Rural Health Information Hub Latest News

DEA Proposes to Make Telemedicine Flexibilities Permanent

The Drug Enforcement Administration (DEA) announced last week that it is proposing rules to make permanent many flexibilities for telemedicine that were established amid the COVID-19 pandemic, with certain safeguards. The DEA said in a release that the rule will give patients access to virtual therapies beyond the end of the COVID-19 public health emergency, which is scheduled to conclude in May. The rules would include certain safeguards for telemedicine consultations from a medical provider who has not conducted an in-person evaluation of a patient and that results in the provider prescribing the patient a controlled medicine. They would allow medical providers to prescribe a 30-day supply of Schedule III and Schedule IV non-narcotic controlled drugs, which are the least likely to result in drug abuse, or a 30-day supply of buprenorphine to treat opioid use disorder without an in-person evaluation or referral, according to the release. The DEA added that the rules would not affect telemedicine consultations that do not involve prescribing controlled medications or those where the provider has conducted an in-person examination of the patient. The updates would also not affect telemedicine consultations and prescriptions from a provider that a patient has been referred to if the referring provider has conducted an in-person examination.

Pennie Announces the New Executive Director

Following a nationwide search, the Pennsylvania Health Insurance Exchange Authority (Pennie) Board of Directors has named Devon Trolley as the next Executive Director of Pennie. Zachary Sherman, Pennie’s inaugural Executive Director, will be stepping down at the beginning of March after more than three years in the role. Devon joins Pennie with extensive Affordable Care Act policy, operational, and leadership experience. Prior to her tenure in New Jersey, Trolley worked for the federal government at the Centers for Medicare and Medicaid Services (CMS) on the implementation and stabilization of the federal health insurance marketplace (Healthcare.gov) in key strategic and policy roles. She also served as a Senior Advisor in the Office of the CMS Administrator working to address the opioid crisis and improve maternal health. Trolley developed health policy in the United State Senate during the passage of the Affordable Care Act in 2010 and is an alumna of Penn State University.

Unwinding, Unwinding, Unwinding in Pennsylvania

As the Pennsylvania Department of Human Services (DHS) begins the Medicaid Continuous Coverage unwinding April 1, DHS is working in conjunction with PA’s health insurance exchange, Pennie, to minimize the number of people who may become uninsured or fall into the coverage gap. There has been an increase of over 820,000 Medicaid enrollments since March 2020 to over 3.6 million due in part to the continuous coverage provision. Some things to keep in mind as Medicaid redeterminations begin:

  •  The number of recipients churning on and off Medicaid decreased as those likely ineligible for Medicaid remained on the rolls. When “normal” renewal and redetermination processing begins, consumers who are deemed ineligible and have coverage terminated will need to appeal and/or request a redetermination within 90 days. Consumers who have coverage terminated will keep coverage under their current Medicaid managed care organization (MCO) until the end of the month.
  •  Health centers should collaborate with MCOs on outreach to assist consumers with renewals and assistance with enrolling in Pennie, if deemed eligible. Health centers must also rely on health insurance enrollment assisters, eligibility and financial counselors and front desk staff to ensure processes and procedures are in place to identify and remind Medicaid patients to update their demographic information with DHS and their HealthChoices MCO. Consumers can renew over the phone at 1-866-550-4355, complete their renewal online in COMPASS, by mail, or in-person at the county assistance office.

On January 5, 2023, the Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin that included timelines for states to submit a renewal redistribution plansystem readiness plans and results, and baseline unwinding data based on when states plan to begin renewals. Along with enhanced reporting requirements, states are required to report the total number of individuals renewed and those renewed on an ex parte basis, break out Medicaid terminations for children’s coverage and pregnancy-related coverage, report the number of individuals whose coverage was terminated for procedural reasons, and report total call center volume, average wait time, and average abandonment rate. Pennsylvania’s lowest uninsured rate was 5.5% but this number is expected to increase over the next 12 months.

The DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities

Last week, the Drug Enforcement Administration (DEA) announced proposed rules for the prescribing of controlled medications via telemedicine beyond the end of the COVID-19 public health emergency. One rule addresses the expansion of induction of buprenorphine via telemedicine encounter while the other covers telemedicine prescribing of controlled substances when the practitioner and the patient have not had a prior in-person medical evaluation. While opioid use disorders occur at similar rates in both rural and urban areas, medication-assisted treatment (MAT) prescribers have been disproportionately located in urban areas. Comments are due by March 31, 2023.

New Information Has Been Released on COVID-19 Waivers and Flexibilities

Earlier this week, the Centers for Medicare & Medicaid Services released a fact sheet with updates to policy on vaccines, testing, and treatments; telehealth services; continuing flexibilities for healthcare professionals; and expanded hospital capacity through care in a patient’s home.  Last week, the agency provided updates specific to Rural Health Clinics and Critical Access Hospitals, describing the Medicare and Medicaid waivers and flexibilities that have been terminated, made permanent, or that will end with the public health emergency (PHE) on May 11, 2023.

HRSA Needs Rural Reviewers for Grant Applications

The Health Resources and Services Administration (HRSA) relies on grant reviewers to select the best programs from a competitive group of applicants. Over the coming months, the Federal Office of Rural Health Policy will be competing a number of programs, including among other things: substance use disorders and opioid use disorder, rural workforce, and rural hospitals. Having reviewers with expertise in rural health greatly benefits the review process and is also an opportunity to learn about the review process itself. Reviews are typically held remotely over a period of a few days and reviewers who participate and complete their assigned duties receive an honorarium. Registration is easy and does not commit you to serving as a reviewer. Please consider lending your expertise to these important initiatives.

Greater Hardship for Rural Hospitals in States that Haven’t Expanded Medicaid

  A new analysis from the national nonprofit Kaiser Family Foundation reports slimmer operating margins for rural hospitals (2.2 percent versus 3.9 percent in states with Medicaid expansion) for the period from July 2021 through June 2022.  Moreover, the report says these margins would have dropped to 1.2 percent in expansion states and -0.7 percent in non-expansion states if not for federal COVID-19 relief funds.

Understand Firearm Deaths by State Here

 RAND Corporation, an independent research organization, examined state-level mortality data to compare state-by-state and national-level rates of death.  An interactive map that sorts by gender, race (Black, White, and Hispanic), urban/non-urban, and age shows that 29 of 50 states have an annual rate of death higher than the national average.  The data originated with the Centers for Disease Control and Prevention, which last year announced historically high rates of firearm homicide nationwide and the highest rates of firearm suicide in rural areas.  RAND reports that suicide deaths drive the overall death rate higher in nonurban areas.  A second interactive map shows how adding or removing firearm laws could affect death rates in each state.