Fewer than a quarter of Pennsylvania residents who tested positive for COVID-19 in late October answered questions from contact tracers as to whether they’d been to any restaurants, bars or mass gatherings. Read more.
Provider Relief Fund – Latest Definition of “Lost Revenues”
Last month, the federal Department of Health and Human Services (HHS) again revised the definition of “lost revenues” which Provider Relief Fund (PRF) funding may be used to offset. On Oct. 22, HHS announced that lost revenues should be defined as the difference between a provider’s actual patient care REVENUE in CY 2019 vs. CY 2020, calculated quarterly. This definition is tighter than the one that HHS announced in June (any reasonable estimate offered by the provider) but looser than the definition announced in September (the difference between net CY19 and CY20 INCOME.) NACHC staff are currently working with the PCA Leadership Committee to create a forum for resolving detailed questions raised by the latest definition. Questions on the new definition and guidance can be submitted to Cheri Rinehart, PACHC President and CEO.
NEW Uniform Data System COVID-19 Reporting Guidance
Developed to provide additional information about Uniform Data System (UDS) reporting that may be impacted by COVID-19, this new guidance includes information about reporting visits and patients, staffing, clinical quality, and revenue. For additional information on other COVID-19-related reporting considerations, such as temporary sites, health center staffing (e.g., volunteers) and funding and revenue, see our COVID-19 Frequently Asked Questions (FAQs).
Trump Administration Finalizes Rule Requiring Health Insurers to Disclose Price and Cost-Sharing Information
The Departments of Health and Human Services, Labor and Treasury finalized their tri-agency final rule on healthcare price transparency to further advance the Administration’s commitment to create a healthcare system that is patient- and consumer-centric. You can learn more about the final rule and the Administration’s transparency efforts by following the links below:
- Read the press release here
- Read more on CMS’s transparency work
- Read a CMS fact sheet on the final rule
- Read the rule
Pennsylvania Board of Dentistry Proposes Changes to PHDHP Practice Sites
The Pennsylvania State Board of Dentistry recently submitted a final-form regulation on public health dental hygiene practitioner (PHDHP) practice sites to the Independent Regulatory Review Commission (IRRC). The regulation expands access to care and oral health education provided by PHDHPs by adding additional facilities regulated by the Department of Human Services, and by adding as an acceptable practice site an office, including a satellite office, or clinic of a physician who is licensed by the State Board of Medicine or the State Board of Osteopathic Medicine that is located in a dental health professional shortage area, as determined by the U.S. Department of Health and Human Services, Health Resources and Services Administration. The final regulation will be considered by IRRC at its public meeting on Thursday, Dec. 3, 2020.
Pennsylvania Updates Guidance for Reporting Point of Care SARS-CoV-2 Test Results
The Pennsylvania Department of Health issued updated guidance for reporting point of care COVID-19 test results in Health Alert 534-10-30-UPD. The U.S. Food and Drug Administration (FDA) has issued Emergency Use Authorizations (EUA) for several COVID-19 point of care (POC) tests for rapid detection of SARSCoV-2. All entities conducting these POC tests are required to report these results, including positive, negative and inconclusive/indeterminate, to public health authorities through PA-NEDSS. Click here to access all 2020 health alerts, advisories and updates.
The ACA – What’s at Stake
The Affordable Care Act (ACA) has been under fire from its inception. Currently the future of the landmark decision and healthcare reform legislation is uncertain. California vs Texas (known as Texas vs U.S. in lower courts) is scheduled to begin oral arguments on Tuesday, Nov.10, 2020. This was sparked by a group of 20 states led by Texas to sue the federal government in February 2018. This case challenges the ACA’s individual mandate which was reduced to zero dollars on Jan.1, 2019 by way of the 2017 Tax Cuts and Jobs Act. The U.S. Court of Appeals for the 5th Circuit affirmed the decision that the individual mandate was no longer constitutional because the individual mandate would no longer produce revenue for the federal government. Instead of striking down the entire ACA, the case was sent back to trial court for additional analysis. The implications for Pennsylvanians and Americans could be disastrous should the law be struck down. Consider:
- Over 760,000 Pennsylvania Medicaid eligibles would lose coverage
- Over 307,000 Pennsylvania Health Insurance Marketplace consumers would lose coverage, 87% of those accessing Advance Premium Tax Credits and 44% with cost-saving reductions
- More than 2.3 million young adults under age 26 nationwide would lose access to coverage through their parents’ group coverage
- Over 2,105,000 Pennsylvanians with a prevalence of pre-existing conditions could be eliminated from purchasing health insurance
- 87% of covered workers with employer-sponsored insurance (approximately 133 million people) were enrolled in plans that must provide free preventive services as of 2019
- Prior to the ACA, 75% of non-group health plans did not cover maternity care, 45% did not cover substance use disorder (SUD) treatment and 38% did not cover mental health services
- Prior to the ACA, 59% of covered workers’ employer-sponsored health plans had a lifetime limit
- Prior to the ACA, only 19% of covered workers had no limit on out-of-pocket expenses
- Reinstating the Medicare coverage gap would increase costs incurred by Part D enrollees who have relatively high drug spending
- Employers with 50 or more employees must now provide adequate break time for breastfeeding women and a private space that is not a bathroom for nursing and pumping
- The ACA prohibits discrimination against individuals on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities, under Section 1557, which builds on long-standing and familiar federal civil rights laws
The ACA is an enormous law and the potential impacts of it being eliminated are monumental.
Pennie Is Open for Business
Pennsylvania’s Insurance Exchange, Pennie, opened on Sunday, Nov. 1. Assisters statewide fielded calls and assisted consumers with enrolling in Qualified Health Plans offered by seven Pennsylvania insurers: Ambetter, Capital Blue Cross, Geisinger, Highmark, Independence Blue Cross, Oscar and UPMC. The Pennie call center experienced issues and was not available to consumers or assisters for part of the day on Monday but resumed operations on Tuesday morning. The call center is open Monday–Friday, 8:00 am – 7:00 pm; Saturdays, 8:00 am – 1:00 pm; and closed Sundays and holidays. Customers needing assistance can call 1-844-844-8040. The dedicated Assister Call Center number for troubleshooting and assisting with enrollment is 1-844-844-4440. Learn more about Pennie.
‘No Mercy’ Chapter 7: After a Rural Town Loses Hospital, Is a Health Clinic Enough?
‘No Mercy’ is Season One of ‘Where It Hurts,’ a podcast about overlooked parts of the country where cracks in the health system leave people without the care they need. Our first destination is Fort Scott, Kansas.
Family physician Maxwell Self is doing his same old job for a new employer. For two decades he was a doctor with Mercy Hospital. But when Mercy packed up and left, a federally qualified health center moved to town — into the hospital building itself — and hired Dr. Self.
The Community Health Center of Southeast Kansas does things differently.
“What CHC says really has teeth and they’re solid,” Self said. “There’s real follow-through. And I have a lot more, I feel like, freedom to take care of people the way I want to and to get them what they need.”
With nutrition counseling and mental health and addiction services, and even things like arranging rides for patients, the center offers people what they need to be healthy, clinic executives said — not only health care for when they’re sick.
In the final chapter of the podcast, we also meet Sherise Beckham, 31, who lost work as a dietitian at Mercy when the hospital closed — just as she was expecting her second child.
“Initially, I cried a lot because I would be losing my job as well as losing a place to have my baby,” Beckham said.
Beckham helps explain how much more difficult it can be to have a baby when a town loses full-service maternity care. Then, later when she gets a job at — where else? — the new CHC clinic, Beckham gives us a front-row seat to the new vision for health care in Fort Scott.
LIHEAP Application Process Opened in Pennsylvania
The Pennsylvania Department of Human Services (DHS) announced the start of the annual Low-Income Home Energy Assistance Program (LIHEAP) application process for the 2020-21 season. LIHEAP assists with home heating bills so low-income Pennsylvanians can stay warm and safe during the winter months. Assistance is available for renters and homeowners. LIHEAP opened for applications on Nov. 2 and closes April 9, 2021. Pennsylvanians can apply for LIHEAP and other public assistance programs online at www.compass.state.pa.us Those who prefer to submit paper applications can print from the website or request an application by phone at 1-800-692-7462 and mail it to their local County Assistance Office (CAO) or place it in a CAO’s secure drop box, if available. While CAOs remain closed to the public, work processing applications, determining eligibility and issuing benefits continues. Click here for more information on LIHEAP.