An October 28, 2019 interview with Rachel Levine, MD, the Secretary of Health for the Commonwealth of Pennsylvania, addressed rural hospital closures and the state’s approach to sustainability. She described the Department of Health pilot as moving from a fee-for-service arrangement to a monthly global budget, which emphasizes population health and outpatient services.  Read more.

Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for individuals who are dually eligible for both Medical Assistance and Medicare–older adults and individuals with physical disabilities.  This program was implemented in southwestern Pennsylvania in January 2018, southeastern Pennsylvania in January 2019, and will be implemented in the remainder of the state on Jan. 1, 2020.  CHC information for providers or participants can be found at www.healthchoices.pa.gov.  Fact sheets and online trainings can be found here.   Access a list of frequently asked questions (FAQs) about CHC by clicking here.  To become part of the provider network contact:

• AmeriHealth Caritas: 1-800-521-6007; email: chcproviders@amerihealthcaritas.com
• Pennsylvania Health & Wellness: 1-844-626-6813; email: information@pahealthwellness.com
• UPMC Community HealthChoices: 1-844-860-9303; email: CHCProviders@UPMC.edu

During the week of October 28, 2019, the Pennsylvania Senate quickly fast-tracked a telemedicine bill that nearly made it to Governor Wolf’s desk last December. Senate Bill 857 expands the use of telemedicine for providers, including Community Health Centers , to provide care and receive reimbursement from both managed care organizations (MCOs) and commercial insurance. One new caveat to the bill is a requirement for any affected licensure boards overseeing specialties to promulgate regulations within 24 months of passage. As of October 30, the legislation is before the House for consideration.

(AP/PBS Newshour, 10/30/19)

The Trump administration has launched a website intended to help people connect with treatment options for substance use disorders. The website, FindTreatment.gov, includes customizable tools that allow users to search for providers based on the type of treatment they want—including detox, inpatient, or telemedicine—and by payment method and insurance type.

Honesdale, PA (October 30, 2019) — Treatment for nearly 2,000 additional patients at the Pike Dental Center will be made possible through a $300,000 grant from  the Oral Health Infrastructure Grant Program of the Health Resources and Services Administration (HRSA).

Officials of Wayne Memorial Community Health Centers (WMCHC) were notified of the grant award earlier this month. The monies will be used to create a 748 square foot expansion within the existing dental center located in Lords Valley, PA. The result, an increase from five to nine operatories at the facility, has the potential of generating between 8,500 – 9,000 additional dental visits per year.

Pike Dental Center was constructed to meet the growing demand for accessible dental care for the greater Pike County area. The state-of-the-art facility first opened its doors in January of 2014 with a total of five operatories. The Lords Valley office, currently staffed by Megan Martino, DMD and John Ridd, DMD, is an extension of the Together For Health Dental Center in Honesdale.

“Even with the development of the Pike office having taken place no more than five years ago, it remains a challenge to provide care as timely as we’d like,” stated Frederick Jackson, executive director, WMCHC. “Wait times exceed four months for some services.”

According to WMCHC’s Dental Manager Nichole Yannone, it became evident as early on as 2015 that the current Pike facility wasn’t large enough to meet the need of the service area. Yannone says the dentists, hygienists and support staff at Pike Dental look forward to the “increased access to care, appointment availability and additional space in which to work” that will be realized when the expansion comes to fruition.

Jackson explained that WMCHC is still “in the design phase of the project” at this time. However, it is hoped that construction will begin in early 2020 with completion by the summer.

WMCHC is a federally qualified health center clinically affiliated with Wayne Memorial Health System, Inc.  In addition to dental services, WMCHC offers primary care, women’s health, pediatric services, pulmonology, general surgery and behavioral health services at satellite offices located in Wayne, Pike, Lackawanna and Susquehanna Counties.  For more information on all services, call 570-253-8390 or visit wmchc.net.

 

From the Rural Yonder, October 29, 2019

Rural America as a whole has struggled with population loss and sluggish job growth during the past decade, but some areas have managed to buck these trends and may serve as bright spots for those focused on economic development outside of cities.

New research from the Center for American Progress, a liberal think-tank, attempts to highlight some of the assets rural areas might use to their advantage and also points out that the fortunes of rural communities differ widely by region and based on other factors.

“What we’re trying to drive home is that rural America is not an economic liability,” said Zoe Willingham, who co-authored the center’s policy brief.

Read the full article here.

This brief from the Pennsylvania State Data Center celebrates the fall season with a look at agriculture across Pennsylvania according to the 2017 Census of Agriculture. Some of the data highlights include:

• Pennsylvania had over 4 million acres of harvested cropland in 2017.
• Nearly half (48.5%) of Lancaster County’s land area is devoted to harvested cropland.
• Over 48,000 acres of vegetables were harvested in Pennsylvania in 2017.

Which vegetable was the most harvested in each county? Click here to read more about trends in harvested cropland and vegetables harvested across the state.

The Centers for Medicare and Medicaid Services (CMS) announced it is delaying the start of several new voluntary value-based payment models, including the Primary Care First and Kidney Care First models, until at least 2021. However, CMS continued to encourage Medicare providers to apply to participate in the models. (Source: Modern Healthcare‘s “Transformation Hub,” 10/24)

A federal judge in a final judgement issued last week ordered the federal government to reimburse nearly 100 health insurers about $1.6 billion in unpaid cost-sharing reduction payments called for under the Affordable Care Act. The ruling is the latest of several decisions stating that the federal government is required to make the payments, which total billions of dollars, but the Department of Justice has appealed those rulings. (Source: Modern Healthcare, 10/24)

Window shopping begins with quality rating information displayed on HealthCare.gov across states for the first time

The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2019 to December 15, 2019, for coverage starting on January 1, 2020. Similar to previous years, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience, and use consumer feedback to drive ongoing improvements across the Exchange platform. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2020 plans and prices before Open Enrollment begins and for the first time HealthCare.gov will also display quality rating information in states that use HealthCare.gov, expanding the information available for consumers in their decision-making when comparing health coverage choices.

NEW THIS YEAR

Key Updates and Enhancements to Healthcare.gov for the 2020 Open

Enrollment

Quality Rating Information Displayed in HealthCare.gov States

Quality ratings will be displayed on HealthCare.gov when consumers view the list of plans available in their area in HealthCare.gov states this year. Under the five-star Quality Rating System, Exchange health plans are given an overall rating on a 1 to 5 scale, with 5 stars representing highest quality. The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration. In some cases — such as when plans are new to the Exchange or have low enrollment — ratings may not be available.

Star ratings in the Exchange help make it easy for consumers to compare health coverage choices by giving consumers a snapshot of how each health plan’s quality compares to that of other Exchange plans in each state in a given year. A quality rating of 3 or above means that a health plan is considered average or above average as compared to other plans across the country. For the 2020 coverage year, 80 percent of plans eligible to receive a rating of at least 3 stars. Similar to national quality reporting programs due to the time needed to collect and analyze survey and clinical quality measure data, the data CMS uses to calculate star ratings is based on plan performance data from two years prior. When shopping for a plan in 2020, consumers should keep in mind that star ratings displayed on HealthCare.gov are generally based on how the plan performed in prior years.

HealthCare.gov will display the Overall Rating with the number of stars from 1 to 5 filled in towards the top of each plan, or let the consumer know if the individual plan hasn’t been rated. Consumers can see three additional star ratings for Member Experience, Medical Care, and Plan Administration which comprises the Overall Rating when selecting an individual plan’s detailed information along with other coverage and benefits. The Overall Rating and the three additional quality rating categories are also displayed when consumers choose to compare up to three plans side-by-side.

For more information, please see the Exchanges Quality Rating System fact sheet.

Summary information is provided in the Plan Year 2020 quality ratings results at a glance.

Expanded Streamlined HealthCare.gov Application

As part of the continued commitment to improving the customer experience, the streamlined application on HealthCare.gov is expanded this year to handle nearly all consumer applications, both simple and more complex eligibility scenarios. The streamlined application provides improved content and integrates help information throughout the application in order to provide a more seamless enrollment experience from start to finish, as well as enhanced mobile optimization. CMS will continue to make enhancements to the application based on consumer feedback and testing.

Visual Refresh of Consumer Shopping Experience

This year, the visual experience for consumers when they preview plans (“See plans & prices”) and shop, compare and enroll on HealthCare.gov has been refreshed based on consumer research and feedback. The visual refresh provides a more consistent user experience throughout the entire enrollment process on HealthCare.gov that includes updates to filters, the plan results list, improved help content and enhanced mobile optimization.

Enhanced Direct Enrollment (EDE) Expanded

Enhanced Direct Enrollment (EDE) will be available throughout the entire Open Enrollment Period for the first time this year. This key development allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage. Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center. This year, more approved partners are offering EDE-capable websites. As of October 25, CMS has approved more than 5 private sector partners to operate an EDE pathway.

The safety and security of consumer information is our number one priority. Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform. CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.

For more information please see the Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage fact sheet.

New resources about Health Reimbursement Arrangements (HRA)

New rules released this year permit employers to fund individual market premiums for their employees through a new type of HRAs – Individual Coverage HRAs. CMS is adding educational information and a consumer worksheet tool to assist employees in determining whether to use an individual coverage HRA from their employer to help pay for coverage. HRAs are employer-funded accounts from which employees are reimbursed tax-free for qualified medical expenses.

For more information please see the Health Reimbursement Agreements webpage.

Consumer Tools and Support

Window Shopping

On October 25, 2019, CMS launched updates to window shopping (the “See plans & prices” page on HealthCare.gov) which allow consumers to preview 2020 plans and prices before Open Enrollment begins. As in previous years, window shopping lets consumers browse plans without logging in, creating an account, or filling out the official application. Starting November 1, consumers can log in to HealthCare.gov and CuidadodeSalud.gov or call 1-800-318-2596 to fill out an application and enroll in a 2020 Exchange health plan.

Consumer Call Center

The Call Center is often the front line of assistance for consumers as they apply for coverage and compare plan options. For the last two consecutive Open Enrollments, the consumer satisfaction rate remained at all-time high – averaging 90 percent – throughout the entire Open Enrollment Period. In order to help prepare the Call Center representatives to handle high consumer demand, CMS will continue providing extensive training to Call Center staff prior to Open Enrollment and weekly refreshers throughout the Open Enrollment Period.

In addition to the Call Center, in-person assistance will continue to be available to help consumers with enrollment. This includes local agents and brokers, Certified Application Counselors, and federally-funded Navigators.

Helping Consumers Connect with Agents & Brokers

CMS will continue to partner with a third party to offer the “Help On Demand” services from agents and brokers. This service allows consumers to choose to request that an agent or broker in their area contact them directly for help applying and enrolling. Registered agents and brokers are able to set times when they’re available and then reach out to consumers who expressed interest in assistance.

Learn more about Help On Demand services.

Find Local Help

Find Local Help is a tool that allows consumers to search by city and state or ZIP code to see a list of local people and organizations who can help them enroll in coverage. Consumers can search for a specific person or organization by entering their name and can filter the results based on their preferences and services provided. Additionally, consumers can filter agents and brokers by their minimum years of participation on the Federal Exchange.

Financial Assistance

Premium tax credits will be available in 2020 for individuals who qualify. Consumers can continue to use Exchange coverage and take advantage of its benefits, including premium tax credits. Plans available from insurance companies will continue to reflect reduced copayments, coinsurance, and deductibles for eligible consumers.

Small Business Health Options Program (SHOP)

Similar to previous years, employers will be able to enroll directly with an issuer, or with a SHOP-registered agent or broker. HealthCare.gov allows small business employers to preview available SHOP plans and find an issuer or agent/broker to work with to offer SHOP coverage to their employees. Quality rating information will also be available for SHOP plans.

Open Enrollment Notices

Each year, the Federal Health Insurance Exchange sends notices to consumers who are currently enrolled in a plan prior to November 1 about the upcoming Open Enrollment Period. This notice provides consumers with the dates for this year’s Open Enrollment and the importance of returning during this time to update their application and actively re-enroll in a plan for 2020. The notice also provides consumers with customized messaging for their situation, such as if they’re at risk of losing tax credits. Consumers receive additional notices from their current issuer with important information about premiums, coverage and benefit changes, and plan availability for 2020.

To see examples of consumer notices, visit: https://marketplace.cms.gov/applications-and-forms/notices.html

Automatic Re-enrollment Process

Similar to previous years, current enrollees who don’t update their application and enroll in a plan by the December 15, 2019 deadline generally will be automatically enrolled in the same plan or another plan offered by the same issuer that is intended to be similar, and if that is not available, another plan with a different insurance company. Consumers who are currently enrolled are strongly encouraged to come back and update their information, shop, and pick a plan that best suits their health care needs before the deadline. Consumers who miss the deadline to actively re-enroll in a plan of their choice during Open Enrollment will not be able to make any plan changes until the next coverage year unless they qualify for certain Special Enrollment Periods.

The Exchange sends a notice alerting consumers who were automatically re-enrolled.

Consumers whose 2019 issuer doesn’t have a plan available to them for 2020 will receive a discontinuation notice from their current issuer by the start of Open Enrollment. Those consumers may also receive a letter from the Exchange notifying them that they have been matched with an alternate plan from a different issuer to help avoid a gap in coverage. These consumers generally will need to pay their premium for January in order for their 2020 coverage to begin. Consumers are not under any obligation to stay with the new plan and are encouraged to take action and choose a plan by December 15. Consumers whose issuer isn’t offering their plan in 2020 are eligible for a Special Enrollment Period due to losing coverage and have the opportunity to choose a different plan.

Marketing and Outreach

CMS plans to spend $10 million on marketing and outreach for the upcoming Open Enrollment Period, matching the same level of spending for the past two years. CMS will continue to use similar marketing tactics that focus funding and attention on the most strategic and efficient ways to reach consumers. This year’s outreach and education campaign will target people who are uninsured as well as those planning to reenroll in health plans, with a special focus on young and healthy consumers. CMS has committed resources to proven high impact, low cost digital outreach efforts including short YouTube videos, social media, and mobile and search advertising.

CMS will also continue to use direct response methods including email, text messaging and autodial messages. Targeted email has proven to be the most cost efficient and effective way to reach consumers. As part of this effort, CMS will send most consumers emails throughout each week, with increasing frequency as the December 15 deadline approaches. CMS will also reinforce educational messaging through ongoing text messages and provide reminder calls encouraging consumers to take action before the deadline.

HealthCare.gov Operations

HealthCare.gov Scheduled MaintenanceWindows

Every year, CMS establishes scheduled maintenance windows that provide periods of time when CMS and its partners can make updates or resolve issues. Maintenance will only occur within these windows when deemed necessary to provide consumers with a better shopping experience. Consumer access to HealthCare.gov may be limited or restricted when this maintenance is required. Regularly scheduled maintenance will continue to be planned for the lowest-traffic time periods on HealthCare.gov, which are Sunday mornings.

The purpose in scheduling these times is to minimize any consumer disruption. Like other IT systems, these scheduled maintenance windows are how CMS updates and improves our system to run optimally and are the normal course of business.

For more information on the scheduled maintenance times, visit: https://marketplace.cms.gov/technical-assistance-resources/healthcaregov-maintenance-windows.pdf

HealthCare.gov Waiting Rooms

Similar to previous years, CMS may deploy a “waiting room” for some consumers who are logging in or creating an account on HealthCare.gov if website traffic becomes high enough to impact the consumer experience.

The waiting room is one tool CMS utilizes to optimize a consumers’ experience because it allows CMS to control the volume of users on HealthCare.gov resulting in better performance of the website. If they are in a waiting room, consumers will see a message asking them to stay on the page. The waiting room will refresh when a consumer can continue to apply and enroll with a smooth experience.

Additional Resources

Weekly Enrollment Snapshots Similar to previous years, CMS plans to release weekly enrollment snapshots throughout the Open Enrollment Period.

2020 Health Insurance Exchange Premium Landscape Issue Brief

To view the 2020 Health Insurance Exchange Premium Landscape Issue Brief, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/QHP-Choice-Premiums.html

2020 Plan Landscape Data

For more information on 2020 individual and family health plans available in the Federal Health Insurance Exchange, visit: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/

2020 Health Insurance Exchange Public Use Files

To see the 2020 Health Insurance Exchange Public Use Files, visit: https://www.cms.gov/cciio/resources/data-resources/marketplace-puf.html

2020 Quality Rating System Public Use Files

To see the Plan Year 2020 Quality Rating System Public Use Files, visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/ACA-MQI-Landing-Page.html

2020 Issuer Participation County Map

To see the 2020 Issuer Participation County Map, visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Health-Insurance-Exchange-Coverage-Maps.html