- 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; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- Public Inspection: CMS: Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: 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 and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
Pandemic Impact: 48,400 Physicians Made a Move
The COVID-19 pandemic accelerated the exodus from private practice to corporate medicine, Fierce Healthcare reports. Between January 1, 2019, and January 1, 2021, hospitals, payers, and other corporate entities acquired 20,900 physician practices, according to the Physicians Advocacy Institute. During that period, 48,400 physicians left independent practice to work for a larger employer. About half of those increases occurred between July 1, 2020, and January 1, 2021. As of January 1, 2021, nearly half of all U.S. practices were owned by hospitals or corporate entities, and 70 percent of physicians were employed by them.
Most Unvaccinated People Have Low Incomes
More than half of unvaccinated Americans live in households that make less than $50,000 annually. Almost two-thirds of unvaccinated people who make less than $50,000 still say they either “definitely” or “probably” will get the vaccine. Making it easier for the working poor to get the COVID-19 shot could help boost vaccination rates. Vaccination has been politicized, but juggling work schedules and child care could be bigger factors than politics, as could worry about experiencing side effects and having to take unpaid time off.
Highmark Proposing to Acquire Gateway Health
Highmark Health will grow by more than 350,000 members if state regulators approve a proposed deal to acquire sole ownership of Gateway Health. The acquisition would expand Highmark’s insurance rolls from 6 million to 6.355 million members, a nearly six percent increase. For nearly three decades, Highmark Inc., has owned 50 percent of Gateway, which is headquartered a few blocks from Highmark’s corporate high-rise in Pittsburgh. The remaining 50 percent of Gateway has been owned by Livonia, Michigan-based Trinity Health, whose provider network spans 90 hospitals and other services across 22 states. Gateway offers Medicaid, Medicare and dual-eligible coverage across Pennsylvania. Highmark’s proposed acquisition of Gateway comes just a few months after the insurer’s affiliation with HealthNow New York Inc. became effective. The newly affiliated organization — which expanded Highmark’s reach to four states — has been rebranded Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York.
Biden Administration Regulatory Agenda includes Medicaid
The Office of Management and Budget released their Unified Regulatory Agenda (URA). The URA, which is updated twice each year, serves as an indicator of discrete regulatory priorities of the Administration and a timeline for expected action. However, the timelines are often aspirational and should not be viewed as hard and fast deadlines. The URA for the U.S. Department of Health and Human Services includes several Medicaid-oriented proposals, including:
- Streamlining the Medicaid and CHIP Application, Eligibility Determination, Enrollment, and Renewal Processes
- Medicaid Drug Misclassification, Beneficiary Access Protection, and Drug Program Administration
- Mandatory Medicaid and CHIP Core Set Reporting
- Medicaid Managed Care Risk-Sharing Mechanisms
- Temporary Federal Medical Assistance Percentage (FMAP) increase under the Families First Coronavirus Response Act
Presidential Order on Competition Includes Health Care
On July 9, President Biden signed an Executive Order aimed at curbing anti-competitive practices within several industries, including in health care. A fact sheet on the order is available here. Key provisions include:
- Drug Importation. The order directs the Food and Drug Administration (FDA) to work with states and Tribes on a plan to import prescription drugs from Canada, pursuant to the Medicare Modernization Act of 2003.
- The order directs the Department of Health and Human Services (HHS) to increase support for generic and biosimilar drugs.
- Drug Pricing. HHS is directed to issue a comprehensive plan within 45 days to combat high prescription drug prices and price gouging.
- Pay for Delay. The order encourages the Federal Trade Commission (FTC) to ban “pay for delay” and similar agreements in the pharmaceutical sector by way of federal rulemaking.
- Hospital Mergers. The order emphasizes that hospital mergers can be harmful to patients, encouraging the Department of Justice (DOJ) and FTC to review and revise hospital merger guidelines.
Pennsylvania Congressman Glenn Thompson Reintroduces Telehealth Bill
U.S. Rep. Glenn Thompson (R-PA) plans to soon reintroduce his HEALTH Act (H.R. 7187 in the 116th).
This bill would codify Medicare reimbursement for FQHCs and rural health clinics for telehealth services. The bill would permanently allow FQHCs/RHCs the ability to provide telehealth services under Medicare. A change from the earlier bill is that reimbursement, instead of being associated with the Medicare Physician Fee Schedule, would be at the same level as if a Medicare beneficiary would receive the same services at a brick-and-mortar FQHC/RHC. The bill includes a provision to make permanent the waivers contained in the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, relating to originating site rules (waivers which are otherwise in effect for the public health emergency period), specific to services where the FQHC/RHC is the distant site provider.
Work Search Requirements Reinstated for Pennsylvania’s Unemployed
Changes to the benefits and rules for unemployment during the COVID-19 pandemic have been identified by many economists and employers as a reason for the substantial number of currently unfilled jobs throughout the nation while unemployment rates remain high. Pennsylvania is struggling with the same situation – continuing levels of high unemployment while there are a sizable number of available jobs – but that might soon start changing as the state’s work search requirement (suspended since March 2020) for those receiving jobless benefits is reinstated this week. Technically, because Unemployment Compensation (UC) claimants always file for benefits the week after they are unemployed, individuals will start certifying they looked for work beginning July 18 – but that doesn’t change that they need to start looking this week.
State officials late last week said job seekers can find help through the state’s PA CareerLink® website or their local PA CareerLink® office, with programs available to help with job search, training and resume assistance as well as provide adult education and other referral services. Additionally, the state Department of Human Services offers employment and training programs that support job seekers specifically within low-income populations.
A New Tool: Vaccine Hesitancy by Zip Code & County
The COVID-19 Collaborative and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine released a new tool that shows data on people’s openness to receiving a COVID-19 vaccine by zip code and county for the entire United States. With more than 30,000 zip codes, compared to only 3,000 counties, this tool offers a ten-fold increase in the localization of data on vaccine intention and will be a significant contribution to vaccine uptake efforts. Current existing visualization maps show only up to the county level. Some vaccine intention rates in counties mask the low level of intention within zip codes in those counties, so it is critical to have this level of data.
Apply Now to Become an HHA Healthy People 2030 Champion
Recognizing that collaboration is essential to achieving the Healthy People 2030 vision, the HHS Office of Disease Prevention and Health Promotion (ODPHP) has launched a new program, inviting public- and private-sector organizations that support Healthy People’s vision to become Healthy People 2030 Champions. Healthy People 2030 Champions are organizations committed to working toward Healthy People’s overarching goals and objectives. ODPHP will recognize Healthy People Champions on health.gov, and Champions will receive a digital badge to highlight their support of the Healthy People 2030 initiative on their own websites. They’ll also receive ongoing information, tools, and resources to help them promote Healthy People 2030 among their communities, partners, and others interested in achieving Healthy People 2030 goals.
If your agency is interested in becoming a Healthy People 2030 Champion, you can learn more at https://health.gov/news/202106/apply-become-healthy-people-2030-champion. ODPHP will also be hosting an informational webinar for organizations interested in becoming Healthy People Champions on July 28, 2021 at 1pm ET. You can register for the webinar here.
Thank you for your support of Healthy People 2030, and we look forward to working with you over the decade! Please stay tuned for forthcoming information on a Healthy People Coordinator kick-off virtual meeting. Tiffani Kigenyi (Tiffani.Kigenyi@hhs.gov) from ODPHP will serve as point of contact for these efforts. Please feel free to contact Tiffani with any questions.
Communities Across the Country Can Apply for $3 Billion in Funding Immediately
U.S. Secretary of Commerce Gina M. Raimondo announced six programs, collectively called Investing in America’s Communities, that the Economic Development Administration (EDA) will execute to equitably invest the $3 billion it received from President Biden’s American Rescue Plan.
This EDA investment is the largest economic development initiative from the Department of Commerce in decades and will help communities across the country build back better.
Investing in America’s Communities includes:
- Build Back Better Regional Challenge ($1 billion) will capitalize on American ingenuity and American workers by providing a transformational investment to regions across the country to revitalize their economies.
- Good Jobs Challenge ($500 million) is designed to help get Americans back in good-paying jobs. The program will develop and strengthen regional workforce training systems and sector-based partnerships with a focus on programs targeted at women, people of color and historically underserved communities.
- Economic Adjustment Assistance ($500 million) grants will help hundreds of communities across the nation plan, build, innovate, and put people back to work through projects tailored to meet local needs.
- Indigenous Communities ($100 million) program will work hand-in-hand with Tribal Governments and Indigenous communities to develop and execute economic development projects they need to recover from the pandemic and build economies for the future.
- Travel, Tourism and Outdoor Recreation ($750 million) program will focus on revitalizing the hard-hit travel, tourism, and outdoor recreation industries and accelerate the recovery of communities that rely on these sectors.
- Statewide Planning, Research and Networks ($90 million) grants include funding for state planning efforts as well as grants to build Communities of Practice to extend technical assistance to support EDA’s work with grantees.
As part of the six programs, EDA is making a Coal Communities Commitment, allocating $300 million to ensure support for these communities as they recover from the pandemic and create new jobs and opportunities, including through the creation or expansion of a new industry sector.
To learn more about EDA and our American Rescue Plan Funding Opportunities sign up for our webinar, EDA 101 and America Rescue Plan Overview, which will be held on July 27 and July 29.
For more information, visit www.eda.gov/ARPA for the latest news on EDA’s implementation plans. Sign up for the EDA newsletter and follow EDA on social media: Instagram, Twitter, LinkedIn, Facebook and YouTube.