medicare. In particular, the proposals, if finalized, would allow CMS to carry out the following in CY2025:

1.  Broaden the capacity for FQHCs and other providers to use audio-only telehealth, rather than the audio-visual modality, where necessary to support patient care;

2.  Allow FQHCs to furnish and be paid for Medicare advanced primary care management (APCM) services—a more comprehensive approach to primary care targeted to individuals with greater clinical needs—and to receive additional payments for use of the APCM model;

3.  Require, for the first time, that FQHCs and rural health clinics (RHCs) bill Medicare for care management and care coordination using detailed codes; this change will allow FQHCs to be paid more for more resource-intensive care management services, and also to be paid add-on fees for add-on fees if time is spent on care management in a month in excess of the threshold requirement;

4.  Provide, for the first time, for separate initial payment to FQHCs for the administration of Medicare Part B-covered preventive vaccines including hepatitis B, pneumococcal, influenza, and COVID-19 vaccines (with payment for all of the latter three being later reconciled to the FQHCs’ documented costs on its cost report);

5.  Refine the payment methodology for FQHCs for intensive outpatient services (IOP), a behavioral health service added to the Medicare FQHC benefit effective Jan. 1, 2024, so that FQHCs could be paid at a higher rate for days of IOP services where more than four services are provided in a single day;

6.  Rebase the FQHC market basket inflationary index (CMS has done this only one time prior since the inflationary index was first introduced in 2017); and

7.  Postpone further (until Jan. 1, 2026) the implementation of a requirement that patients receiving telecommunications-based mental health visits in an FQHC have had an in-person mental health visit during the six months prior to the initiation of the telecommunications-based care.

Comments are due by Sept. 9. Click here to learn more and access the proposed rule.

The Pennsylvania Primary Care Career Center is seeking a Talent Acquisition Specialist to join their team and help Community Health Centers recruit primary care providers and other staff. If you know anyone who would be a great candidate for this position, please share the link to the job post and encourage them to apply online or send their resume and cover letter to Caitlin Wilkinson, Co-Director of the Pennsylvania Primary Care Career Center.

Legislation reining in prescription drug middlemen was signed by the Governor this week. House Bill 1993 deals with contracts between pharmacies and the 72 pharmacy benefit managers (PBM) operating in the state, transparency and accountability measures and pharmacies administering immunizations among other things. Through our aggressive advocacy, PACHC was able to have language added to help protect covered entities, including FQHCs, from pickpocketing by PBMs. The language in the bill in Chapter 6 states that, A PBM licensed by the department to conduct business in this Commonwealth may not, as part of a contract agreement issued or renewed following the effective date of this section with a pharmacist or pharmacy under this part reimburse a qualified health center or covered entity an amount lesser than similar entities not participating in the program under section 340(b) of the Public Health Service Act (58 Stat. 682, 42 U.S.C. § ). This language does not address the issue with contract pharmacies.