Centers for Medicare and Medicaid Services (CMS) regulations at 42 CFR § 438.66(e) require states to submit a Managed Care Program Annual Report (MCPAR). Under the regulation, each state must submit to CMS, no later than 180 days after each contract year, a report on each managed care program administered by the state. In June, Pennsylvania submitted four MCPA Reports: Behavioral HealthChoices, Community HealthChoices, Physical HealthChoices, and Adult Community Autism Program (ACAP).

On August 1, 2023, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital payments (LTCH-PPS) for fiscal year 2024. Effective October 1, 2023, the IPPS rates will increase by 3.1% overall, increasing hospital payments by $2.2 billion. The rule continues the low wage index policy for FY 2024 and will treat rural classified hospitals as geographically rural for purposes of calculating the wage index. It finalizes a policy designating Rural Emergency Hospitals (REHs) as graduate medical education (GME) training sites and codifies in regulation the information hospitals must include in their application to convert to an REH. The rule addresses policies around quality measurement, including the incorporation of a health equity adjustment for the Hospital Value-Based Purchasing (VBP) Program. In addition, CMS received feedback from stakeholders on the potential future inclusion of two geriatric measures and on the establishment of a publicly reported hospital designation for geriatric care.

 CMS released final rules for Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Inpatient Psychiatric Facilities (IPF), and Hospices.   Each rule updates Medicare payment and quality measurement policies for Fiscal Year 2024, which begins October 1. The final rules indicate a 3.3 percent increase in payments for rural SNFs, a 3.6 percent increase in payments for rural IRFs, a 2 percent increase in payments for rural IPSs, and a 2.8 percent increase in payments for rural hospices.

By law, health plans must provide their members with reasonable access to in-network providers and services. Yet many Pennsylvanians face delays of months or even years in scheduling appointments as well as excessively long driving distances to treatment locations. The Pennsylvania Health Action Network (PHAN) released a new report, Healthcare Network Inadequate to Serve All: Causes and Solutions in Pennsylvania, which discusses what happens when health plan networks are inadequate to serve their members, why this happens, and what the Commonwealth of Pennsylvania can do about it.

The Centers for Medicare and Medicaid Services (CMS) released a detailed summary of the mitigation strategies states are using to address areas of non-compliance with Medicaid renewal requirements. This includes a summary of the top 10 mitigation strategies and information on each state’s area(s) of non-compliance and the adopted strategies to address non-compliance. This information is current as of March 31, 2023. CMS also released a three-page summary on CMS authority and oversight on returning to regular Medicaid renewals. This document outlines the data monitoring strategy CMS is implementing, actions CMS can take when states are not complying with federal requirements and technical assistance opportunities from CMS.

Researchers interviewed 20 individuals – clinicians, peer support specialists, cultural practitioners, and others familiar with OUD treatment – in a Minnesota tribal community.  The Cascade of Care model measures the quality of outcomes at each stage of treatment, from diagnosis to long-term maintenance, and was first proposed in 1998 as an approach to care for HIV/AIDS.

By law, health plans must provide their members with reasonable access to in-network providers and services. Yet many Pennsylvanians face delays of months or even years in scheduling appointments as well as excessively long driving distances to treatment locations.

Our new report, Healthcare Network Inadequate to Serve All: Causes and Solutions in Pennsylvania, discusses what happens when health plan networks are inadequate to serve their members, why this happens, and what the Commonwealth of Pennsylvania can do about it.

 The National Conference of State Legislatures provides an overview of programs states have implemented to address or mitigate workforce shortages.  The report describes programs across various stages of education, including K-12, community college, and undergraduate programs.

 This report from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) details key trends in factors that will be important to evaluate the No Surprises Act (NSA) and describes the framework for future evaluations.  The NSA, enacted on December 27, 2020, addresses certain instances of surprise billing where individuals with private health coverage receive unexpectedly high medical bills when they are unknowingly or unavoidably treated by an out-of-network provider, facility, or provider of air ambulance services.  ASPE found that overall, between 2012 and 2020, out-of-network claims decreased similarly in rural and urban areas.