CMS: Failure to File and Reconcile (FTR) Operations Flexibilities for Plan Year 2023

Posted on by lad3

The guidance referenced in this document is applicable to all Exchanges. It does not replace or revise previously issued guidance, but extends previous guidance issued for plan years 2021 and 2022 to plan year 2023. The original guidance referenced current federal regulation at 45 CFR 155.305(f)(4), and the statute at section 1412 of the Affordable Care Act. This guidance extends the same flexibilities for consumers and Exchanges regarding Failure to File and Reconcile (FTR) operations for plan year 2023.

In plan years 2021 and 2022, CMS did not act on data from the Internal Revenue Service (IRS) for consumers who have failed to file tax returns and reconcile a previous year’s advance payments of the premium tax credit (APTC) and with the premium tax credit (PTC) allowed for the year. This change was made in response to the impact of the COVID-19 public health emergency (PHE) on the processing of federal income tax returns and changes concerning the reconciliation of APTC with PTC for tax year 2020 announced by IRS in response to the American Rescue Plan. This change allowed APTC to continue for consumers not required to reconcile by attaching Form 8962, Premium Tax Credit, to their 2020 tax return due to IRS’ announcement and consumers who reconciled but whose tax returns have not yet been processed by the IRS.

CMS will continue to not act on data from the IRS for consumers who have failed to file tax returns and reconcile a previous year’s APTC with the PTC allowed for the year, for plan year 2023. The continuation of this operations flexibility is due to the continued impact of the COVID-19 pandemic on the processing of 2021 federal income tax returns. This flexibility also extends to State-Based Exchanges. As with last year’s announcement, today’s announcement does not change the general requirement for taxpayers for whom APTC was paid in 2021 to file their taxes and reconcile the APTC with the PTC allowed for the year.

For more information, please refer to last year’s FTR Operations Flexibility for Plan Years 2021 and 2022 – Frequently Asked Questions.

References

  1. https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/FTR-flexibilities-2021-and-2022.pdf
  2. As of May 20, 2022, the IRS reports having 9.8 million unprocessed individual federal tax returns, which includes new tax year 2021 returns. For more information on IRS’ operations during COVID-19, please see https://www.irs.gov/newsroom/irsoperations-during-covid-19-mission-critical-functions-continue

ARC Announces READY Appalachia

Posted on by lad3

Appalachians are ready to strengthen their communities, and ARC is here to provide the resources they need.

READY Appalachia is ARC’s new community capacity-building initiative offering free training and flexible funding to Appalachians working in four key economic development pillars: nonprofits, community foundations, local governments, and Local Development Districts.

Participants in each READY Appalachia learning track access 10 weeks of cohort-based learning, skill development, and grant opportunities to increase their capacity to solve pressing issues and create positive economic change.

READY Nonprofits

READY Nonprofits helps nonprofit executives and board members increase their capacity in fundraising, financial management, board development, staff and volunteer recruitment and retention, marketing, and more.

Applications for fall term are open until Friday, August 19.

READY LDDs

READY LDDs will offer awards to increase staffing for Appalachia’s Local Development Districts. Increased team capacity will help LDDs effectively serve clients, including local governments, during this time of increased federal funding.  Coming soon!

READY Foundations

READY Foundations will help local philanthropies working in economic development as they build endowments, leverage different funding sources, develop boards, and learn other foundation-specific fundraising methods. Coming soon!

READY Local Governments

READY Local Governments will help local government employees better apply for, manage, leverage, and implement federally funded projects to invest in infrastructure, business and workforce development, and other long-term solutions to improve the lives of residents.  Coming soon!

Rural Hospitals Again Face Financial Jeopardy

Posted on by lad3

From Axios

After weathering the pandemic with federal COVID aid, rural hospitals are facing a convergence of challenges that could leave many facilities deep in the red and at risk of closing as soon as the end of this year.

Why it matters: Hospitals are among the biggest employers in rural communities and the only health providers in large swaths of the country. But they’ve been operating on the edge for years, tending to older, sicker patients who often can’t afford care.

Driving the news: Hospitals couldn’t persuade Congress to delay a scheduled 2% cut in Medicare payments, then were frustrated by a Medicare payment proposal for 2023 they say ignores the effects of inflation, labor and supply cost pressures.

  • Many facilities have burned through federal COVID provider relief funds and Paycheck Protection Program loans that helped them cope with staffing and supply shortages and lower demand as patients deferred care.
  • “The data would suggest we will see a lot more rural hospital closures at the end of this year and into 2023,” Alan Morgan, chief executive of the National Rural Health Association, told Axios.
  • Closures could dramatically reduce access to care, forcing patients to travel longer distances for inpatient services, substance use treatment and other needs, per the Bipartisan Policy Center, which recommends new payment models and incentives to retain health workers to ease the crunch.
  • But sympathy may be limited for an industry that recently received large sums of federal dollars to get through the pandemic.

Flashback: Rural hospital closures are not a new story — since 2010, 140 rural hospitals have closed, according to the University of North Carolina’s Rural Health Research Program’s tracker.

  • The majority of closures were in the Southeast, where “you’ve got a lower-income, sicker population that is underinsured or uninsured,” Morgan said.
  • The pandemic forced facilities to lay off staff and, in some cases, restrict services just to COVID patients. But Congress responded with a bailout, including $175 billion to hospitals and clinicians around the country that was particularly advantageous to rural facilities.
  • While revenues might have dropped, margins at most facilities held firm, a May study in JAMA found.
  • Since the beginning of 2021, just five rural hospitals have closed, compared to 19 that closed in 2020 and 18 in 2019.

Go deeper: Experts say many of the rural facilities are running on unsustainable business models.

  • Some “only had one-third of their beds filled, with a low occupancy rate, and then you have to run a hospital with a lot of fixed costs and that’s a fundamental reason that hospitals are facing financial challenges,” Ge Bai, a Johns Hopkins University professor who studies rural hospital finance, said.
  • The situation leaves facilities in peril without federal aid, especially since many rural residents bypass their local facilities for elective surgeries, Bai said.

CMS Proposes Rule to Advance Health Equity, Improve Access to Care, & Promote Competition and Transparency

Posted on by lad3

CMS is proposing actions to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology. Additionally, in line with President Biden’s Executive Order on Promoting Competition in the American Economy, the calendar year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule includes proposed enhanced payments under the OPPS and the Inpatient Prospective Payment System for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators and a comment solicitation on competition and transparency in our nation’s health care system.

More Information:

988 Offers New, Easier Way for Pennsylvanians to Connect to Mental, Behavioral Health Crisis Services

Posted on by lad3

Starting July 16, 2022, Pennsylvanians will have a new, easier way to connect to behavioral or mental health crisis services. Dialing 988 will connect callers directly to the National Suicide Prevention Lifeline.

76,000 calls were received by the the National Suicide Prevention Lifeline  from Pennsylvania residents in 2020.

In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. The Substance Abuse and Mental Health Services Administration (SAMHSA) sees 988 as a first step towards a transformed crisis care system in America.

People who contact 988 via phone, text, or chat will be directly connected to trained counselors located at 13 PA crisis call centers who can immediately provide phone-based support and connections to local resources, if necessary. Between 80-90 percent of calls are resolved through conversations with call center staff, without further intervention. By directing cases to 988 when a mental or behavioral health crisis isn’t life threatening, the response provided by public services, such as law enforcement and EMS, can be reserved for situations when there is a risk to public safety.

If you’re in crisis, reach out now.

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7.

  • CALL: Dial 988
  • TEXT– By texting 988, individuals will be asked to complete a short survey to let 988 trained crisis counselors know more about their current situation. After finishing the survey, texters will be connected to crisis counselors.
  • CHAT – Lifeline Chat connects individuals with trained counselors for emotional support and other services via web chat.

The current Lifeline phone number (1-800-273-8255) will remain available to people in emotional distress or suicidal crisis, even after 988 is launched.

Who Can Use the New Number?

988 can be used by anyone who needs support for a suicidal, mental or behavioral health, and/or substance use crisis — no matter where they are or where they live.

988 can also be called on behalf of someone else. Counselors can offer guidance on helping a friend or loved one navigating a mental health emergency, and experts advise that people reach out particularly if a loved one reveals a plan to hurt themselves.

Lifeline services are available 24 hours a day, seven days a week at no cost to the caller.

What Happens When You Call 988?

When calling 988, the caller will hear the following recording:

“You have reached the National Suicide Prevention Lifeline, also serving the Veterans Crisis Line. Para español, oprima numero dos. If you are in emotional distress or suicidal crisis, or are concerned about someone who might be, we are here to help. If you are a U.S. military veteran or current service member, or calling about one, please press 1 now. Otherwise, please hold while we route your call to the nearest crisis center in our network.”

The following steps will follow depending on the callers needs and call center availability:

  • The caller will be routed to a local PA 988 crisis call center.
  • If the call is not answered within 60 seconds at the local level, the call is routed to one of PA’s three regional 988 crisis call centers.
  • If a regional call center is unavailable, the call is routed to the national backup network.
  • Note: Veterans and Spanish-speaking callers are given options to connect to resources specific to their needs.

Trained, compassionate counselors located at 13 crisis call centers across Pennsylvania are ready to provide phone-based support and connections to local resources. Counselors may be able to provide referrals for treatment for mental health, substance abuse, or other behavioral health needs if to local service providers are available. Also, if the counselor recognizes the caller is in need of an in-person response, they are able to dispatch emergency personnel from EMS or law enforcement, or a mobile mental health crisis team if one is available in the caller’s area.

Additional 988 Resources

Pennsylvania’s Indiana Regional Medical Center Introduces First Residency Program for Rural Family Medicine

Posted on by lad3

The Indiana Gazette

Indiana Regional Medical Center (IRMC, Indiana, PA) officials introduced the hospital’s first residency program as well as six new family medicine residents during a press conference Thursday at IRMC.

IRMC’s Rural Family Medicine Residency Program officially started July 1 after six resident physicians from a pool of roughly 600 applicants matched with IRMC. The resident physicians are Esther Ezeani, of Baltimore, Md.; Narinder Sangha, of California; Mohit Chhatpar, of New York; Tanvi Bharathan, of Indiana, Pa.; Nawar Al Janabi, of Baghdad, Iraq; and Robin Rodriguez, of Corpus Christi, Texas.

The resident physicians will work with/report to an attending physician as they learn and practice family medicine over the next three years. This will benefit patients, who will get access to two physicians for the price of one, according to IRMC Residency program director Dr. Amanda Vaglia.

“Whenever you see a resident physician, you actually get two physicians, because the resident physicians, particularly at the beginning of their training, are not allowed to see patients on their own,” Vaglia said.

The program will help increase access to family medicine for local and regional residents, a service everyone in the country needs, according to IRMC Chief Medical Officer Dr. Richard Neff.

Vaglia and IRMC CEO Steve Wolfe said they hope the program will bring new physicians into the area and improve access to quality health care in local, rural communities.

“Rural communities across the nation suffer from a shortage of health care, primarily primary care health care,” Vaglia said. “There have been studies done that indicate that the more rural education that (resident physicians) have throughout their medical training, the more likely they are to practice in a rural area.”

Wolfe said hospitals across the country are currently struggling to recruit family medicine physicians. A residency program will not only increase the number of physicians coming into the area, but it will also increase the number of physicians who stay, according to Wolfe.

The new residency program has a specific focus on rural medicine, which impacted how resident physicians were selected.

Residents were chosen based on how they ranked on a list of qualities and attributes, including their commitment to living and working rurally, commitment to family medicine, maturity, resilience and service, according to Vaglia.

Vaglia said that because Indiana is “100 percent rural,” medicine is practiced differently, and physicians must be in-tune with the specific needs of rural health care.

“Here, out in rural areas, you have to be a little more versatile; you have to be a little bit more brave; you have to be willing to learn; you have to get to know your patient,” Vaglia said. “If we have a patient in our population who comes down with an unusual disease, we can’t just refer them up the street because specialists are far away. So, we have to learn more about that patient; we have to learn more about their disease state; we have to be comfortable communicating with them and coordinating their care.”

Beyond better access to quality health care, the residency program could help boost the local economy, too, according to Wolfe, by bringing new physicians into the area to live and work. Wolfe’s sentiments were echoed by state Rep. Jim Struzzi, R-Indiana, and state Sen. Joe Pittman, R-Indiana, who also spoke at the press conference.

“For us, this is about our economy, this is about the future of our community and it’s also about quality health care in rural communities,” Pittman said.

Over the past two years, Pittman and Struzzi have worked to help fund IRMC’s residency initiative, and they said they couldn’t be happier with the results.

“When this initiative came forward, Jim and I came together, and … we were able to allocate $1 million specifically to the hospital for this initiative,” Pittman said. “I’m pleased to say today … we’ve been able to replicate that commitment. So, we’ve been able to bring $2 million to this initiative. I think our desire is to allow that to continue in the years ahead; certainly there are no guarantees.”

“We’re very pleased that we were able to get this included in this year’s budget, and we’ll continue to work for additional funding moving forward to make sure that not only is IRMC strong … but Indiana County is strong,” Struzzi said. “(IRMC is) bringing people here and providing that quality health care that people need. We all know that that’s lacking in rural areas right now.”

IRMC is considering developing another residency program in a specialty outside of family medicine; though, nothing has been finalized yet, according to Wolfe.

Pennsylvania Medicaid Program: Vaccines for Kids Older Than Six Months Now Available

Posted on by lad3

COVID-19 vaccines are now available for children 6 months through 5 years of age. As a result of the recommendation from the CDC’s Advisory Committee on Immunization Practices (ACIP) as well as the Food and Drug Administration (FDA), nearly 20 million additional children are now eligible nationally for vaccination. 

The pediatric COVID-19 vaccine is safe, and it is highly effective at protecting children against COVID-19-related illness, hospitalization, and death. Vaccinating children against COVID-19 is the best way to help keep families and communities healthy and schools safer this fall.

All children, including children who have already had COVID-19, should get vaccinated.

Distribution of pediatric vaccinations for these younger children has started across the country, and will be available at thousands of pediatric practices, pharmacies, Federally Qualified Health Centers, local health departments, clinics, and other locations. Children in this younger age group can be vaccinated with whichever vaccine is available (either Moderna or Pfizer-BioNTech). Parents can reach out to their doctor, nurse, local pharmacy, or local health department, or visit vaccines.gov to see where vaccines for children are available.

Learn more about COVID-19 vaccines for children:

Finding a Vaccine is Easy!

Many vaccine providers now take walk-ins and offer same-day appointments. You can find a vaccine provider near you:

  • Online – go to Vaccine Finder and search by zip code.
  • Text – send your zip code to GETVAX (438829) for English, or VACUNA (822862) for Spanish and receive three possible vaccination sites in your area, with phone numbers to call for an appointment.

Phone – if you need help or do not have internet access, call the PA Department of Health Hotline at 1-877-724-3258.

About the Pediatric Vaccine

Vaccine Dosage

The dosage for the pediatric COVID-19 is based on the child’s age on the day of vaccination, not the child’s size or weight. Children get a smaller dose of COVID-19 vaccine than teens and adults that is the right amount for their age group. COVID-19 primary series vaccination for children and teens. As of June 18, 2022:

​Child’s Age

​Pfizer-BioNTech

​Moderna

​J&J/Janssen
​6 months–4 years old ​3 dose primary series ​2 dose primary series ​Not authorized
​5 years old ​2 dose primary series ​2 dose primary series ​Not authorized
​6–17 years old ​2 dose primary series ​2 dose primary series ​Not authorized

More than 596 million doses of COVID-19 vaccine had been given in the United States since December 2020.

  • View the CDC COVID Data Tracker — See current total COVID-19 vaccinations administered in the United States.
  • Enroll in V-Safe — V-safe provides personalized and confidential health check-ins via text messages and web surveys so you can quickly and easily share with CDC how you, or your dependent, feel after getting a COVID-19 vaccine.

COVID-19 vaccines are safe and effective. COVID-19 vaccines were evaluated in tens of thousands of participants in clinical trials. The vaccines met the FDA’s rigorous scientific standards for safety, effectiveness, and manufacturing quality needed to support authorization.

The Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen COVID-19 vaccines will continue to undergo the most intensive safety monitoring in U.S. history. This monitoring includes using both established and new safety monitoring systems to make sure that COVID-19 vaccines are safe.

Spread Vaccine Awareness!

The Pennsylvania Department of Health has created a number of resources to help you share accurate vaccine information with children and families regarding the COVID-19 vaccines.

Additional COVID-19 Vaccine Resources

COVID-19 Public Health Emergency Extended in the U.S.

Posted on by lad3

The Biden administration on July 15, 2022 extended the Covid-19 public health emergency for another three months.

U.S. Department of Health and Human Services Secretary Xavier Becerra officially renewed the declaration, extending it through October 13, 2022.

The emergency declaration has been in place since January 2020, and the latest renewal comes as the Omicron offshoot BA.5, the most contagious variant yet, continues to stake its claim in the US. Daily case rates, though vastly undercounted, are the highest they’ve been in months, as are Covid-19 hospitalizations and deaths.

Data published this week by the US Centers for Disease Control and Prevention shows that more than half of the country’s population lives in a county with a “high Covid-19 Community Level,” where the health care system is at risk of becoming overburdened and universal indoor masking is recommended.

“The Public Health Emergency declaration continues to provide us with tools and authorities needed to respond to the highly transmissible COVID-19 subvariants that are currently circulating around the country,” a Biden administration official told CNN. “The PHE provides essential capabilities and flexibilities to hospitals to better care for patients, particularly if we were to see a significant increase in hospitalizations in the coming weeks.”

Indeed, ensemble forecasts from the CDC published this week do predict that hospitalizations in the US will rise over the next month. It’s the first time in weeks that the forecasts have predicted an increase in hospitalizations, instead of a stable outlook.

“Without the PHE in place, we would be limited in our ability to provide broad and equitable access to lifesaving treatments through our Test to Treat initiative, for example, which relies on flexibility for telehealth and operations,” the official said. “Not renewing the PHE would leave us with fewer tools to respond and mean more Americans would get severely ill and end up in the hospital.”

The public health emergency declaration allows many Americans to obtain free Covid-19 testing, therapeutic treatment and vaccines. Once it ends, people could face out-of-pocket costs depending on whether they are covered by Medicare, Medicaid or private insurance. But vaccinations would generally continue to be free for those covered by Medicare and private insurance, while state Medicaid programs would determine whether to continue covering vaccinations for their enrollees.

Also, Medicare has relaxed the rules governing telehealth so that many more beneficiaries can access such services during the declaration. Telehealth services are no longer limited just to those living in rural areas, and enrollees can conduct visits at home, rather than having to travel to a health care facility, and they receive a wider array of services via telehealth. These flexibilities will end for most beneficiaries after the emergency expires.

And states are not involuntarily disenrolling residents from Medicaid during the declaration, in exchange for receiving more generous federal matching funds. As many as 14 million people could lose Medicaid coverage after the emergency ends, according to separate projections by Kaiser and the Urban Institute.

Plus, many low-income families are receiving enhanced food stamp benefits thanks to the declaration, though some states have ended their own public health emergencies and stopped the beefed-up allotments.

A separate emergency declaration allows for the emergency use authorization of testing, treatments and vaccines. Its end date will be determined by the secretary of the US Department of Health and Human Services.

Explore ARC’s County Status Map for FY 2023

Posted on by lad3

Every year, the Appalachian Regional Commission (ARC) compares each of Appalachia’s 423 counties with national averages. By analyzing unemployment rates, per capita market income, and poverty rates, counties are classified within one of five economic status designations:

  • Distressed,
  • At-risk,
  • Transitional,
  • Competitive, or
  • Attainment

The designations are used to determine the match requirements for ARC grants, as well as research topics and investment strategies targeting resources to the region’s most distressed areas.

We’ve seen an uptick in at-risk (+14) and distressed (+1) counties, especially in the wake of COVID-19, but Appalachians throughout the region are more resolved than ever to address distress and believe in the potential for progress.

Has your county’s status designation changed this year? Check out our interactive map to find out.