- Biden-Harris Administration Releases National Strategy for Suicide Prevention and First-Ever Federal Action Plan
- Biden-Harris Administration Takes Historic Action to Increase Access to Quality Care, and Support to Families and Care Workers
- Biden Administration Sets Higher Staffing Mandates. Most Nursing Homes Don't Meet Them.
- Rural Jails Turn to Community Health Workers To Help the Newly Released Succeed
- Rural Communities Face Primary Care Physician Shortage
- Miles for Milk: How Student-Run Grocery Store Reshaped Rural Community's Food Access
- Native Americans Have Shorter Life Spans, and It's Not Just Due to Lack of Health Care
- Promotoras Play Essential Role in Connecting Farmworkers with Health Care in Rural NorCal
- Using Medicaid to Address Young People's Mental Health Needs in School Settings
- Across the Country, Amish Populations Are on the Rise
- Sunsets, Wildlife and Limited Care: Challenges of Aging in Place in Rural America
- City-Country Mortality Gap Widens amid Persistent Holes in Rural Health Care Access
- Tribal Environmental Impact Network
- Minnesota's Rural Ambulance Providers Look to State Capitol for Their Own Lifeline
- Biden-Harris Administration Takes Action to Support the Primary Care Workforce
CMS Releases Hospital Interpretive Guidelines for Informed Consent
Last week, the Centers for Medicare & Medicaid Services (CMS) updated this guidance to clarify that informed consent from patients is required before medical students or other students perform important surgical tasks, invasive procedures, or examinations. This guidance specifically references hospital enforced consent obligations in response to increasing public attention to the traditional practice of allowing practitioners or supervised medical, advanced practice provider, or other applicable students to perform examinations to training -related examinations outside the medically necessary procedure, particularly on anesthetized patients.
CMS Announces 2025 Medicare Advantage and Part D Payment Rates
In finalizing changes to payment policies for these programs, the Centers for Medicare & Medicaid Services (CMS) estimates an increase in Medicare Advantage plan revenues by an average 3.7 percent, or over $16 billion, from 2024 to 2025. The notice implements changes to the Part C risk adjustment model finalized in the CY 2024 final rule. The changes will be phased in over a three-year period. CMS also finalized technical updates to the Part C and D star ratings and will implement changes to the standard Part D drug benefit required by the Inflation Reduction Act of 2022. This includes capping annual out-of-pocket costs for people with Medicare Part D at $2,000 in 2025. Finally, CMS reminds stakeholders the agency seeks public input on Medicare Advantage Data – comment by May 29.
CMS Issues Final Rule for 2025 Medicare Advantage and Part D Prescription Drug Program
The changes from the Centers for Medicare & Medicaid Services (CMS) are intended to improve access to behavioral health care; cap and standardize MA plan compensation to brokers which includes prohibiting volume-based bonuses for enrollment into certain plans; streamline enrollment for individuals dually eligible for Medicare and Medicaid; and annually review MA utilization management policies for health equity considerations. Medicare Advantage enrollments continue to become a significant form of insurance coverage for Medicare eligible rural enrollees with 45.1 percent of nonmetropolitan eligible beneficiaries are enrolled in a MA plan (November 2023 RURPI Rural Policy Brief). Additionally, MA enrollment grew by 7.7 percent (2.2 million) from 2022 to 2023; the highest rate of growth was observed in non-metropolitan counties.
Notice of Benefit and Payment Parameters for 2025 Marketplaces Released
The final rule from the Centers for Medicare & Medicaid Services sets standards for Marketplaces and issuers, as well as requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters that help Marketplace consumers. The rule includes policies that extend the special enrollment period for low-income people to enroll in coverage in any month rather than only during Open Enrollment, provides states the ability to increase access to routine adult dental services such as cleanings, diagnostic X-rays, and restorative services like fillings and root canals, and sets network adequacy standards for the time and distance people travel to appointments with in-network providers. The rule standardizes certain operations across the Marketplaces to increase reliability and consistency for consumers. Lastly, the rule includes several policies impacting the Medicaid program, Children’s Health Insurance Program, and the Basic Health Program.
What Happens to Rural Hospitals During a Ransomware Attack? Evidence From Medicare Data
Researchers at the University of Minnesota Rural Health Research Center used data on hospital ransomware attacks from 2016 to 2021, describing disrupted operations at hospitals in rural and urban areas.
An Observational Study of Physicians and Nurse Practitioners Providing MAT
Researchers used data from electronic license renewals in 2021 to examine what factors affect the likelihood of providing medication-assisted treatment (MAT) for opioid use disorder. Physicians and nurse practitioners who were younger, practiced in a public or community health center, and offered a sliding fee scale in their practice had a greater likelihood of providing MAT. The study builds on previous research showing a lack of mental health services, professional burnout, and stigma associated with lower rates of MAT provision in rural areas, with a further look at organizational and personal barriers to prescribing.
ERS Shares Research on the Widening Gap in Urban-Rural Mortality
The Economic Research Service (ERS) at the U.S. Department of Agriculture analyzed natural-cause mortality data for adults aged 25-54 from two three-year periods – 1999 through 2001 and 2017 through 2019. Researchers found that the mortality rate from natural causes such as chronic disease and cancer in rural areas was only 6 percent higher than for city dwellers during the first period, but the gap widened to 43 percent by 2019.
New Oral Health Resources Available in Pennsylvania
PCOH staff have been working on a number of print projects this spring that we hope will be helpful to you in your own advocacy and work.
- Medicaid Provider Brochure: This tri-fold flyer helps explain the many reasons that dentists and PHDHPs should participate in Medicaid and provides information on recent updates to the program.
- Medicaid Patient Brochure: Many adults enrolled in Medicaid don’t even know they have a dental benefit. This flyer helps explain some of the dental benefits offered and shares links to additional resources.
- Finding Dental Care: This flyer is available in English and Spanish and lists high-level resources in PA to help everyone find care.
Thank you to CareQuest Institute for Oral Health for helping to fund this work. These materials are all able to be printed and shipped, or you can use the PDF file to share electronically or print yourself. Email info@paoralhealth.org to request printed materials.
Policy Alert! CMS Publishes Final Rule to Allow States to Select Adult Dental Coverage as an Essential Health Benefit
The Centers for Medicare & Medicaid Services (CMS) released the 2025 Notice of Benefit and Payment Parameters final rule, designed to enhance accessibility and reliability within the Affordable Care Act (ACA) Marketplaces. In Pennsylvania, we use Pennie (pennie.com).
One significant aspect of the new policies is the expansion of access to health care services, particularly the inclusion of adult routine dental care as a state option. Effective January 1, 2027, states can include adult routine dental services as an essential health benefit (EHB) within their plans offered through the marketplaces. However, states can begin the EHB benchmark application process on January 1, 2025.
Navigating Health Policy in an Election Year: Insights From a Health Policy Expert
On the April 2, 2024 episode of Managed Care Cast, we talked with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care® and a health policy professor at Penn State University. Topics discussed include President Biden’s recent prescription drug proposals, prior authorization practices, price transparency, and the potential impact of health policy on the upcoming election.
Listen to the Podcast here.