- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- 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; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
Pennsylvania Sues Juul, Demands Ban on Maker’s Vaping Products
Philadelphia Inquirer, by Sarah Gantz,
Pennsylvania has joined a growing list of states suing leading e-cigarette maker Juul Labs, whose sleek vape pens and cartridges in fruit, dessert, and candy flavors have been blamed for contributing to a sharp rise in e-cigarette use among teenagers and adolescents.
The lawsuit, filed Monday by Pennsylvania Attorney General Josh Shapiro, alleges that Juul misled consumers about the health risks and addictive power of its nicotine vaping pods and improperly marketed the products to youths. The lawsuit seeks a statewide ban on all Juul products, including tobacco-flavored ones. If the court does not grant a full ban, the state wants to ban all of Juul’s flavored, menthol, and high-nicotine vaping products except those that are tobacco-flavored.
The U.S. Food and Drug Administration this month forbade the sale of flavored vaping pods nationwide. Over the last two years, Juul has phased out sales of flavored pods, except for those with menthol and tobacco flavors.
“Juul knowingly targeted young people with tactics similar to the tobacco companies’ playbook,” Shapiro said in a statement. “There is no proof these e-cigarettes are safe and until there is, we need to get Juul products off shelves and out of the hands of young people.”
Juul has said that adults are its target audience and that it does not aim to attract underage customers.
“While we have not yet reviewed the complaint, we remain focused on resetting the vapor category in the U.S. and earning the trust of society by working cooperatively with attorneys general, regulators, public health officials, and other stakeholders to combat underage use and convert adult smokers from combustible cigarettes,” said Austin Finan, a spokesman for Juul, in a statement.
Last year, the company ceased all major digital, print and television advertising, and said it would not lobby Congress over a federal ban on flavored e-cigarettes.
Pennsylvania’s lawsuit and similar suits in New York, Massachusetts, California and other states follow a surge of vaping-related lung illnesses and deaths that cast a spotlight on the sharp rise in vaping among teenagers. Bucks and Montgomery Counties have also sued.
Vaping-related lung illnesses spiked over the summer and have been declining in recent months. As of Jan. 21, a total of 2,711 people have been hospitalized, and 60 have died, according to the U.S. Centers for Disease Control and Prevention. The CDC found a strong link between the illnesses and vitamin E acetate, an additive in some vaping products containing THC, the psychoactive ingredient in cannabis. That ingredient has not been found in nicotine vaping pods, such as those sold by Juul. But the outbreak of illnesses drew attention to vaping’s rising popularity among young adults. More than a third of the cases involved patients between ages 18 and 25.
While combustible cigarette smoking rates have declined, nicotine vaping rates more than doubled among high schoolers between 2017 and 2019, with about a third of high school seniors reporting that they have vaped within the last 30 days, according to the National Institute on Drug Abuse’s 2019 Monitoring the Future Survey. The annual report surveys 42,500 students in grades 8, 10, and 12 at 400 public and private schools across the country. Marijuana vaping has also risen dramatically among teenagers. In response to teen vaping trends, many states and cities have pursued legislation to restrict e-cigarette sales.
Philadelphia is rolling out a ban on the sale of flavored vaping pods and those with high levels of nicotine at stores that teens and children are allowed to enter, such as 7-Eleven and Wawa, as well as smaller retailers. The FDA ban took effect Feb. 6. It affects one-time use cartridges in fruit, candy and mint flavors, which are available at convenience stores and have been popular among teens. The ban does not apply to menthol and tobacco flavors or tank-based vaping systems sold at specialty vape shops.
New Fund Helps PA Abuse Survivors Pay for Counseling Without Involving Police
Pennsylvanians who have experienced sexual assault and never reported it to police can apply for a share of $5 million to pay for counseling.
“What we have seen with the #MeToo movement, what we have seen with all the unfortunate cases that have befallen Pennsylvania — whether it’s the Jerry Sandusky case, the Bill Cosby case, the [Catholic] Archdiocese … and now we’re seeing it also with the Jehovah’s Witnesses — what that’s doing is kind of stirring up all of these old wounds that have never come forward,” said Jennifer Storm, the commonwealth’s victim advocate.
The state has previously established funds available for crime victims seeking counseling, but Storm said abuse survivors needed to have filed reports with police and claims with the state within two years from the time they gained knowledge of the abuse, which isn’t always plausible. She said the state decided to do something to address barriers to treatment when it saw the Roman Catholic Church’s response to abuse claims after the release of a historic grand jury report that outlined widespread clergy sexual abuse in six Pennsylvania archdioceses.
The church created victims’ compensation funds that put money aside for counseling, made free therapy available for survivors, and reimbursed victims if they sought private therapy before the funds were made available.
“You almost had this huge door that opened that enabled you to access funds and counseling that no other survivor in the commonwealth had,” said Storm.
That left other victims wondering: What about me?
The $5 million set aside from the state’s general fund eliminates the requirement to file a police report and has no statute of limitation.
Victims who were abused before their 18th birthday can get up to $10,000 for therapy. If the abuse occurred after turning 18, victims can access up to $5,000 for therapy with a psychiatrist, psychologist, licensed professional counselor, or licensed social worker by filling out a Sexual Assault Counseling Claim form.
Clergy abuse survivors who received financial help from the church’s compensation funds can also apply for the newly freed state dollars.
Storm said the new funds will provide help to those who have not reported their assaults to law enforcement out of fear of not being believed. According to the Rape, Abuse & Incest National Network, known as RAINN, 3 out of 4 survivors don’t report their assaults — whether out of fear of retaliation or because they thought there was not enough to report.
“It is not the norm to have an assault and then immediately report it, go to the hospital, go to law enforcement,” said Storm. “That certainly does happen, but what we know is that that’s not the norm. The norm is that there’s usually a delayed disclosure.”
But swift action is what the state’s Victims Compensation Assistance Program — the only state-sponsored financial recourse victims had until this week — requires.
VCAP offers up to $35,000 to victims of any crime — not limited to sexual abuse — and can be used to offset the costs of medical expenses, loss of earnings, and counseling. Up to $10,000 can go to therapy, depending on the victim’s age when the abuse happened.
But access to any of that money requires navigating a sometimes-retraumatizing system.
“In part, law enforcement has been a relatively hostile venue for survivors, and even when it’s supportive, it’s a very complex system to be involved in,” said Carol Tracy, executive director of the Women’s Law Project, which has long partnered with police departments to review how they handle sex crimes.
Victims are often interviewed multiple times by police, and have to go through thorough physical examinations for evidence, which is why that process has resulted in underreporting of such incidents across the country.
Survivor advocates have long argued that the quick action required of victims does not always align with how survivors respond.
As with VCAP funds, the risk of fraud is minimized through a vetting process and giving the funds directly to the treatment provider, Storm said. That medical professional is expected to confirm that the client is receiving help.
“As many of us are trying to work to reform our justice system to be more responsive to survivors of sexual assault, this is something that is an important interim measure to make sure that people do have some opportunity outside of law enforcement to get some public funds to help them,” said Tracy.
Seven people have submitted applications so far.
Connecting Medicaid Enrollees to Employment & Training Programs
Pennsylvania Department of Human Services Secretary Teresa Miller and Department of Labor & Industry Secretary Jerry Oleksiak joined PCN TV to discuss a new partnership that will connect Medicaid recipients to employment and training programs.
Medicaid Work Supports
The Medicaid Work Supports initiative will identify and connect Medicaid enrollees to resources that can help address barriers to employment and lead to more success in the workforce.
“The Wolf Administration strives to build a Pennsylvania that works for everyone, and that includes making meaningful, sustaining employment accessible to all people, particularly underserved communities that may experience greater barriers to finding and retaining employment,” said Sec. Miller. “We want all people to be able to work, but we cannot do so in a way that is punitive or risks access to the health care people need to be able to get a job. The Medicaid Work Supports initiative will create that connection to employment and training.”
The Medicaid Work Supports initiative will create a more direct and systematic introduction to employment and training resources available to Pennsylvanians. When people are deemed eligible and enroll in a new Medicaid health plan, they will be asked if they are interested in help finding a job, training programs, and opportunities to get a high school diploma or GED. The referral system will help identify this population for the first time and create the opportunity for a meaningful, encouraging partnership between the MCOs, the PA CareerLink® system, and the enrollee to facilitate connections to employment and success in the workforce.
Individuals interested in learning more about these services will receive outreach either through PA CareerLinks®, their selected health plan, or their local county assistance office to provide awareness of and referrals to resources and programs available in their local community.
DHS will work with its partners to monitor whether outreach attempts and connections to employment or training programs are being made through PA CareerLinks® and in partnership with the MCOs. This data will be used to evaluate and identify effectiveness of this referral system, opportunities for new interventions or connections, and emerging best practices as the partners gain more experience with this referral model.
“This partnership between DHS and L&I is a great example of state agencies working together to assist people,” said Sec. Oleksiak. “PA CareerLinks® matches employers with qualified and skilled candidates and helps prepare job seekers to meet local employer’s needs. Providing Medicaid recipients with a connection to the employment and training services PA CareerLinks® provide can be the first step toward individuals obtaining the skills they need to enter, or reenter, the workforce and move toward gainful employment.”
Many MCOs offer employment and education support programs for their Medicaid enrollees and are integrating remediating barriers to employment and addressing social determinants of health like housing, food security, and transportation into these programs.
PA CareerLink® has a customer-centered approach that helps prepare job seekers to meet the needs of the global economy and matches employers with qualified and skilled candidates. PA CareerLink® provides workforce services to more than 783,753 job seekers annually. In addition, over 120,000 employers post more than 212,000 jobs a year with PA CareerLink® and access a range of free services, including customized job training programs and talent matching.
The Medicaid Work Supports initiative builds upon work by DHS and L&I to redesign employment and training programs for Pennsylvanians receiving Temporary Assistance for Needy Families (TANF), many of whom are also covered by Medicaid.
Policy Updates: Comments Requested: Proposed Changes to 2021 Health Insurance Marketplace
Comments Requested: Proposed Changes to 2021 Health Insurance Marketplace – March 2. Last week, CMS posted its proposed changes to the Notice of Benefits and Payment Parameters and its draft Annual Letter to Issuers, which provide guidance to states and insurers for the administration of the American Health Benefit Exchanges (aka “the Marketplace”) in 2021. Proposals address the cost of prescription drugs, determining eligibility for other public programs, the user fee rate, and the display of quality rating information on State-based Exchanges. Application submission dates and requirements for Essential Community Providers (e.g., Rural Health Clinics, Critical Access Hospitals) are unchanged from 2020. CMS has also extended for one year the policy allowing issuers to continue offering plans that do not meet all Marketplace reforms, if approved by the State.
Research: Variation in Use of Home Healthcare Among Fee-for-Service Medicare Beneficiaries by Rural-Urban Status.
Variation in Use of Home Healthcare Among Fee-for-Service Medicare Beneficiaries by Rural-Urban Status. Despite incentive payments for home health care in rural communities, available data showed a significantly lower percentage of beneficiaries using home health in the most remote rural counties. The brief is the work of the WWAMI Rural Health Research Center.
Research: Are Rural Infants Benefitting from Woman, Infants, and Children (WIC) Food Package Rule Changes?
Are Rural Infants Benefiting from Woman, Infants, and Children (WIC) Food Package Rule Changes? In 2009, revisions were made to the WIC program to promote and support breastfeeding among those who are able and to improve infant feeding practices. This study compared breastfeeding initiation for rural and urban WIC participants, as well as changes in breastfeeding and infant feeding practices before and after the WIC Food Packages revisions.
Comments Requested: Proposed Research on Maternal Mortality
Comments Requested: Proposed Research on Maternal Mortality – February 21. The National Institutes of Health (NIH) request insight on the needs of the maternal mortality research field. NIH is considering a two-pronged approach researching disparities: 1) a multi-site community-based participatory research effort to evaluate and implement effective maternal mortality interventions; and 2) research opportunities to address risk factors, particularly in minority and underserved populations.
2020 Census Response Rate Challenge
The U.S. Census Bureau created a toolkit designed to help local leaders improve their communities’ response rate in the upcoming national census. The toolkit is downloadable and contains ideas and resources for creating a local challenge, promotional materials, and general information about the 2020 Census.
Insurer Participation in State Insurance Marketplaces
The Kaiser Family Foundation reports on changes in health insurer participation from 2014-2020 for all counties in the U.S. with charts, tables, and interactive maps.
GAO Report: Barriers to Medicaid Beneficiaries’ Access to Treatment Medications
GAO Report: Barriers to Medicaid Beneficiaries’ Access to Treatment Medications. The Government Accountability Office (GAO) identifies state and federal policies that can impose barriers to Medication-Assisted Treatment (MAT) for opioid use disorder. A 2018 study found that about 40 percent of states may not provide Medicaid coverage for some MAT medications as required by law. A 2016 study of rural physicians found that more than half of providers with waivers to prescribe medications to treat addiction were not accepting new patients.