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.

Gov. Tom Wolf unveiled a $36.1 billion state spending plan on February 4, 2020 that will rely on continued strong economic growth. He proposes no increases in the state’s sales or personal income tax rates. The Wolf administration says the budget plan raises state spending by about four percent. The proposed budget adds an additional $450,000 for the Primary Health Care Practitioner Program to bring the program total to $5 million as was requested by the Pennsylvania Association of Community Health Centers, the Pennsylvania Office of Rural Health, the Pennsylvania Academy of Family Physicians and the Pennsylvania Area Health Education Center program.

From the Governor’s Budget Book:

“Investing in our Public Health Workforce, the Primary Health Care Practitioner Program encourages primary care practitioners to practice in Health Professional Shortage Areas throughout Pennsylvania, helping to ensure health care access in underserved communities. An additional $450,000 for the Primary Health Care Practitioner Program will facilitate expanded access to quality, affordable primary health care in areas of need by increasing the volume of health care providers as well as helping to provide them with adequate resources to treat vulnerable populations. This additional investment will help to reduce the clinician shortage in Pennsylvania through a more robust support network that will entice more health care professionals to work in the commonwealth.” 

Additional information on the proposed budget can be found here.

Together with the Juvenile Law Center, the Pennsylvania Partnerships for Children (PPC) are championing policy reforms for older youth in the foster care system and have produced several resources to articulate the needs of this population. This week PPC released their third fact sheet in a series about Transition Age Youth, which seeks to educate policymakers on ensuring foster youth successfully transition to adulthood. In the coming weeks and months, PPC will work with their partners in the legislature to advance legislation to enhance permanency services for these youth. To date, Rep. Karen Boback, Chair of the House Children and Youth Committee, has filed a co-sponsor memo to introduce the legislation that would enact these needed reforms.

With so much going on in the world of health care and beyond, it would be easy to have missed what’s happened. Pennsylvania Partnerships for Children (PPC) has developed highlights of the latest on Public Charge, CMS’ proposed “Fiscal Accountability” Rule and CMS’ issued guidance on Block Grants. Additionally, PPC released new fact sheets on Medicaid and CHIP enrollment in Pennsylvania by Congressional, State Senate and State House legislative districts (the first time we’ve ever presented enrollment datPreview (opens in a new tab)a at this state level!). Read on…

Saddled with chronic health workforce shortages, widespread substance misuse and high HIV transmission rates, rural care networks – often staffed by volunteers and peer counselors – increasingly are the backbone of care delivery in small town America, HRSA Administrator Tom Engels told some 500 conference attendees at the Rockville Hilton last month.

The audience consisted of participants in three outreach programs run by HRSA’s Federal Office of Rural Health Policy. The programs have infused some $29 million in seed money into remote pockets of the country to help advocates and providers form local healthcare partnerships.

Read about the Rural Partnership Development Meeting.

It can be difficult to communicate the benefits of living and working in a rural area. Even though Pennsylvania’s rural regions are often within an hour or two of a large town or city, it’s still a commitment for a physician, dentist or other clinician to work in rural areas. EduMed.org, a web-based organization that connects students with educational opportunities, has produced the page “Why You Should Work in Rural Healthcare, and How to Thrive When You Do“ to help you tell your story and make candidates more comfortable with and accepting of working in a rural setting. Some of the articles relate to working in any underserved area.

The Nurse Corps Loan Repayment Program is now accepting applications through Thursday, March 12, 2020. Nurse Corps supports registered nurses (RNs), advanced practice registered nurses (APRNs) and nurse faculty by paying up to 85% of their unpaid nursing education debt. In exchange, participants serve for at least two years at a health care facility with a critical shortage of nurses or an eligible school of nursing in the case of nurse faculty. Before you apply, learn about application details including eligibility and service requirements in the 2020 Application and Program Guidance. Program highlights for 2020 include:

• To combat the nation’s opioid crisis, special funding has been provided for psychiatric nurse practitioners. Learn more by listening to a previously recorded webinar
• To increase the field strength of nurses that provide maternity care to women living in rural and underserved communities, there is a percentage of Nurse Corps funds dedicated to nurses specializing in women’s health

Before you apply, read the annually updated Application and Program Guidance. Make sure you understand the terms and conditions of the Nurse Corps contract, which outlines the requirement for fulfilling your minimum two years of service at an eligible critical shortage facility.