The National Association of Community Health Centers (NACHC), a HRSA-funded national training and technical assistance partner (NTTAP), shares this publication, Guidance: Sliding Coinsurance for CMS/Medicare Care Management Services, to assist health centers with managing the relationship between CMS/Medicare care management services and sliding fee policies. While health centers are required to enforce Medicare coinsurance for CMS/Medicare care management services, the coinsurance may be “slid” in accordance with the health center’s sliding fee discount program (SFDP) policy. Federal anti-kickback statutes and beneficiary inducement prohibitions include exceptions allowing health centers to discount coinsurance for patients who are eligible for the health center’s sliding fee discount program without violating Medicare rules.

A consumer is eligible to have an Advance Premium Tax Credit (APTC) for health insurance on the Marketplace paid on their behalf if they meet all of the following requirements:

• Is not claimed as a dependent by another person
• For one or more months of the year, the consumer or another member of the consumer’s tax family (spouse, if filing jointly, and dependents) is enrolled in coverage (excluding catastrophic coverage) through the Individual Marketplace
• Is not eligible for or enrolled in other minimum essential coverage (MEC); for example, is not offered “affordable” coverage through an eligible employer-sponsored plan that provides minimum value or enrolled in employer-sponsored coverage (ESC) regardless of affordability or provision of minimum value

• •  An employer-sponsored plan is affordable if the self-only premium is no more than 9.78 percent of annual household income in 2020
  •  It provides minimum value if the plan covers at least 60 percent of the total cost of medical services for a standard population and includes substantial coverage of physician and inpatient hospital services

• Is not eligible for coverage through a government program like Medicaid, Medicare, CHIP or TRICARE

Pennsylvania will be transitioning to a state-based marketplace for the 2021 health insurance enrollment period. The Pennsylvania Insurance Department (PID) has released the health insurance plan rate filings as required under the Affordable Care Act. All 67 PA counties will have coverage options available for consumers, with a gain of one new insurer in 13 counties. If these rates are finalized as planned, there will be an average statewide premium decrease of 2.6% on the individual market and an increase of 2.2% in the small group market. PID has been watching enrollment trends across all sectors, including employer-sponsored COBRA, Medicaid, CHIP and Marketplace enrollment during the COVID-19 pandemic. Thousands of individuals moved to employer-sponsored COBRA plans during the COVID crisis and many of these individuals may be eligible for Medicaid or may seek a special enrollment period through the Health Insurance Marketplace, which will allow consumers access to subsidies for changes in their income due to loss of employment or coverage. Details are available on the PID website.

Pennsylvania Governor Tom Wolf signed his 11th renewal of his January 2018 opioid disaster declaration to help the state fight the then-burgeoning opioid and heroin epidemic. The declaration allows the state to loosen regulations and work outside of typical procedures to expedite aid and initiatives to help those suffering from opioid use disorder and those who work to prevent and treat this medical condition.

“In the midst of the COVID-19 pandemic, the commonwealth’s Opioid Command Center continues its work to fight another health crisis – the opioid epidemic,” Gov. Wolf said. “The work that is enabled by this declaration is vital to saving the lives of so many Pennsylvanians, providing education and treatment, and advancing initiatives across the state to continue to battle this epidemic. This work is no less important during COVID and I am grateful for all those dedicated professionals who continue the drumbeat of compassionate care and work toward ending this crisis.”

The declaration allows for the redirection and reorganization of commonwealth resources to align programs from multiple agencies to work together to mitigate the opioid crisis, its causes and its effects. Because of the magnitude and complexity of the opioid crisis, additional resources may be needed to fully contend with the severity of this continuing and expanding disaster emergency.

“As the commonwealth continues to grapple with the COVID-19 pandemic, continuing our fight against the opioid epidemic has never been more important,” said DDAP Secretary Jennifer Smith. “Governor Wolf’s 11th renewal of the disaster declaration shows his unwavering commitment to support individuals suffering from substance use disorder and focusing resources to support the drug and alcohol community.”

Yesterday, Secretary of Health Dr. Rachel Levine signed an updated naloxone standing order permitting community-based organizations to provide naloxone by mail. This will assist organizations with distributing naloxone to Pennsylvanians in-need while reducing the risk of COVID-19 transmission. All Pennsylvanians can continue to obtain naloxone at a pharmacy under a previous standing order issued by Dr. Levine in 2018.

“The opioid crisis continues for those with the disease of addiction, our communities and our state,” Secretary of Health Dr. Rachel Levine said. “Renewing the disaster declaration allows us to continue our efforts to ensure that we are helping those in need. Recovery works, and treatment is possible for those with this disease.”

Work to address the opioid crisis focuses on three areas: prevention, rescue and treatment. Efforts over the past several years, working with state agencies, local, regional and federal officials, have resulted in significant action to address the opioid crisis:

• The Prescription Drug Monitoring Program has reduced opioid prescriptions by 34 percent and has virtually eliminated doctor shopping.
• The number of people receiving high dosages of opioids (defined as greater than 90 morphine milligram equivalents per day) has dropped 53 percent since the PDMP launched in August 2016.
• The Opioid Data Dashboard and Data Dashboard 2.0 has provided public-facing data regarding prevention, rescue and treatment.
• 11 Pennsylvania Coordinated Medication Assisted Treatment (PacMAT) programs are serving as part of a hub-and-spoke model to provide evidence-based treatment to people where they live, with just under $26 million dedicated into the centers.
• More than 45 Centers of Excellence, administered by the Department of Human Services, provide coordinated, evidence-based treatment to people with an opioid use disorder covered by Medicaid. The COEs have treated more than 32,500 people since first launching in 2016.
• The waiver of birth certificate fees for those with opioid use disorder has helped close to4,800 people, enabling easier entry into recovery programs.
• A standing order signed by Dr. Rachel Levine in 2018 allowed EMS to leave behind more than 2,400 doses of naloxone.
• Education has been provided to more than 6,600 prescribers through either online or face-to-face education.
• 882 drug take-back boxes help Pennsylvanians properly dispose of unwanted drugs, including 178,540 pounds of unwanted drugs in 2019.
• The Get Help Now Hotline received close to 38,700 calls, with nearly half of all callers connected directly to a treatment provider.
• The state prison system has expanded their Medication Assisted Treatment (MAT) program which is viewed as a model program for other states.
• A body scanner pilot project was successful in reducing overdoses and violent crime in a number of facilities. Body scanners are in place in more than 30 locations and are currently being expanded to additional facilities.
• Several agencies have worked together to collaborate on the seizure and destruction of illicit opioids across Pennsylvania.
• Education and training on opioids have been provided to schools. Future plans are in place to make opioid education a standard component of their school-based training.
• The coordination with seven major commercial providers has expand access to naloxone and mental health care, while also working to make it more affordable.
• Naloxone has been made available to first responders through the Commission on Crime and Delinquency, with more than 63,400 kits made available and close to 12,700 saves through that program. More than half of those saves, 6,633, occurred in 2019.
• EMS have administered more than 40,600 doses of naloxone and more than 10,000 doses were made available to members of the public during the state’s naloxone distribution last year.

For more information on Pennsylvania’s response to the opioid crisis visit www.pa.gov/opioids.

The Office of the National Drug Control Policy announced $15.9 million in discretionary funding for its HIDTA Program, adding to the $266 million in baseline funding released earlier this year. Combined, this represents the highest award level ever for the HIDTA program. This new allocation of discretionary funds expands the HIDTA Overdose Response Strategy (ORS) — a public health and public safety partnership designed to reduce overdoses and save lives — to all 50 states.

Read the full ONDCP press release HERE

The Pennsylvania Department of Drug and Alcohol Programs is providing the opportunity for public comment on its annual Pennsylvania Substance Abuse Prevention and Treatment Block Grant (SABG) Submission. This submission will occur in three parts:

1. The Substance Abuse Prevention and Treatment (SAPT) Plan which will be submitted to SAMHSA by October 1 and is currently available in draft and available for review by September 30;
2. The SAPT Report which will be available in November for comment prior to submission on December 1st, and;
3. The Annual Synar Report which will also be made available in December for comment prior to submission on December 31st.

These documents can be accessed at bgas.samhsa.govOpens In A New Window utilizing “citizenpa” as your login and “citizen” as your password.

Please submit all comments to ra-dabaps@pa.gov by timeframes indicated.