- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- HRSA Announces Action to Lower Out-of-Pocket Costs for Life-Saving Medications at Health Centers Nationwide
- Public Inspection: HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Increased Risk of Cyber Threats Against Healthcare and Public Health Sector
- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- Announcing the 2030 Census Disclosure Avoidance Research Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
Resources Available for Caregivers of Children with Autism
The ASERT Collaborative (Autism Services, Education, Resources and Training) is a statewide partnership that provides streamlined access to information for Pennsylvanians living with and impacted by autism. In partnership with UPMC for You Dental Care Managers, ASERT developed a resource for parents and caregivers to help children with autism prepare for dental visits. The content covers learning to tolerate tooth brushing, establishing dental hygiene routines, and getting ready for dental visits. There are also social stories for getting teeth cleaned, getting x-rays, and getting a cavity filled. Printed resources are also available upon request.
Critical Gaps: U.S. Veterans and Comprehensive Dental Care
The Coalition for Oral Health Policy, an initiative of the Santa Fe Group, published “All Veterans Deserve Comprehensive Dental Care.” This article addresses the critical gap in dental care access for U.S. veterans, highlighting how limited eligibility for dental services contributes to health challenges and financial strain. The authors propose actionable policy solutions to expand access tackling issues such as workforce shortages and outdated eligibility criteria to ensure all veterans receive the comprehensive care they deserve.
Pennie Submits Comment Letter on CMS Proposed Rule
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.
Embracing AI for Patient Care
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.
American Academy of Pediatric Dentistry (AAPD) Affirms Safety and Effectiveness of Community Water Fluoridation
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.
Approaches to Pain Management and Substance Use Care
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.
Pennsylvania DOH 2024 Mobile Unit Survey Results
The Pennsylvania Department of Health (PA DOH) conducted a statewide, voluntary survey of mobile units between July and August 2024. Results indicate the majority of mobile units deployed were launched in the last seven years, and many operate less than five days per week. Preventive care was the service most often provided by mobile units. Lastly, the funding that most often supported mobile units was federal, philanthropy, and state funding.
Pennsylvania Medical Assistance Bulletin MAB2025041602: MA Enrollment per Location
IMPORTANT REMINDER: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every five years. Providers should log into PROMISe to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Use this link for enrollment revalidation applications.
MMA Releases New Polling Data on Medicaid
The Modern Medicaid Alliance (MMA) released new polling data on Medicaid. The polling highlights the program’s overall popularity, the favorability of specific parts of it, and the number of voters who have a personal or family connection to Medicaid. Click here for more information about the report.
Federal Community Project Funding Requests
The House Appropriations Committee recently announced the beginning of the Fiscal Year 2026 appropriations process. As of Monday, April 14, House Members may begin submitting programmatic and language requests and Community Project Funding requests for the upcoming year. Deadlines for all the different subcommittees are available. The Senate Appropriations Committee also released guidance to the Senators for Fiscal Year (FY) 2026 Congressionally Directed Spending (CDS) requests. The earmark requests to the Committee are May 16, so individual senators will set even earlier deadlines for their own consideration. Visit the website of your Member of Congress and/or Senator to find out if they are accepting requests and their deadline.