Health Plans Can No Longer Impose Cost Sharing for Follow-up Colonoscopy

Posted on by lad3

The policy loophole that allowed patients to be charged for colonoscopy following a positive non-colonoscopy screening text has been plugged. On January 10, the U.S. Departments of Labor, Health and Human Services, and the U.S. Treasury issued FAQs regarding coverage of colonoscopies pursuant to USPSTF recommendations. The FAQ specifies that plans are required to cover without cost-sharing, a follow-up colonoscopy performed to evaluate a positive non-invasive stool-based screening test or direct visualization test. Plans and issuers must provide coverage without cost sharing for plan or policy years beginning on or after May 31, 2022.

There are some limitations, to find out more visit View the FAQs (see questions seven and eight on pages 11-12). You can also visit the American Cancer Society’s CAN press release to learn more at: New Guidance from Administration Helps Ensure Coverage for Follow-up Colonoscopies, Will Save Lives from Colon Cancer.

Rural Hospitals that Closed between 2017‐20: Profitability and Liquidity in the Year Before Closure

Posted on by lad3

Researchers at the North Carolina Rural Health Research and Policy Analysis Center used data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System to compare the pre-closure profitability of rural hospitals that closed between 2017 and 2020 with the performance of rural hospitals that remained open.

Click here to read the results of the analysis:  Rural Hospitals that Closed between 2017‐20: Profitability and Liquidity in the Year Before Closure

New Research Brief: The High Performing Rural Health System

Posted on by lad3

This brief presents the Rural Policy Research Institute (RUPRI) Health Panel’s vision for a high-performing rural health system and specific pillars of such a system. The RUPRI Health Panel envisions rural health services that are affordable and accessible for all rural residents through a sustainable health system that delivers high quality, high value services. A high-performing rural health system informed by the needs of each unique rural community and population groups will improve community health and well-being.

Click here to access the brief:  High Performing Rural Health System.

 

Updated Materials Available – Visiting Nursing Homes During Omicron Surge

Posted on by lad3

The Centers for Medicare & Medicaid Services (CMS) has updated our Nursing Home Resource Center with two new informational products.

As of January 6, 2022, the Nursing Home Visitation FAQs have been updated to provide additional guidance about visitation during the Omicron surge. CMS has also created an infographic to graphically represent how to safely conduct visits to nursing homes during this time of spiking COVID cases around the country. These two new resources are available for nursing home providers, patients, caregivers, and CMS partners to stay informed about CMS’ latest thinking for keeping nursing homes safe in the current COVID climate.

USDA Seeks Applications to Improve Rural Transportation Systems

Posted on by klb520

U.S. Department of Agriculture (USDA) Under Secretary for Rural Development Xochitl Torres Small today announced that USDA is accepting applications to enhance the operation of rural transportation systems. These investments in rural transportation build opportunity and prosperity for the people who live in rural communities by connecting them to economic resources they may not otherwise be able to access.

The grants are part of the Rural Business Development program https://www.rd.usda.gov/programs-services/business-programs/rural-business-development-grants. Eligible applicants are qualified national organizations seeking to provide rural communities with training and technical assistance to improve passenger transportation services and facilities. USDA does not provide funding directly to individuals under this program.

USDA is offering priority points to projects that advance key priorities under the Biden-Harris Administration to help communities recover from the COVID-19 pandemic, advance equity and combat climate change. These extra points will increase the likelihood of funding for projects seeking to address these critical challenges in rural America.

Applications will be scored, reviewed, and selected on a competitive basis. Applications must be submitted to the applicant’s nearest USDA office by April 14, 2022, at 4:30 p.m. local time.

Four Years Later: Pennsylvania Opioid Disaster Declaration Continues to Open Doors for Progress, Treatment, and Recovery

Posted on by lad3

Much like COVID-19, the prescription opioid and heroin overdose epidemic continues to plague the public health of Pennsylvania. It affects individuals across the commonwealth — from big cities to rural communities.

Every day, Pennsylvania loses 14 Pennsylvanians to substance use disorder overdoses. Preliminary numbers show there have been 5,063 drug overdose deaths reported for 2020 through July 21, 2021. In comparison, Pennsylvania saw 4,458 drug overdose deaths in 2019. Recent statistics reveal that 2020 ranks second to 2017, in which there were 5,403 overdose deaths, the most overdose deaths in a single year since the opioid epidemic began.

Pennsylvania Governor Wolf’s administration has made the fight against opioid use disorder a top priority by taking an all-hands-on deck approach to prevent the disease from happening, rescuing those suffering, and getting Pennsylvanians into treatment. Since Governor Wolf took office, he and his administration have worked with the General Assembly to take aggressive steps to combat opioids, making Pennsylvania a national leader in the fight. Governor Wolf first signed the opioid disaster declaration in January 2018 to help the commonwealth fight the deadly opioid and heroin epidemic and renewed the declaration 15 times, most recently on August 4, 2021.

As the commonwealth continues to fight this battle, It’s important to know where to get treatment and resources. Preventing overdose death and finding treatment options are the first steps to recovery.

The Risk of Prescription Opioids

Prescription opioids can be an important part of treatment for pain, but they also come with serious side effects and risks. It is important to consider the risks and talk to your health care provider about your options. Physical tolerance and dependence, addiction, and death from overdose are some of the serious risks associated with opioids. These risks are specifically associated with long-term use, but can happen anytime.

Finding Treatment

Call the Get Help Now hotline: 1-800-662-HELP (4357)
If you or someone you know are suffering from substance use disorder, help is available. Call the Get Help Now hotline for information about treatment resources. Your call is confidential. The hotline is staffed by trained professionals 24 hours a day, seven days a week, and is available in both English and Spanish.

Find County Treatment Programs

Local treatment programs are administered through county drug and alcohol offices called Single County Authorities. These programs can help with treatment funding, assessing the need for treatment, and making referrals to match treatment and/or service needs.

Find a Treatment Provider

You can reach out directly to a treatment provider for treatment. A treatment provider or facility provides treatment options for those suffering from substance use disorder.

Centers of Excellence

Centers of Excellence, created by the Wolf Administration in 2016, are designed to get more people into treatment and keep them engaged in their care. The centers coordinate care for people with Medicaid and, to date, more than 40,000 Pennsylvanians have engaged with the 60 centers to receive treatment. Treatment is team-based and “whole person” focused with the explicit goal of integrating behavioral health and primary care.

Get Naloxone: It Can Save a Life

Naloxone is a medication that can reverse an overdose caused by an opioid drug (prescription pain medication or heroin). When given during an overdose, naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes. Naloxone is safe to use and has no potential for abuse.

Family members and friends can access naloxone by:

  • Obtaining a prescription from their family doctor
  • Using the standing order issued by Acting Physician General Denise A. Johnson. To use the standing order, print it and take it to the pharmacy or have the digital version on your phone.

What type of Naloxone is available?

Two of the most common ways naloxone is administered are intranasal (nasal spray) and auto-injector.

  • Intranasal has two pieces that are easily assembled: a prefilled medication tube and an atomization device, which is sold separately.
  • The auto-injector comes in a manufactured dosage form (similar to an EpiPen) and has a recorded message to talk you through giving the medication.

* Please note, not all pharmacies have both forms, and insurance coverage can vary depending on the type of medication being purchased and each individual insurance plan.

How do I administer Naloxone?

Help for Families

It’s not easy supporting a loved one with substance use disorder or dealing with the many challenges that come along with it. You are not alone. Resources are here to help you.

Support Resources

PA KinConnector

As a result of the opioid crisis, more grandparents and extended relatives are raising children in Pennsylvania. PA KinConnector was created to connect grandparents and other caregiver relatives to local, state, and federal resources, including physical and mental health services, health care coverage, school enrollment help, support groups, financial assistance, legal aid, and more.

Drug Take-Back Boxes

The Department of Drug and Alcohol Programs (DDAP), in partnership with the Pennsylvania Commission on Crime and Delinquency, the Office of the Attorney General, the National Guard, and the Pennsylvania District Attorneys Association, spearheaded an expanded prescription drug take-back box program placing hundreds of take-back boxes across all 67 of Pennsylvania’s counties. Since it’s inception, more than 500 tons of prescription drugs have been collected and safely discarded by the program.

Bipartisan Save America’s Rural Hospitals Act Introduced

Posted on by lad3

Congressman Sam Graves (MO-06) and Congressman Jared Huffman (CA-02) introduced the bipartisan Save America’s Rural Hospitals Act to rescue rural hospitals on the brink of bankruptcy and help put these critical care providers back on solid ground.

“This isn’t a new problem. Our rural hospitals have been struggling to keep their doors open to patients for years,” said Graves.“But, the COVID-19 pandemic has undoubtedly made this crisis worse, as many critical access hospitals are facing severe workforce shortages and skyrocketing expenses while reimbursement rates fall behind. This legislation reverses disastrous Medicare cuts that have hamstrung our rural hospitals for years and will help many of them get back on track. There’s no better time to get this done.”

“For years, rural hospitals have faced seemingly insurmountable odds: a raging pandemic, provider consolidation, and ever-increasing costs have piled challenge after challenge at their doors. And now, they’re facing added pressures brought on by the Omicron variant—leaving many hanging on by a thread,” said Rep. Huffman. “Rural hospitals and health centers, like the many in my district that have stepped up to care for our community, need legislative action and they need it now. My bill with Rep. Graves takes the steps necessary to help keep rural hospitals afloat and protect access to high-quality care, regardless of where folks live. By offering greater Medicare reimbursement, we can provide a much-needed lifeline to facilities on the edge of collapse—and save lives in the process.”

The Save America’s Rural Hospitals Act comes at a time when rural hospitals and health centers are facing unprecedented challenges. Since 2005, more than 170 rural hospitals across the country have closed their doors—forcing patients to travel further to get the care they need and leaving others to put off necessary healthcare. This problem has been exacerbated by the COVID-19 pandemic and today 453 rural hospitals are currently operating at levels similar to those that have shut down over the last decade.

The Save America’s Rural Hospitals Act will reverse this dangerous trend by:

  • Eliminating Medicare sequestration for rural hospitals
  • Making Medicare telehealth service enhancements permanent for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
  • Extending increased Medicare payments for rural ground ambulance services currently set to expire December 31, 2022

The bill was applauded by the National Organization of State Offices of Rural Health and the National Rural Health Association.

“The National Organization of State Offices of Rural Health (NOSORH) applauds Rep. Graves and Rep. Huffman for introducing this comprehensive rural health bill.  This comes at a critical time for rural communities and rural health providers as our nation continues to deal with the Public Health Emergency.  We call on House members from both sides of the aisle to support and advance this important piece of legislation in 2022.”  – Teryl Eisinger, Executive Director of National Organization of State Offices of Rural Health (NOSORH).

“The National Rural Health Association (NRHA) applauds Representatives Graves and Huffman for introducing the Save America’s Rural Hospitals Act. Since 2010, 137 rural hospitals have closed their doors, leaving the majority of those communities without access to a health care provider. The provisions in this important legislation will ensure that the more-than-60 million Americans who reside in rural America will maintain access to the care they need. NRHA believes passing the Save America’s Rural Hospitals Act will improve and expand access to health care in rural America.” – Alan Morgan, Chief Executive Officer of the National Rural Health Association.

You can read the bill here.

You can read highlights of the bill here.

https://graves.house.gov/media/press-releases/graves-huffman-introduce-save-americas-rural-hospitals-act

Delayed & Missed Child Preventive Checkups During the Pandemic

Posted on by lad3

A new study from the Maternal and Child Health Bureau (MCHB) found that more than 1 in 4 households have delayed or missed children’s preventive checkups due to the COVID-19 pandemic. The study, “Missed and Delayed Preventive Health Care Visits Among U.S. Children Due to the COVID-19 Pandemic,” was published by Public Health Reports and uses data collected in April and May of 2021.

Click here for more information.

Primary Care and Oral Health Integration

Posted on by lad3

A new article, “What Primary Care Innovation Teaches Us About Oral Health Integration” emphasizes the role of primary care and oral health integration in improving population health and addressing health inequities. The article was published in the in the January 2022 issue of the American Medical Association (AMA) Journal of Ethics. The article offers five lessons from the patient-centered medical home movement to inform primary and oral health care integration.

Click here to read the article.

Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests

Posted on by lad3

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15.  The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

As part of the requirement, the Administration is incentivizing insurers and group health plans to set up programs that allow people to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs.  Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement. When plans and insurers make tests available for upfront coverage through preferred pharmacies or retailers, they are still required to reimburse tests purchased by consumers outside of that network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For example, if an individual has a plan that offers direct coverage through their preferred pharmacy but that individual instead purchases tests through an online retailer, the plan is still required to reimburse them up to $12 per individual test. Consumers can find out more information from their plan about how their plan or insurer will cover over-the-counter tests.

“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly diagnose COVID-19 so that it can be effectively treated. Today’s action further removes financial barriers and expands access to COVID-19 tests for millions of people,” said CMS Administrator Chiquita Brooks-LaSure.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19 tests without cost sharing under CMS’s interpretation of the American Rescue Plan Act of 2019 (ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People enrolled in a Medicare Advantage plan should check with their plan to see if their plan offers coverage and payment for at-home over-the-counter COVID-19 tests.

This effort is in addition to a number of actions the Biden Administration is taking to expand access to testing for all Americans. The U.S. Department of Health and Human Services (HHS) is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country.  To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/11022-faqs-otc-testing-guidance.pdf

For additional details on the requirements, visit https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf