January 24, 2020

In 2010, PACHC was successful in advocating to the Department of Human Services (DHS) for Public Health Dental Hygiene Practitioners (PHDHPs) as providers eligible to generate an FQHC/RHC encounter, meaning that PHDHP visits are billed as T1015-U9 encounters.  Initially, DHS directed that PHDHPs not only did not need, but could not get a PROMISe number.  That direction changed with an August 2017 Medical Assistance Bulletin indicating that PHDHPs must be enrolled in the Medical Assistance (MA) program to provide services to MA beneficiaries.  To enroll in the MA PROMISe system and receive an MA ID number, an NPI number is also required.

January 24, 2020

A little-noticed change in a massive spending bill passed by Congress late last year broadens the scope of a $1.5 billion grant program previously restricted to the opioid crisis. Pressed by constituents and state officials alarmed by the growing number of people struggling with meth and cocaine, lawmakers of both parties and the Trump administration agreed to lifting the previous limitations on use of the funding.

January 24, 2020

The 340B Drug Pricing Program doesn’t create strong incentives for participating hospitals to use more expensive drugs, according to new research by the Medicare Payment Advisory Commission (MedPAC). MedPAC said hospitals that participate in the 340B program spend about $300 more on drugs for prostate and lung cancers, but not breast, colorectal or leukemia-lymphoma cancers, and that the higher spending at 340B hospitals seems to be driven by the type of cancer that people are treated for rather than 340B’s financial incentives.

January 24, 2020

With health care an election-year priority, the American College of Physicians (ACP) this week called for sweeping government action to guarantee coverage for all, reduce costs and improve the basic well-being of Americans. Declaring that the U.S. health care system “is ill and needs a bold new prescription,” the ACP endorsed either of the two general approaches being debated by Democratic presidential candidates: a government-run “single-payer” system that would cover everyone; or a new “public option” government plan that would offer comprehensive coverage to compete with private insurance.

January 24, 2020

The Supreme Court on Friday announced it will hear two cases on whether employer health plans should be allowed religious and moral exemptions from the Affordable Care Act (ACA) requirement to cover birth control. The Trump administration in November 2018 issued final rules to allow more employers to opt out of providing no-cost birth control, but federal judges stopped the rules from taking effect. The justices said Friday they would hear the administration’s appeal of lower-court decisions that blocked the rules nationwide. In the case before the court, Pennsylvania and New Jersey sued the administration, arguing that its exemptions would unlawfully deny preventive health care to millions of women. The Supreme Court will decide whether the Trump administration may allow employers to limit women’s access to free birth control under the ACA.

January 24, 2020

The Supreme Court on Friday announced it will hear two cases on whether employer health plans should be allowed religious and moral exemptions from the Affordable Care Act (ACA) requirement to cover birth control. The Trump administration in November 2018 issued final rules to allow more employers to opt out of providing no-cost birth control, but federal judges stopped the rules from taking effect. The justices said Friday they would hear the administration’s appeal of lower-court decisions that blocked the rules nationwide. In the case before the court, Pennsylvania and New Jersey sued the administration, arguing that its exemptions would unlawfully deny preventive health care to millions of women. The Supreme Court will decide whether the Trump administration may allow employers to limit women’s access to free birth control under the ACA.

Governors of both major political parties are warning of dire consequences of a regulation proposed by President Donald Trump’s administration that could lead to big cuts in Medicaid, reducing access to health care for low-income Americans. The fiscal accountability rule proposed by the Centers for Medicare and Medicaid Services (CMS) would tighten federal oversight and approval over complex financing strategies states have long used to help pay for their share of the Medicaid program. Also targeted are certain payments to hospitals that treat many low-income patients. Public comments closed last week amid a chorus of criticism from hospitals, nursing homes, insurers, doctors and advocates for the poor. Trade associations for hospitals, nursing homes and doctors are asking the administration to withdraw the proposal and go back to the drawing board.

On January 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced its long-awaited guidance to states, “Healthy Adult Opportunities” (HAO). This initiative allows states to make drastic changes to their Medicaid programs through waivers to implement block grants and per capita caps. NACHC released a statement, submitted a further statement through the Partnership for Medicaid and is working directly with primary care associations (PCAs), like PACHC, to assess the state level impact of the HAO initiative on FQHCs. Of special note in this new guidance are the FQHC-specific provisions allowing states to waive FQHC PPS (and even alternative payment methodologies) and services via a HAO waiver. NACHC and PACHC participated in a call with CMS this week to get further information and express our concerns. We believe there is overwhelming evidence that HAO waivers would essentially lead to a cap on Medicaid spending. Shortly after release by CMS of the HAO guidelines, Pennsylvania Governor Wolf indicated his administration does not intend to seek an HAO waiver.

Monday, February 24 is the deadline for covered entities to recertify and retain 340B participant status. All 340B covered entities must annually recertify their eligibility to remain in the 340B Drug Pricing Program and continue purchasing covered outpatient drugs at discounted 340B prices. Any covered entity who does not recertify by the deadline will be terminated from the HRSA 340B Program on Wednesday, April 1. Terminated entities will be required to submit a new registration and will not be eligible to participate in the 340B Program until July. To recertify, Authorizing Officials (AOs) and Primary Contacts (PCs) must set up a user account in the HRSA 340B Office of Pharmacy Affairs Information System (340B OPAIS) and then choose “I am a participant.” For questions or assistance, email the 340B call center or call 888-340-2787 (Monday-Friday, 9:00 am-6:00 pm ET).

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 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 managed care organizations (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. Learn more.