The Centers for Medicare & Medicaid Services (CMS) issued new guidance to clarify that state Medicaid and CHIP programs will be able to pay specialists directly when a beneficiary’s primary healthcare provider asks for advice. The aim is to help improve access to specialty care, particularly mental health care services.  Citing FORHP-supported research, CMS  notes that, “Rural areas face the most significant provider shortage challenges; more than 60 percent of nonmetropolitan counties do not have a psychiatrist and almost half of the nonmetropolitan counties do not have a psychologist.”  Up to now, providers referring a patient to specialty care were required to coordinate payment through separate agreements with the treating practitioner.  The new policy gives state-level Medicaid and CHIP agencies the flexibility to reimburse consulting practitioners directly.  Importantly, these consultations can occur when the beneficiary is not physically present. To be covered under Medicaid or CHIP, both the treating practitioner and the consulting practitioner must be enrolled in Medicaid or CHIP. For consultations that cross state lines, consulting practitioners must be enrolled in Medicaid or CHIP providers in the state in which the beneficiary resides. For more information, see the State Health Official Letter available on Medicaid.gov.

On January 11, HHS extended the current Public Health Emergency (PHE) declaration for another 90 days. The extension of the PHE means the continuation of flexibilities for healthcare providers, such as the COVID Waivers issued by CMS.

HHS extended the deadline for submitting comments on the updated draft HHS Tribal Consultation Policy to January 27, 2023. The updated draft addresses comments and recommendations received during the first round of consultation in spring 2021, as well as the input of the Secretary’s Tribal Advisory Committee (STAC) Tribal Consultation Policy Workgroup. Comments on the updated draft may be submitted to consultation@hhs.gov. Please see the Dear Tribal Leader Letter, linked above, outlining the major recommendations and changes in the updated draft. Also, please see the clean and redline version of the updated draft to facilitate the commenting process. – New Deadline, January 27.

 The Centers for Medicare & Medicaid Services (CMS) added a telehealth indicator on Medicare Care Compare, the site that allows consumers to search for doctors, clinicians, groups, and facilities accepting Medicare beneficiaries.  Last year, CMS reported a 30-fold increase in telehealth services.  The new indicator helps beneficiaries and caregivers more easily find clinicians who provide telehealth services.

 The Centers for Medicare & Medicaid Services (CMS) awarded the first round of Medicare-funded residency slots to 100 teaching hospitals across 30 states, the District of Columbia, and Puerto Rico, effective July 1, 2023.  The graduate medical education slots prioritize hospitals located in Health Professional Shortage Areas, and the majority are allocated for primary care – including obstetrics/gynecology – and mental health specialties.  CMS is set to create 200 new positions every year over the next five years.  The application period for the second round of 200 residency slots will open in January 2023 and close on March 31, 2023.

A new state law regarding blood lead tests for young children went into effect on Tuesday. The state Health Department gave notice in the Pennsylvania Bulletin regarding how Act 150 of 2022 is to be implemented by healthcare providers. The law requires that doctors should order blood tests for pregnant moms and young children if they determine that the women or children are at risk of lead exposure. The notice said a health care provider will consider possible lead exposure by evaluating risk factors in accordance with recommendations from the federal Centers for Disease Control (CDC) and American Academy of Pediatrics for children 24 months of age or under and the CDC and American College of Obstetricians and Gynecologists guidelines for pregnant women.

Average American life expectancy fell from 77 to 76.4 years last year, bringing U.S. figures back to where they were in 1996, according to new federal data. For American men, life expectancy fell by more than eight months, and for women, the loss was about seven months, the study found. Life expectancy, which is a measure of death rates, dropped in every age category over age 1. Though the rate of decline in life expectancy wasn’t as dramatic as in 2020, the fall-off in 2021 was worse because it came on top of that year’s 17% decline. The latest decline came as other wealthy countries saw a rebound after the first year of the pandemic. The race gap reversed somewhat in 2021 as white people lost more ground than people of color, though they still live longer on average. Read more.

The Rothman Opioid Foundation for Opioid Research & Education is offering a free online curriculum that will aid current and future prescribers to fight opioid addiction across the Commonwealth of Pennsylvania and the Appalachian region. Launched in 2019, the Philadelphia nonprofit is dedicated to raising awareness of the risks and benefits of opioids, while educating physicians, other providers, patients, and policymakers on safe opioid use. The organization also supports research and education to use alternative pain strategies to decrease opioid use. Click here to access additional details on the Opioids & Pain Management course and to take it.

The Pennsylvania Department of Human Services, Office of Medical Assistance Programs has issued MA Bulletin 99-22-11, Reinstatement of Provider Enrollment Requirements. In response to the COVID-19 pandemic, DHS requested provider enrollment flexibilities under Section 1135 of the Social Security Act. CMS approved DHS’ Section 1135 request for provider enrollment flexibilities on March 27, 2020. Providers were advised of these flexibilities in Provider Quick Tip 240, which was issued on April 9, 2020. Effective Feb. 27, 2023, this Bulletin reinstates the requirements for provider payment for enrollment application fees, fingerprint-based backgrounds, and site visits for providers. Providers temporarily enrolled in the MA Program during the Public Health Emergency who did not satisfy the enrollment requirements that were suspended under the Section 1135 flexibilities must satisfy the enrollment requirements as described in the Bulletin.