Health committees in the Pennsylvania House and Senate are working on a compromise agreement that will increase oversight of pharmacy benefit managers (PBMs). The Pennsylvania legislation would allow the state’s Insurance Department to regulate certain aspects of pharmacy benefit managers’ business that have been called anti-competitive. Read more. Included in this legislation is language that will prohibit PBMs from reimbursing qualified health centers participating in 340B less than they would reimburse similar entities that do not participate in the program. This is an evolving process so stay tuned for updates.

Legislation addressing worker shortages in healthcare and facilitating Pennsylvania’s entry into interstate compacts has been sent to Gov. Josh Shapiro to be signed into law. Sponsored by Rep. Frank Burns, D-Cambria, HB 2200 enables interstate licensing compacts to become operational. The legislation requires applicants in healthcare professions to submit fingerprints as part of their criminal history records check and lays out the process that Pennsylvania State Police and state licensing boards must follow in considering them. The change in law allows licensees to practice in other participating states with just one license. Without the fingerprinting process in place, previous efforts to implement the compacts were unsuccessful.

– Tuesday, July 16 at 2:00 pm Eastern. In this hour-long session, the Centers for Medicare and Medicaid Innovation will provide an overview of the new ACO Primary Care Flex Model (ACO PC Flex Model), which will focus on primary care delivery in the Medicare Shared Savings Program (SSP).  CMS has released a Request for Applications  and the application portal is open until August 1 for new or renewing ACOs who submitted an application to SSP by June 17, 2024.  CMS plans to announce applicants selected to participate in October 2024.  This model seeks to increase accountable care relationships for people with Medicare, especially those in rural and underserved communities.

– Monday, July 15 at 2:00 pm Eastern. The National Association of Rural Health Clinics (NARHC) will host the free, FORHP-supported webinar, with information on the Department of Health and Human Services (HHS) Office of Civil Rights and the Centers for Medicare & Medicaid Services final rule under Section 1557 of the Affordable Care Act Nondiscrimination in Health Programs and Activities and the RHC impacts, including:

• Requirement to post a notice of nondiscrimination.
• Requirements to post notice of availability of translation and auxiliary aid services in top 15 foreign languages.
• Requirement to establish and train employees on policies and procedures related to nondiscrimination.

Additional time for Q&A will be provided. Advanced registration is required.

– Comment by July 29. This week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for mitigating the impact of significant, anomalous, and highly suspect (SAHS) billing activity on the Medicare Shared Savings Program financial calculations in calendar year 2023. This proposed rule is part of a larger strategy to address significant, anomalous, and highly suspect (SAHS) within ACO reconciliation, and additional information will be forthcoming in the Physician Fee Schedule. Due to a recent, observed increase in Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) billing to Medicare for selected intermittent urinary catheter supplies in CY 2023, CMS  proposes to exclude use of these codes from any supplier in 2023 from ACO expenditure and revenue calculations.

This exciting new clearinghouse highlights the work of three different Rural Centers of Excellence on Substance Use Disorders (SUD), all of which are funded by FORHP’s Rural Communities Opioid Response Program (RCORP). Visitors to the website will find current information and technical assistance opportunities on SUD through a rural lens.

On Thursday, June 20, Change Healthcare started sending out breach notifications to affected customers. In addition, they have updated the Change Healthcare website with a HIPAA Substitute Notice. It is important to note that the Department of Health and Human Services said on May 31 that Change can be the notifying entity, however, per the National Association of Community Health Centers (NACHC), it’s on the covered entity (health center) to reach out to Change to delegate the tasks of providing the required HIPAA breach notifications on their behalf. Change plans to start sending actual letters to the affected individuals themselves in late July, though the company noted it may not have addresses for everyone. Exposed data could include contact information, health insurance details, medical information like diagnoses and test results, billing and payment information and personal details like Social Security numbers or ID numbers