– Comment by November 12. This proposed rule from the Centers for Medicare & Medicaid Services (CMS) sets standards for Affordable Care Act (ACA) Marketplaces and issuers, as well as requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters that help Marketplace consumers. It includes proposals to:

• prevent unauthorized activity among agents and brokers,
• mitigate health disparities by incentivizing plans that focus on underserved communities, and
• simplify plan choices.

Since 2018, the number of Marketplace plans in rural areas has grown, increasing the choices of coverage available to consumers.

Researchers from the North Carolina Rural Health Research and Policy Analysis Center created a model for predicting rural hospital closures in 2017. This update for 2024 was published last week in The Journal of Rural Health.

The latest Morbidity and Mortality Weekly Report from the Centers for Disease Control (CDC) highlights just how connected Adverse Childhood Experiences (ACEs) are to adolescent health.  Billed as the most comprehensive data yet on this subject, the report concludes that preventing ACEs could reduce suicide attempts by as much as 89 percent, prescription pain medication misuse by as much as 84 percent, and persistent feelings of sadness or hopelessness by as much as 66 percent. Earlier this year, the CDC issued a Rural Policy Brief showing suicide rates have been consistently higher in rural areas than in urban areas over the past two decades.  Between 2000-2020, suicide rates increased 46 percent in non-metro areas compared to 27.3 percent in metro areas.  A separate CDC Rural Policy Brief on suicide prevention released in July features a case study from a successful program for adolescents in tribal community in New Mexico.  In 2018, the National Advisory Committee on Rural Health and Human Services delivered an in-depth report on the rural context for ACEs, with recommendations for federal policy.

The Centers for Medicare & Medicaid Services (CMS) released guidance on state compliance with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements under Medicaid and the Children’s Health Insurance Program (CHIP).  Current law entitles eligible children under the age of 21 to Medicaid coverage of health care, diagnostic services, treatment, and other measures described that are medically necessary.  This guidance provides an overview of EPSDT requirements and discusses policies, strategies, and best practices to maximize health care access and utilization for EPSDT-eligible children.  Strategies include promoting EPSDT awareness and accessibility, expanding and using the child-focused (EPSDT) workforce in rural areas, and improving care for EPSDT-eligible children with specialized needs, including providing behavioral health services in Rural Health Clinics. Medicaid and CHIP covers about 47 percent of children in rural areas and small towns.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule addressing significant, anomalous, and highly suspect (SAHS) billing activity within Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (SSP). In 2023, CMS identified a concerning rise in urinary catheter billings, which was attributed to a small group of durable medical equipment supply companies. CMS determined that the beneficiaries did not receive catheters and were not billed directly, physicians did not order these supplies, and supplies were not needed.  This rule specifies how CMS will calculate various factors used in SSP financial calculations for 2023.  The proposed Physician Fee Schedule addresses SAHS billing activity for 2024 onwards.  As of January 2024, over 500 Critical Access Hospitals and 2,500 Rural Health Clinics participated in Medicare SSP ACOs.

– Comment by November 29. This week, the Centers for Medicare & Medicaid Services (CMS) released an interim final action with comment period (IFC) that removes the low wage index hospital policy following the appellate court decision in Bridgeport Hosp. v. Becerra. The low wage index hospital policy was implemented in FY2020 to address wage index disparities affecting low-wage index hospitals, including many rural hospitals.  The court decided that the policy and related budget neutrality adjustment must be reversed. As a result, this IFC revises the Medicare wage index values for FY 2025, establishes a transitional payment exception for low wage hospitals significantly impacted by those revisions, and makes conforming changes to the Medicare hospital Inpatient Prospective Payment System (IPPS) payment rates for FY 2025. These changes are effective September 30, 2024. To be assured consideration, comments must be received by November 29, 2024.

Health care weathered more ransomware attacks last year than any other sector, and that was before a debilitating February hack of payments manager Change Healthcare. Executives, lawyers, and policymakers are worried the federal government’s response is underpowered, underfunded, and too focused on hospital security. Read more.

This week, legislation was introduced by Senate Democrats to make tax credits a permanent fixture to lower the cost of health insurance plans through the Affordable Care Act by Senators Jeanne Shahaan (D-NH) and Tammy Baldwin (D-Wis). This builds on the original legislation that was introduced four years ago, the enhanced tax credits enacted by the American Rescue Plan in 2021 and the Inflation Reduction Act of 2022. The original tax credits are set to expire at the end of 2025. Congressional action is needed by the end of 2024 to ensure market stability in 2026. The Congressional Budget Office projected these tax credits would help millions including those who are chronically ill but cost billions over the next 10 years.

The Centers for Medicare & Medicaid Services (CMS) has awarded the PA Insurance Department $635,352 to improve women’s access to critical health benefits in Pennsylvania. The funding is part of a $9 million grant program from the Biden-Harris Administration to advance and support maternal and reproductive health outcomes and increase awareness of benefits available under insurance policies. The grant will be used to launch a multifaceted campaign focused on awareness and education about the importance of preventive care, enhance benefit reviews and issuer education to reduce coverage barriers, and improve compliance with pre-selected federal market reforms.

Health eCareers recently released a study on women’s experiences, perceptions, and attitudes in the medical field. In the United States, about 8 in 10 healthcare workers are women, however nearly a third of the respondents of the study reported experiencing gender discrimination or bias in the workplace, and 40% reported general workplace challenges due to their gender. Furthermore, almost half reported gender discrimination during patient interactions. To find out more about the results of the study and learn takeaways about how their attitudes and perceptions can shape your hiring approach and workplace policies, download the published report for free.