Walmart and UnitedHealth Group announced a 10-year partnership to offer healthcare services. They say that beginning in 2023, they will provide a range of affordable health services designed to improve care outcomes and the patient experience at 15 Walmart Health outlets in Georgia and Florida. They will then expand to other states. Among the offerings: is a co-branded Medicare Advantage plan in Georgia, called UnitedHealthcare Medicare Advantage Walmart Flex (HMO-POS). Walmart Health Virtual Care will be in-network for commercial members in UnitedHealth’s Choice Plus PPO plan.

Two articles published in the New York Times this past Saturday—including one on the front page of the newspaper—are generating extensive discussion and concern among policymakers, 340B stakeholders, and the media, and raising concerns that Community Health Centers could be “painted with the same brush” as the hospitals in the articles. The first article, entitled How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits, was featured on the front page under the heading “Profits over Patients.” It claims that the hospital used 340B to generate hundreds of millions of dollars, which it directed to facilities in wealthier neighborhoods areas while removing services from underserved neighborhoods. On Monday, NACHC sent a response to the Times stating, “Bon Secours has chosen to put profits over patients, and the community suffered as a result. Despite the tragic circumstances of this case, it is essential to note that 340B has been instrumental in expanding access to life-saving care in low-income communities. Community Health Centers rely on 340B to provide critical drugs to patients who are typically low-income, uninsured, and members of racial and ethnic minorities.” The second article, entitled “They were Entitled to Free Care. Hospitals Hounded them to Pay,” discussed how a large non-profit, 340B-eligible hospital system “trained staff to wring money out of patients, even those eligible for free care.” While the article did not explicitly mention 340B, some 340B opponents are linking the two articles together as examples of how 340B providers abuse the program.

A proposed rule by the Biden Administration would enhance equity by continuing to mandate healthcare-related protections for many populations that health centers serve, including LGBTQ patients, patients with disabilities, Medicare/Medicaid/Marketplace patients, and patients with Limited English Proficiency (LEP). This proposed rule changes Section 1557 of the Affordable Care Act, which prohibits discrimination based on race, color, national origin, sex, age, and disability within health care settings, programs, and activities. The original rule was released in 2016 under the Obama Administration, providing regulatory authority to non-discrimination provisions within the Affordable Care Act. The Trump Administration made fundamental changes to the rule in 2019 that rolled back many protections from discrimination. Now, the Biden Administration is taking steps to restore and extend patient protections. NACHC created a customizable comment letter template to make sharing your support for these vital patient protections easier. Share your comments before the Monday, Oct. 3 deadline; submit them here.

Announced at the Sept ember 9 Pennie Community Workgroup, new system enhancements will be available beginning October 2022. Pennie plans to pilot a Live Chat feature and add organ donor and voter registration information to the end of the Pennie enrollment application. The Pennie system will also use current monthly income when assessing potential eligibility for Medicaid and CHIP. On previous applications, yearly income was used to determine eligibility. This change will result in a more accurate assessment of likely eligibility due to fluctuating income. To listen to the recording or view slides, click here.

In a new issue brief, the Commonwealth Fund explores how changing the benchmark plan might affect consumers’ deductibles and out-of-pocket limits and how those costs would compare to those in employer health plans. The benchmark plan refers to the second lowest-cost silver plan in the marketplace in each area or in the individual/family insurance market to define essential health benefits within that state for individual/family and small group plans. According to the researchers, “Modest changes like these could encourage more people to get the care they need and keep them from incurring medical debt.” Read more here.

FamiliesUSA published a white paper discussing the importance of Community Health Workers (CHW) and the need for sustainable funding to address health disparities. Community Health Centers employ CHWs to address enabling services, including disease-specific education, translation issues, transportation coordination, language services, enrollment assistance and other non-clinical services.

Congressional negotiators released the full text of the CR on September 27. After several weeks of debate, Congress decided to permanently extend the Federal Tort Claims Act (FTCA) coverage for Volunteer Health Professionals. This is a big victory and will ensure that qualified Volunteer Health Professionals can continue providing critical primary and preventative care at health centers in communities impacted by natural disasters or provider shortages.

Acting Secretary of Health and Physician General Dr. Denise Johnson joined representatives from Feeding Pennsylvania and the Second Harvest Food Bank of Northwest Pennsylvania to showcase the Pennsylvania Healthy Pantry Initiative (PA HPI) program in action. This program has supported tens of thousands of pantry clients to increase their consumption of healthy foods by highlighting the healthy food choices within the food pantries, equipping clients with reliable and helpful information, and providing displays and storage equipment to showcase healthier options. Program materials include shelf talkers, signage, produce information, and recipe cards that are instrumental in food demonstrations, tastings, and nutrition classes hosted through local food pantries. In April 2022, PA HPI was added as a nationally recognized program offering a practice-tested intervention in the U.S. Department of Agriculture’s SNAP-Ed toolkit. Click here to learn more.

From the National Rural Health Association

Alongside the White House Conference on Hunger, Nutrition, and Health this past Wednesday, the Biden Administration released its National Strategy on Hunger, Nutrition, and Health. Please see below for a summary highlighting the most rural-relevant proposals.

The National Strategy is made up of five pillars, each with corresponding goals and action items to achieve the listed goals:

Pillar 1: Improve Food Access and Affordability

Help more individuals experiencing food insecurity benefit from federal assistance programs.

• The Administration will work with Congress increase funding for Older Americans Act nutrition programs. This will help address rural seniors’ unique health, social, and nutritional challenges associated with shopping and cooking.
• The Administration will make it easier for eligible individuals to access federal food and health services. The Department of Agriculture (USDA) will partner with other agencies to increase outreach and awareness for SNAP to older adults and other populations.
• USDA, through American Rescue Plan funds, will expand online shopping for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). NRHA is hopeful that this will expand access for rural residents that travel longer distances to grocery stores.
• The Administration will support Congress in removing unnecessary barriers for SNAP recipients, like the inability to purchase hot and prepared foods with SNAP dollars.

Invest in community and economic development to increase access to food. Almost 40 million Americans live in areas where no grocery stores are nearby, including rural areas.

• The Federal Trade Commission will publish a report summarizing how supply chain distributions have affected grocery stores, including independent grocery stores that often serve rural communities.
• The Federal Emergency Management Agency and USDA will partner to integrate food security as a priority area when conducting outreach with state, local, and Tribal leaders for disaster planning and messaging. This is especially important for rural areas when there are natural disasters and other emergencies.

Pillar 2: Integrate Nutrition and Health

Provide greater access to nutrition services to better prevent, manage, and treat diet-related diseases.

• Expand Medicare and Medicaid beneficiaries’ access to food as medicine by supporting legislation to create a pilot program for Medicare coverage of medically tailored meals for beneficiaries with diet-related health conditions.
• The Centers for Medicare and Medicaid Services (CMS) will use its 1115 demonstration authority to pilot innovative coverage options for diet-related interventions. For example, CMS just announced that it approved Oregon and Massachusetts’ Medicaid state plans for nutritional assistance and medically tailored meals.
• The Administration will support legislation to expand nutrition and obesity counseling to more Medicaid beneficiaries, specifically in states that have not expanded Medicaid and have large rural populations. The Administration also supports expanding nutrition and obesity counseling to Medicare beneficiaries who currently may only seek counseling in a primary care setting with a primary care practitioner. CMS will examine its authority to increase access to such counseling.
• Indian Health Services (IHS) will implement a National Produce Prescription Pilot Program. Produce prescriptions provide fresh fruits and vegetables as a medical treatment or preventative service for patients who are eligible due to diet-related health risk or condition or food insecurity.
• The Department of Veterans’ Affairs (VA) will implement produce prescription programs and mobile food pantries that will aid our rural veteran population.
• CMS will develop a strategy to increase access to diabetes prevention and treatment for Medicare and Medicaid beneficiaries. NRHA looks forward to this work as rural residents are at a greater risk for diabetes.
• CMS will support efforts to develop the data infrastructure needed for food insecurity and other social determinants of health (SDOH) elements to be captured in electronic health records. NRHA is hopeful that CMS will support rural providers in this endeavor.

Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices

Create healthier food environments and a healthier food supply.

• The Administration will work with Congress to expand incentives for purchasing fruits and vegetables with SNAP.
• USDA will make investments to support local and regional food and farm businesses.
• USDA will establish Regional Food Business Centers to support local food business growth, particularly in rural and underserved areas like Appalachia, Colonias, the Mississippi Delta, and in Tribal communities.

Pillar 4: Support Physical Activity for All

 Build environments that promote physical activity.

• Expand the Centers for Disease Control (CDC) State Physical Activity and Nutrition Programs to all states and territories. The Administration will work with Congress to expand the Program from 16 states to nationwide.

Pillar 5: Enhance Nutrition and Food Security Research

• HHS and USDA will create a 2025 Dietary Guidelines Advisory Committee with a diverse membership, including geographic diversity. The committee will review dietary guidelines with a health equity lens.
• USDA will conduct research to better understand nutritional needs of Native Americans and Native Alaskans.
• USDA will leverage its partnership with the University of North Dakota to better understand Native diets and Indigenous foods.
• CMS will measure SDOHs, including food insecurity, for at-risk Medicare Advantage beneficiaries.