Penn Medicine and Independence Blue Cross have been studying a new billing code created to help healthcare providers address mental health issues since 2018. Their work previously showed that linking primary care and mental health services increased the number of patients receiving needed behavioral health care and led to mental health improvements. Their new research shows it doesn’t add costs. Read more.

More than a third of schools nationwide don’t have a full-time nurse on-site, according to a 2021 survey by the National Association of School Nurses. Meanwhile, the nation is facing high rates of chronic illnesses among K-12 students, such as diabetes and asthma, along with an unprecedented mental health crisis among youth. Read more.

From Fierce Healthcare

The Centers for Medicare & Medicaid Services (CMS) has dropped the final rule to remedy the invalidated 340B-acquired drug payment policy for calendar years 2018 to 2022.

Earlier in July, the federal government agreed to pay eligible hospitals in the 340B program $9 billion to offset payment cuts that the Supreme Court had previously ruled unlawful. The prescription drug payment cuts were made by the Department of Health and Human Services (HHS) in 2018 and subsequently opposed in the courts by the American Hospital Association (AHA) and other hospital groups.

In 2022, the Supreme Court rejected the massive payment cuts, ruling them to be unlawful because HHS did not follow the proper procedure.

As part of its final rule, CMS is maintaining budget neutrality. The agency estimates that hospitals were paid $7.8 billion more for non-drug items and services during that time period than they otherwise would have been without the 340B payment policy. To carry out the nearly $8 billion budget neutrality adjustment, CMS will reduce future non-drug item and service payments by adjusting the conversion factor for payments for outpatient services.

The offset was originally proposed for 2025 but faced industry pushback during the comment period. The adjustment will continue until the full $7.8 billion is offset, which CMS estimates will take 16 years.

In a statement, AHA president and CEO Rick Pollack commended the coming repayment to 340B hospitals but condemned HHS’ choice to cut Medicare rates. “HHS made a grievous mistake in choosing to claw back billions of dollars from America’s hospitals, especially those that serve rural, low-income, and other vulnerable communities. HHS decided to ignore hundreds of comments from hospitals and other providers explaining why this Medicare cut is both illegal and unwise,” he said.

Healthcare group purchasing organization Premier Inc. echoed Pollack’s disappointment. “Premier will continue to press CMS to hold hospitals harmless from policy deemed unlawful to preserve patient access to high-quality pharmaceuticals,” Soumi Saha, senior vice president of government affairs at Premier, said in a statement.

In a statement, Chip Kahn, president and CEO of the Federation of American Hospitals, condemned the rule, saying “CMS’s decision to brush aside the Medicare statute and recoup $7.8 billion from hospitals treating Medicare beneficiaries is extremely disappointing. This sets a dangerous precedent by breaking a promise to seniors and their providers that care will be covered.”

The annually determined payment rate is final, Kahn added, and hospitals rely on it to serve their populations. It does not allow Medicare to claw back funds. “This statutory predictability and stability of payment is mission critical to sustain patient access to care,” he said. The recoupment through outpatient rate cuts will also likely reduce Medicare Advantage plan payments to hospitals, per Kahn.

The average cost of workplace health insurance premiums for family coverage reached nearly $24,000 this year, jumping 7% from 2022, according to the latest annual Kaiser Family Foundation survey of employer-sponsored coverage. Workers on average contributed $6,575 toward the cost of family coverage — up about $500 from last year — while employers kicked in $17,393, according to the KFF survey of over 2,000 firms. “It’s just an incredible amount of money to spend on health insurance every year,” according to KFF health insurance expert Matthew Rae, a co-author of the report. Higher expenses for healthcare providers increase health costs for employers, which is leading to higher premiums. Average deductibles stayed largely the same in recent years, hovering around $1,735 and continuing five years of relatively flat deductible growth following years of steady hikes. Read more.

As a part of a collaborative project for the Bureau of Primary Health Care’s National Training and Technical Assistance Cooperative Agreement, the Association of Asian Pacific Community Health Organizations (AAPCHO), MHP Salud, the National Health Care for the Homeless Council (NHCHC), and Health Outreach Partners (HOP) will host a webinar on Health Center Enabling Services and Social Drivers of Health (SDOH), Nov. 8 at 3:00 pm. Learn about the role of enabling services staff, including Community Health Workers, in screening for and addressing SDOH and how data can be used for meaningful change. Speakers will discuss successes, challenges, best practices, and other helpful information. Register here. 

The Pennsylvania Department of Human Services (DHS) is struggling with tech issues, persistent staffing shortages, and flawed procedures as it redetermines thousands for Medicaid and CHIP coverage due to the Medicaid Continuous Coverage Unwinding which began April 1, 2023. The ex-parte process for renewing of applications using existing data sources has garnered a very low success rate. Just 4% of Medicaid renewals have been done through the ex parte process, higher than only Texas and Wyoming. The federal government has been pushing states to use this method, which is considered to be more efficient for administrators and easier for benefit recipients, who end up with a lower chance of churning on and off of Medicaid rolls. As of Oct. 23, KFF Medicaid Enrollment and Unwinding Tracker reported 46% of PA disenrollments were due to procedural reasons, and 54% were deemed ineligible. DHS has also published demographic and county-specific unwinding data. Read more.

Notice of Inquiry to Explore How FCC’s Broadband Health Mapping Tool Can Be Expanded and Enhanced to Address Maternal Health Crisis in U.S.

The Federal Communications Commission voted to launch a proceeding designed to explore ways the Commission’s Mapping Broadband Health in America platform could be expanded and enhanced to help better leverage digital health tools to improve maternal care.

The United States is the only developed country with increasing maternal mortality and severe maternal morbidity rates, and research from the Centers for Disease Control and Prevention suggests that more than 80 percent of these deaths and complications are preventable.  Additional research further demonstrates that access to broadband and the connection to healthcare that Internet service enables can help address the crisis.  Meanwhile, access to maternal health care remains a major challenge, especially for women of color, women living in rural areas, and women from lower income households.  In June 2023, the Commission updated the Mapping Broadband Health in America platform to reflect certain maternal health data required under the Data Mapping to Save Moms’ Lives Act.

Through this inquiry, the Commission seeks comment on issues that will help guide the next phase of this mapping platform and inform associated data analytics work concerning the relationship between broadband and maternal health.  This would include future plans to incorporate additional maternal health variables, other relevant data, and functionalities; to assess how best to address data limitations while still protecting privacy and confidentiality; and to ensure that future updates result in improved user experience and actionable insights.

In addition, this proceeding will also seek information and comment on current uses of broadband-enabled health technologies, solutions, and services that are available and being used in maternal health care, as well as the range of barriers that prevent access and utilization by childbearing women or women receiving postpartum care.  Lastly, it will seek comment on potential actions or activities the Commission could pursue to help improve maternal health outcomes; to reduce maternal mortality and severe maternal morbidity rates; and to promote maternal health equity.

Action by the Commission October 19, 2023 by Notice of Inquiry (FCC 23-85).  Chairwoman Rosenworcel, Commissioners Carr, Starks, Simington, and Gomez approving.  Chairwoman Rosenworcel, Commissioners Carr, Starks, and Gomez issuing separate statements.

GN Docket No. 23-309

Open Enrollment for Pennsylvania’s health insurance marketplace, Pennie, begins in just a few days on Nov. 1. All insurers currently offering individual marketplace coverage in Pennsylvania’s 67 counties will continue to provide plans in 2024 with a statewide average increase of 3.9%, which is lower than what insurers initially filed. For 2024 health plans, Highmark is expanding into five new counties (Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) and Geisinger will expand its individual and small group offerings into Bedford County, increasing choice for consumers. In addition, consumers in Bucks, Philadelphia, and Montgomery counties will see one more health insurer offering coverage in the individual market as Pennsylvania welcomes another new entrant, Jefferson Health Plans, to the southeastern market. Consumers enrolling by December 15 can get coverage starting January 1, 2024, although Open Enrollment does not end until January 19, 2024