The Pennsylvania Maternal Mortality Review Committee (PA MMRC) is accepting applications for new membership. The PA MMRC reviews de-identified summaries of all pregnancy-associated deaths in the commonwealth, regardless of cause of death and including drug-related deaths, homicides, and suicides. The committee determines if the death was related to the pregnancy, identifies contributing factors, determines if the death could have been prevented, and makes recommendations to prevent future deaths.

Learn more about the committee and member expectations. If you are interested in becoming a member, please complete the application and return it to ra-dhmmrc@pa.gov by the deadline of Tuesday, November 30, 2021.

The Pennsylvania Senate passed SB 705 authorizing the regulation of telemedicine by professional licensing boards and providing for insurance coverage of telemedicine. Sponsored by Sen. Elder Vogel, SB 705 now heads to the House of Representatives for its consideration. The bill has language that was in the previous version of the bill that led to the governor vetoing the bill last session. When vetoing SB 857 last session, Gov. Wolf noted that “this legislation arbitrarily restricts the use of telemedicine for certain doctor-patient interactions. As amended, this bill interferes with women’s health care and the crucial decision-making between patients and their physicians.” At this time, the Pennsylvania House of Representatives is not expected to act on this legislation.

November brings us an opportunity to welcome two health observances, National Diabetes Awareness Month and National Rural Health Day.

CMS OMH will recognize National Diabetes Awareness Month as part of our ongoing strategy to share resources and initiatives that aim to improve access to health care services and improve health equity. Factors including lack of access to health care, quality of care received, and socioeconomic status have disproportionately affected racial and ethnic minority populations in both the prevalence of this disease and health outcomes. Type 2 diabetes is the most prevalent form of diabetes, with about 90-95% of the estimated 34 million people living with diabetes having type 2 diabetes. There are also an additional 88 million Americans with prediabetes. As incidences of new diabetes cases have become more prevalent among non-Hispanic Blacks, coupled with existing cases being highest among American Indian and Alaska Native people, it’s important to highlight and address health disparities in diabetes impacting minority populations. Visit our Health Observances website to find resources to help promote diabetes awareness.

As we approach National Rural Health Day on November 18, CMS recognizes that more than 57 million Americans live in rural areas and face several unique challenges. Those challenges can differ dramatically among the different kinds of rural areas across the country. Rural residents tend to be older and in poorer health than their urban counterparts, and rural communities often face challenges with access to care, financial viability, and the important link between health care and economic development. Starting in November, our Rural Health webpage will highlight multiple tools and resources that can be distributed to providers, patients, and other organizations to help improve the health of rural Americans.

To further support the health of rural communities and recognize National Rural Health Day, please join CMS, along with representatives from the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention, for a partner webinar to discuss federal COVID-19 resources, health care workforce mandates, health care coverage related to the COVID-19 vaccine, and more.

Date: Monday, November 15

Time: 1:00-2:30 p.m. ET

To register: https://us06web.zoom.us/webinar/register/WN_c2JR-sw8TbydOWOxOSmA0Q

All Americans deserve the opportunity to have comprehensive, affordable, and accessible health care. Join CMS OMH this Diabetes Awareness Month, National Rural Health Day, and beyond to make that a reality.  – Dr. LaShawn McIver

CMS is taking action to close health equity gaps by providing Medicare patients living with End-Stage Renal Disease (ESRD) with greater access to care. Through the ESRD Prospective Payment System (PPS) annual rulemaking, CMS is making changes to the ESRD Quality Incentive Program (QIP) and the ESRD Treatment Choices (ETC) Model, and updating ESRD PPS payment rates. The changes to the ETC Model policies aim to encourage dialysis facilities and health care providers to decrease disparities in rates of home dialysis and kidney transplants among ESRD patients with lower socioeconomic status, making the model one of the agency’s first CMS Innovation Center models to directly address health equity.

“Today’s final rule is a decisive step to ensure people with Medicare with chronic kidney disease have easy access to quality care and convenient treatment options,” said CMS Administrator Chiquita Brooks-LaSure. “Enabling dialysis providers to offer more dialysis treatment options for Medicare patients will catalyze better health outcomes, greater autonomy and better quality of life for all patients with kidney disease.”

According to CMS Office of Minority Health’s studies on racial, ethnic and socioeconomic factors, disadvantaged people with Medicare have higher rates of ESRD. They are also more likely to experience higher hospital readmissions and costs, as well as more likely to receive in-center hemodialysis (vs. home dialysis). Studies also indicate non-white ESRD patients are less likely to receive pre-ESRD kidney care, become waitlisted for a transplant, or receive a kidney transplant.

CMS is improving access to home dialysis for patients of all socioeconomic backgrounds. For example, CMS is finalizing changes to the ETC Model to test a new payment incentive that rewards ESRD facilities and clinicians who manage dialysis patients for achieving significant improvement in the home dialysis rate and kidney transplant rate for lower-income beneficiaries. In addition, CMS is approving the first ever technology under a recently established policy that allows for enhanced payments for innovative technologies that represent a substantial clinical improvement relative to existing options. This approval will help ESRD facilities offer an additional option to beneficiaries for home dialysis at this critical time in the pandemic.

Consistent with President Biden’s Executive Order 13985 on “Advancing Racial Equity and Support for Underserved Communities through the Federal Government,” CMS is addressing health inequities and improving patient outcomes in the U.S. through improved data collection for better measurement and analysis of disparities across programs and policies. In response to the proposed rule, CMS received valuable feedback on potential opportunities to collect and leverage diverse sets of data such as race, ethnicity, Medicare/Medicaid dual eligible status, disability status, LGBTQ+ and socioeconomic status, to better measure disparities. CMS also received feedback on various methodical approaches to advance equity through the ESRD Quality Incentive Program (ESRD QIP). This valuable stakeholder feedback will help guide future rulemaking to improve health equity.

The rule finalizes policies for the ESRD QIP that address the circumstances of the COVID-19 public health emergency and functionality challenges relating to the implementation of a new data collection system. These challenges include a special scoring and payment policy under which no facility will receive a payment reduction under the ESRD QIP for the upcoming year, especially since such payment reductions would have been based on performance during the height of the pandemic in 2020.

CMS’ proposed rule included several requests for information (RFIs) for the agency to consider as part of its goal to increase access to dialysis treatments at home. Commenters’ responses to the RFIs included specific suggestions for improving Acute Kidney Injury (AKI) payment and the ESRD PPS.

More Information:

• Fact sheet
• Final rule

Beginning October 2021, the Pennsylvania Department of Human Services (DHS) will begin terminating state-funded Medicaid coverage for individuals who are found ineligible for the program. There are roughly 2,400 state-funded Medicaid recipients at risk of termination; all will receive renewal packets giving them a chance to demonstrate eligibility before DHS takes action to terminate. It is vital that recipients complete their renewals on time and in full. State-funded Medical Assistance recipients are immigrants, and many have limited English proficiency. Many are also seniors and/or disabled. As a reminder, DHS now has many forms (PA60, application for benefits; PA600HC, application for healthcare only; and the PA 1663, Employability Assessment Form) translated into six languages—Spanish, Chinese, Russian, Vietnamese, Cambodian, and Arabic—and they can be found in the DHS Medical Assistance Eligibility Handbook.

The state’s decision to terminate state-funded coverage does not affect the majority of Medicaid enrollees, since most people are getting federally-funded Medicaid, which is still protected under the Federal Public Health Emergency (PHE) and its continuous coverage protections.

Individuals who believe their Medicaid coverage has been improperly stopped can call the Pennsylvania Health law Project Helpline at 1-800-274-3258 or email them at staff@phlp.org.

The Pennsylvania Department of Human Services (DHS), Office of Medical Assistance Programs (OMAP) released MA Bulletin 99-21-06, “Guidelines for the Delivery of Physical Health Services via Telemedicine.” The purpose of this bulletin is to notify providers that, effective Sept. 30, 2021, the DHS is expanding the scope of services for which telemedicine may be used, expanding the scope of providers who may render MA covered services to beneficiaries using interactive telecommunication technology to include all enrolled providers, if permitted according to their scope of practice, licensure, or certification and establishing ongoing guidelines for services rendered via telemedicine. Key points from the Bulletin:

• The MA Program will pay for MA covered services rendered to beneficiaries via telemedicine when clinically appropriate and allowable according to the provider’s scope of practice. Services rendered via telemedicine must be provided according to the same standard of care as if delivered in-person. Providers are encouraged to establish protocols for the use of telemedicine. MA MCOs may, but are not required to, allow for the use of telemedicine.
• Providers are to obtain consent prior to rendering a service via telemedicine from the beneficiary receiving services or their legal guardian. Providers must also allow beneficiaries to elect to return to in-person services at any time.
• Providers should fully document the services rendered and the telecommunication technology used to render the service in the MA beneficiary’s medical record. If the service was rendered using audio-only technology, providers are to document that the services were rendered using audio-only technology and the reason audio/video technology could not be used. Providers should obtain the location of the beneficiary at the time each service is rendered via telemedicine should there be a need for emergency medical services.
• DHS added Place of Service (POS) 02 (telemedicine) for providers to identify services that are rendered via telemedicine. Providers are no longer required to utilize the GT modifier to indicate the use of telemedicine and are instead to use POS 02. Providers are to indicate in the beneficiary’s medical record when telemedicine services are rendered via audio-only.

This bulletin obsoletes MA bulletin 09-12-31 et al., Consultations Performed Using Telemedicine, issued May 23, 2012 and, Provider Quick Tips #229 and #242, Telemedicine Guidelines Related to COVID-19.

Pennsylvania Governor Tom Wolf signed HB 1861 to “allow temporary regulatory flexibilities to continue the emergency response to the COVID-19 pandemic by requiring the state agencies to issue a final report of the regulatory suspensions and terminations.” The bill allows for additional temporary extensions for regulatory statues, rules and regulations which are in effect on Sept. 30, 2021, to be extended until March 31, 2022, unless they were already terminated by the authority which initially authorized the suspension. The extension includes the following regulatory statutes:

• Regulatory statutes, rules or regulations enforced by the Department of Health.
• Regulatory statutes, rules or regulations enforced by the Department of Human Services.
• Regulatory statutes, rules or regulations enforced by the Bureau of Professional and Occupational Affairs.