CMS released a State Health Official (SHO) letter that provides guidance to states on policy for Medicaid and the Children’s Health Insurance Program (CHIP) to allow one provider to discuss a Medicaid or CHIP beneficiary’s case with a specialist, with or without the beneficiary present, and to pay the specialist for their services directly. The current policy only allows payment in this circumstance if the provider who is seeking the consultation is paid for the consulted provider’s services and then pays the consulted provider directly. This change more directly “links” routine care with specialty care, allowing more people to benefit from practitioners with specialized knowledge.

For more, read the full letter https://www.medicaid.gov/federal-policy-guidance/downloads/sho23001.pdf

CMS issued an informational bulletin on the provisions included in the Consolidated Appropriations Act, 2023 (CAA, 2023) related to the Medicaid continuous enrollment condition.

The CAA, 2023 updates various Medicaid and CHIP provisions, including significant changes to the continuous enrollment condition of the Families First Coronavirus Response Act. Under the CAA, 2023, expiration of the continuous enrollment condition will no longer be linked to the public health emergency (PHE) and instead the condition will end on March 31, 2023. Following the end of the condition, states will have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled in Medicaid, the Children’s Health Insurance Program, and the Basic Health Program. As of January 2023, the PHE is still in effect.

Read the Informational Bulletin for more detail.

During January, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Poverty in America Awareness Month. The United States measures poverty based on how income compares to a federal guide. In 2021, an individual was considered to be living in poverty if their income was lower than $12,880, $26,500 for a family of four.  The poverty rate in 2021 was 12.8%, an increase from the 11.4% rate recorded in 2020. American Indian/Alaskan Native individuals were the most impacted (25.9%), followed by Black Americans (21.7%), Hispanic Americans (17.6%), Asian/Native Hawaiian and Pacific Islanders (10.2%), and White Americans (9.5%).

Poverty in the United States is concentrated in specific regions, counties, and neighborhoods. These areas face obstacles such as poor housing and health conditions, higher crime and school dropout rates, lower employment opportunities, and lack of healthy foods, contributing to social determinants of health. Rural poverty rates continue to be higher than urban rates, with Black Americans being the most likely to live in poverty in nonmetro areas. The Southern United States had the highest rural and urban poverty rates (19.7% and 13.8) between 2015 and 2019 while the Northeast had the lowest (12.9% and 12%).

Poverty is shown to influence health outcomes, with unmet social needs, environmental factors, and barriers to accessing health care contributing to worse health outcomes for people with lower incomes. Those who qualify as impoverished may have more difficulty obtaining health insurance or paying for expensive procedures and medications. Children comprise the largest age group experiencing poverty and childhood poverty is associated with developmental delays, toxic stress, chronic illness, and nutritional deficits.

CMS OMH calls for an advancement in health equity for American’s during National Poverty in America Month. Visit the below resources for additional information on how to help during National Poverty in America Awareness Month.

Resources

• Review the CMS Framework for Health Equity 2022–2032 to learn how we’re working to further advance health equity, expand coverage, and improve health outcomes for those supported by CMS programs, including those affected by persistent poverty.
• See the Medicare Savings Program website for Medicare qualifications.
• Details on insulin savings within Medicare can be found here
• Insure Kids Now has an Outreach Tool Library to identify resources to help connect kids to coverage and spread the word about Medicaid and CHIP resources.
• Medicaid has Outreach Tools that provide materials and messages states may use and adapt to support outreach activities.
• Prevention Resources to learn more about preventive services available to adults, teens, children, and infants at no cost.
• See the CDC’s Social Determinants of Health Map for more information on poverty percentages by state.
• Check out the Health People 2030 website to learn more about economic stability’s impact on health.

Visit the ASPE’s FAQs for poverty guidelines and general poverty.

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) and Pennsylvania Department of Community and Economic Development (DCED) joined C&J Catering employees to discuss substance use disorder (SUD) in the restaurant and hospitality industries, highlighting the importance of SUD education and prevention for employees and employers.

“Just below the construction and mining industries, the restaurant industry has a high rate of substance use disorder among its employees,” said DDAP Special Assistant to the Secretary Steve Ross. “Long, irregular hours and high-pressure, physically demanding work can all have an impact on an individual’s behavioral health. We must ensure that employers and employees know about every resource available to them to support individuals living with the disease of addiction. It is also critical to keep providing education to all employers and all Pennsylvanians to address the stigma still faced by those who are struggling with substance use disorder.”

Thomas Jefferson University Hospital reported an increase in opioid overdose deaths among restaurant-industry workers in Philadelphia in 2020. According to the U.S. Bureau of Labor and Statistics, the restaurant industry holds more than four million available positions across the country and is projected to grow faster than the average for all occupations from now until 2031.

“We need to make sure we are providing employees in the tourism industry, and their families, with the SUD resources and support they need to navigate these difficult situations,” said DCED Executive Director of Tourism Michael Chapaloney. “In the tourism industry, the restaurant industry – in all industries – we want employees to be both physically and mentally healthy.”

Pennsylvania Governor Wolf’s Administration’s Just Five initiative is a self-paced program designed to increase awareness, reduce stigma, and provide education about SUD prevention and treatment. It is displayed as six short learning modules that each take “just five” minutes to complete. The interactive lessons include:

• The Science of Addiction
• Are You at Risk?
• The Dangers of Opioids
• Signs, Symptoms and Treatment
• How You Can Help
• The Gift of Recovery

DDAP rolled out a version of Just Five to Pennsylvania commonwealth employees in May 2021 and an additional version of Just Five is available to all of Pennsylvania’s workforce. Since roll out, the statewide Just Five tool has had nearly 12,000 new users and users, with an average of 12 minutes of engagement per session.

Use of the Just Five website is completely confidential and voluntary, and no personal information regarding utilization of the program is shared. It can be accessed virtually from anywhere at any time with no registration required. The program is also available in English and Spanish and accessible for individuals with visual and/or hearing impairments.

DDAP operates the Get Help Now hotline at 1-800-662-HELP (4357). The hotline is a trusted resource for individuals and/or their loved ones if SUD treatment or resources are needed. The hotline is confidential, available 24 hours a day, 365 days a year and staffed by trained professionals who will connect callers to resources in their community. Callers can also be connected with funding if they need help paying for treatment.

To learn more about the Wolf Administration’s efforts in combating the addiction crisis, visit ddap.pa.gov.

The National Academy for State Health Policy provides this interactive map summarizing state Medicaid reimbursement policies for all types of midwives.  Midwives still have an important role to play in providing care in rural areas, where there are currently more midwives than physicians in practice.

CMS recently displayed a proposed rule that includes revisions to Medicare Advantage, also known as Medicare Part C, as well as changes to the Medicare prescription drug benefit, Medicare Part D, that are part of Inflation Reduction Act (IRA) requirements passed earlier this year. As part of updates to promote health equity, CMS is proposing to update its current regulations that require MA organizations to ensure that services are provided in a culturally competent manner to list populations for consideration including rural residents. The rule also makes updates to Programs of All-Inclusive Care for the Elderly (PACE) and to all 4 parts of Medicare regarding the standard for an identified overpayment. According to a recent brief from the RUPRI Center, while rural counties had a lower rate of MA participation than urban counties (34.6 percent and 44.6 percent, respectively), the rate of enrollment growth was higher in rural areas between 2020 and 2021 (14.2 percent and 6.2 percent, respectively). Comments are due by  February 13

CMS seeks public comment on the Notice of Benefit and Payment Parameters for 2024, which proposes updates to the standards for issuers and Marketplaces offering qualified health plans through Healthcare.gov.  Proposals include adding Mental Health Facilities and Substance Disorder Treatment Centers as Essential Community Provider (ECP) categories, including Rural Emergency Hospitals as a provider type in the Other ECP Providers category, adding a special enrollment period for consumers who lose Medicaid/CHIP coverage during the year and allowing assisters to conduct door-to-door enrollment.  The number of Marketplace plans offered in rural areas has been increasing, although there are still fewer plans available compared to urban areas. Comments are due January 30.

 A joint program of the U.S. Department of Health & Human Services (HHS) and the U.S. Department of Defense (DoD) is available at no cost to hospitals caring for COVID-19 patients. Teams of critical care clinicians – critical care physicians, nurses, respiratory therapists, and other specialized clinical experts – are available to deliver virtual care through telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians, and email to learn more and sign up.