As directed by the Fair Contracting for Health Care Practitioners Act (act), Act 74 of 2024, the Health Care Cost Containment Council (Council) has begun studying the prevalence and impact of non-compete agreements in the Commonwealth. The Council will be collecting public comments for analysis and inclusion within the final report. Comments received between September 21, 2024, and October 21, 2024, will be included for analysis.
Persons who wish to comment on the act may do so by contacting the Health Care Cost Containment Council
Letter by Mail:
PA Health Care Cost Containment Council
225 Market St, Suite 400, Harrisburg, PA 17101
Thank you in advance for your consideration. If you have any questions, please feel free to contact Jake Muskovitz, PHC4’s project manager for the study: jmuskovitz@phc4.org.
People who travel overseas are usually advised to do a bit of research beforehand about how to behave there. Closer to home, though, they may be unintentionally obtuse about the etiquette of rural places they visit.
n the hospitality business it’s common knowledge that doctors and lawyers, judges and business executives like to cut loose where their professional colleagues, customers and constituents are unlikely to notice. And rural places, whether they’re across the country or across the county, are just the ticket.
My theory, for what it’s worth, is that people who’ve been trained to never take no for an answer in their day jobs forget that negotiation isn’t part of every interpersonal exchange.
Some people raise misbehaving to an art form worthy of lyrics in country songs. But mostly, it’s not worthy. Manners matter, even when you’re around people you think you’ll never see again. So here are things you might wish to know about how to behave in rural areas.
There’s a reason. For every sign posted in a rural area, there’s a reason. Sadly, though, there are always people who think they only apply to other people. Often, as they disregard a sign, they declare, “I’m only going to be here a minute.” And somehow they always seem to have missed childhood lessons about how long a minute is. So here’s one of the simplest rules of behavior in rural areas: Don’t block driveways, mailboxes, gates, dry hydrants or anything else marked by a sign.
People pay attention. Where there are fewer people and fewer vehicles on the roads, there’s not much anonymity. So you can assume folks note the make and model of unfamiliar vehicles. Recently, I stopped to visit with someone who told me about a pickup truck that’s been racing past his place. I’ve seen that truck and think it might belong to someone working a construction project nearby.
When a project is expected to take several months, an out-of-town work crew might find rental housing (good luck) or park a trailer somewhere. They might never actually meet the people who live on that narrow, curvy, hilly road – people who may be reluctant to flag down an unfamiliar vehicle to ask the driver to slow down. So visitors might want to know that rural populations skew older, and behave as if behind every window there’s someone with all the time in the world to take down license plate numbers, note patterns of activity, and call the sheriff.
Word gets around. I have to assume that misunderstood manners are why, in the city, Uber drivers get to review guests like guests review drivers. VRBO and AirBnB short-term rental hosts also get to review guests. But even when there’s no formal mechanism to record bad behavior, word gets around. When we hear a business owner mutter, “That guy’s as welcome as a fart in church,” we take note. It’s best to assume that people in a rural area all know each other, and the person behind the bar is texting her cousins about the unruly patron who might be headed their way after she invites the bad boy to leave. As a rule, it’s best to treat rural bartenders like tough mothers, regardless of gender.
Patience is a virtue. I know people with years of experience in the hospitality industry who will not work on Friday nights. Here in Wisconsin, that’s when people go out for fish fry. Here in the Northwoods, that’s also when people with cottages head north to relax after leaving more populated places with more restaurant options. I don’t know why some reality show doesn’t drop celebrities and CEOs into Northwoods taverns to work Friday fish fries (or maybe they have but I don’t watch those shows).
People skilled in other lines of work might not fully appreciate the careful preparation, teamwork and timing it takes to get fried fish orders through the line and out of the kitchen. People who know and love this culinary tradition just order a brandy old fashioned (sweet) and wait patiently for their food. Unless they see a large party with fussy children arguing with the wait staff about making 20 or 30 minor substitutions: Then locals take our orders to-go.
Planning is appreciated. In rural areas, it’s safe to assume that there are no simple solutions to supply problems nearby. So we try to plan ahead as much as possible. That includes not just restaurants but also volunteer fundraisers like fish boils and pancake breakfasts. An order of 50 meals to-go is most appreciated when we know in advance it’s coming. Then we can have sufficient containers on hand not just for that one order but for all the other folks who want carryout, and set up for food prep that doesn’t extend the wait time for people standing in line. The volunteers flipping flapjacks can’t make their griddles larger, or shorten the distance to town to send someone for more to-go boxes.
Make eye contact. This may be difficult to comprehend for people who spend most of their time trying to avoid making eye contact with strangers. But in rural areas, we actually look at each other when we talk. Pair that with a smile and folks will be treating you like family in no time. Add a friendly wave if you’re driving by. But don’t slow down unless there’s a deer in the ditch or you may seem creepy.
Language matters. In general, in rural places you can’t go wrong with please, thank you, and “may I ask…” Respectful questions are generally appreciated in both private homes (would you prefer I take off my shoes?) and in businesses (is it too close to closing time to order food?). Even respectful questions may not yield the hoped-for answer. Back when my husband and I owned a paddling school on a whitewater river, we said no to a lot of people who thought they should be able to rent a canoe or kayak – whether or not they knew how to paddle in whitewater rapids. Some of them seemed to think no meant talk louder using coarse language. The first time it happened to me, I asked the guy, “Would you speak that way if your mother was standing behind you?” He actually looked over his shoulder.
To avoid any misunderstanding, cussing at the person behind the counter is not good manners. Cussing where families are present (and by that I mean people of every age) – not good manners. Anybody on a ladder helping a neighbor get a fallen tree off a roof gets a free pass on language. But otherwise, watch your mouth. Anything else I might have to add can be best expressed by Wisconsin musicians Pete and Lou Berryman in their song, A Chat With Your Mother:
I can’t control how you young people
Talk to one another,
But I don’t want to hear you use
That F word with your mother.
Once you hear that sung to the accordion, it’ll be with you forever.
In June 2023, Pennsylvania was awarded over $1.16 billion in funding through the National Telecommunications and Information Administration’s (NTIA) Broadband Equity, Access, and Deployment (BEAD) Program. As a next step in implementing this historic investment, the PBDA Board of Directors recently approved guidelines that detail the requirements to participate in the program.
Pennsylvania’s BEAD Program Guidelines will be posted for at least 30 days prior to PBDA beginning to accept applications. Additionally, the PBDA is aware that other states have, or will, implement a pre-qualification process for potential applicants interested in applying for BEAD funding. However, the PBDA has determined that it will not require pre-qualification in advance of accepting applications.
Lastly, the PBDA has updated the Pennsylvania Broadband Map to include Broadband Serviceable Areas (BSAs) eligible under the PBDA BEAD Program. You can find a CSV file and other pertinent information, to include Program Webinars and upcoming Office Hours details, on the PBDA BEAD Program website.
The NIH’s All of Us national population health program is increasing its rural presence.
Where you live affects how you feel. Because everything around you contributes to your health. That includes the food you eat, the places where you spend your days, and the air you breathe. Or how far you live from medical care.
That is a central idea of the All of Us Research Program. Enrolling people from different backgrounds and neighborhoods is the key to precision medicine.
People who live in rural areas have unique experiences to share. All of Us already has more than 70,000 participants who live in rural areas. That’s about 9% of our participants. But 20% of people in the United States live in rural areas. So we know we can do more.
The Heartland Consortium is a new group of All of Us enrollment partners in four Midwestern states. The group came together last year and is already enrolling people in All of Us.
There’s a new morning ritual in Pinedale, Wyoming, a town of about 2,000 nestled against the Wind River Mountains.
Friends and neighbors in the oil- and gas-rich community “take their morning coffee and pull up” to watch workers building the county’s first hospital, said Kari DeWitt, the project’s public relations director.
“I think it’s just gratitude,” DeWitt said.
Sublette County is the only one in Wyoming — where counties span thousands of square miles — without a hospital. The 10-bed, 40,000-square-foot hospital, with a similarly sized attached long-term care facility, is slated to open by the summer of 2025.
DeWitt, who also is executive director of the Sublette County Health Foundation, has an office at the town’s health clinic with a window view of the construction.
Pinedale’s residents have good reason to be excited. New full-service hospitals with inpatient beds are rare in rural America, where declining population has spurred decades of downsizing and closures. Yet, a few communities in Wyoming and others in Kansas and Georgia are defying the trend.
“To be honest with you, it even seems strange to me,” said Wyoming Hospital Association President Eric Boley. Small rural “hospitals are really struggling all across the country,” he said.
The American College of Obstetricians and Gynecologists created a new self-paced course focusing on the need for routine dental care before and during pregnancy. Pregnant patients experience gaps in care, which can lead to suboptimal perinatal outcomes and overlooked oral health needs. There is 1 CEU available for dental providers.
PCOH is thrilled to announce that our coalition has been named a 2024 Highmark Bright Blue Futures Rising Star!
The Highmark Bright Blue Futures Awards Program recognizes extraordinary nonprofit organizations that are advancing health equity across Pennsylvania, western and northeastern New York, West Virginia, and Delaware. The program launched in 2023 as an expansion of Highmark’s corporate giving and community involvement program, Highmark Bright Blue Futures, and was designed to recognize those making significant impact in the community. Nearly 250 organizations applied this year.
Thank you to Highmark for this amazing opportunity!
The Centers for Medicare & Medicaid Services (CMS) released comprehensive guidance to support states in ensuring the 38 million children with Medicaid and the Children’s Health Insurance Program (CHIP) coverage – nearly half of the children in this country – receive the full range of health care services they need.
Under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, eligible children and youth are entitled to a comprehensive array of prevention, diagnostic, and treatment services — including well-child visits, mental health services, dental, vision, and hearing services. These requirements are designed to ensure that children receive medically necessary health care services early, so that health problems are averted, or diagnosed and treated as early as possible. Because of the EPSDT requirements, Medicaid provides some of the most comprehensive health coverage in the country for children and youth.
The guidance issued today reinforces the EPSDT requirements and highlights strategies and best practices for states in implementing those requirements. This guidance, which was required by section 11004 of Title I of Division A of Bipartisan Safer Communities Act (BSCA) (P.L. 117–159), is the most comprehensive EPSDT guidance that CMS has released in a decade and is a critical step to ensuring the health of children.
“We need to make sure our children have what they need to stay well. Medicaid makes that possible,” said HHS Secretary Xavier Becerra. “This guidance to our states today will help millions of kids get the services that are crucial to their health and development, no matter where they live.”
“Our children are the future. They deserve the very best care possible and CMS is committed to ensuring that our nation’s children and youth get the right care, at the right time, in the right setting,” said CMS Administrator Chiquita Brooks-LaSure. “The implementation of the EPSDT requirements, in partnership with states, is vital to the tens of millions of children in the nation who are covered by Medicaid and CHIP. We’ll keep working until every child can get the care they need, when they need it.”
Today’s guidance is a critical step in CMS’ efforts to strengthen the Medicaid and CHIP programs across the country. The guidance clearly explains the statutory and regulatory EPSDT requirements, and suggests best practices across key areas, including increasing access to services through transportation and care coordination, expanding the children-focused workforce, improving care for children with specialized needs (including children in the child welfare system and children with disabilities), and expanding awareness among families of their children’s rights under the EPSDT requirements.
The EPSDT guidance also includes information to help address the needs of children with behavioral health conditions. Youth in the United States are experiencing a mental health crisis, research shows. The EPSDT guidance includes a series of strategies and best practices that states can use to meet children’s and youth’s behavioral health needs. For example, it suggests that states create a children’s behavioral health benefit package and support the management of children and youth with mild to moderate behavioral health needs in primary care settings. States must provide coverage for an array of medically necessary mental health and SUD services along the care continuum – including in children’s own homes, schools and communities — in order to meet their EPSDT obligation. This work builds on the HHS Roadmap to Behavioral Health Integration, which outlines the Department’s commitment to providing the full spectrum of integrated, equitable, evidence-based, culturally appropriate, and person-centered behavioral health care to the populations it serves, and builds on the President’s Unity Agenda to advance mental health.
The EPSDT requirements play a crucial role in the long road to achieving health equity by helping to provide access to essential care for children enrolled in Medicaid and CHIP. The guidance released today is one important step in the Biden-Harris Administration’s commitment to child health and access to affordable, quality health coverage for all, and is part of CMS’ broader strategy to ensure that children have the comprehensive and high-quality care they need. Beyond the importance of the EPSDT requirements, Medicaid more broadly is vital for ensuring the health of America’s youth. A new HHS report, Medicaid: The Health and Economic Benefits of Expanding Eligibility, by researchers in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) examines the impact of Medicaid throughout its six decades and highlights the importance of Medicaid coverage for low-income children. Studies show that access to Medicaid coverage is associated with a significant improvement in health and mortality that continues beyond childhood. In addition to improved health outcomes, children with Medicaid have improved educational and economic outcomes.
Congresswoman Carol Miller (R-WV) introduced the Rural Communities Opioid Response Program (RCORP) Authorization Act with Representatives Terri Sewell (D-AL), Buddy Carter (R-GA), and Ann Kuster (D-NH). The RCORP Authorization Act will establish and expand prevention, treatment, and recovery services in rural areas for opioid users.
“Ensuring there are enough resources for those who are suffering from addiction is a top priority for me. As a representative for a rural district, I have seen firsthand how important it is for my constituents to have access to quality health care. The Rural Communities Opioid Response Program provides funding to rural communities that are in need of recovery facilities, and the program should be authorized to provide certainty for communities and providers. I thank my colleagues for partnering with me on this bipartisan issue to establish addiction prevention services in the most rural areas of the United States,” said Congresswoman Miller.
“The opioid epidemic doesn’t discriminate. As we see in Alabama, it affects people of every background and every zip code, urban and rural. By authorizing the Rural Communities Opioid Response Program, we can take critical steps toward expanding prevention, treatment, and recovery services for opioid users in rural communities. I’m grateful to be part of the bipartisan group of lawmakers working to make that happen,” said Congresswoman Sewell.
“The opioid epidemic is a nationwide crisis that especially impacts rural communities. As a pharmacist and representative for a rural district, I understand the importance of ensuring that all Americans have access to prevention, treatment, and recovery services. Formally authorizing the Rural Communities Opioid Response Program will save lives in districts like mine. I am proud to work in a bipartisan manner to ensure continued access to these vital health care resources,” said Congressman Carter.
“From health care workforce shortages to limited access to treatment and recovery services, rural communities in New Hampshire and across the country have been hit particularly hard by the addiction and overdose crisis. Ending the substance use disorder epidemic calls for an all-of-the-above government response, and the Rural Communities Opioid Response Program will help ensure that even our most rural communities have access to the resources and support they need to save lives,” said Congresswoman Kuster.
“Substance use, including opioid use, is exacerbated in rural America by a lack of access to care and treatment. The Rural Communities Opioid Response Program (RCORP) is a grant program aimed at alleviating this gap by establishing and expanding prevention, treatment, and recovery services. NRHA applauds the efforts of Representatives Miller, Sewell, Carter, and Kuster for their introduction of the RCORP Authorization Act and their continual leadership on rural issues,” said Alan Morgan, CEO of the National Rural Health Association.
“Rural communities have been uniquely tested by the opioid epidemic. Limited care options, transportation issues, and incomplete support systems along with barriers to reintegration into the workforce have created unique barriers on the road to recovery. The RCORP program has been critical in deploying needed resources to these communities while promoting unique collaborations that provide patient-centered care. As such, we enthusiastically support the continuation of this vital program,” said David Gozal, M.D., M.B.A., Ph.D. (Hon), Vice President for Health Affairs and Dean of the Joan C. Edwards School of Medicine at Marshall University.
”On behalf of the 50 State Offices of Rural Health, we are thrilled to see Reps. Carol Miller, Ann Kuster, and Buddy Carter introduce the RCORP Authorization Bill of 2024. The RCORP grant program has been a lifeline for Rural population in West Virginia, New Hampshire, Georgia and all 50 states. If passed into law this bill solidifies the standing of the program in the eyes of Congress – we look forward to working with our rural champions to ensure Congress passes this bipartisan bill into law,” said Tammy Norville, CEO of the National Organization of State Offices of Rural Health.
The Centers for Medicare and Medicaid Services is planning oversight of third-party healthcare vendors in the wake of the Change Healthcare cyberattack, said Jonathan Blum, the agency’s principal deputy administrator. Blum, who also serves as chief operating officer for CMS, said that the agency is working to determine what levers it can pull to ensure severe disruptions in care like those linked to the cyberattack on the UnitedHealth Group subsidiary aren’t repeated. CMS declined to provide any details of its oversight strategy, but said it is collaborating with other partners across the Health and Human Services Department to “promote high-impact cybersecurity practices and enhance accountability for healthcare organizations and their vendors.”
PCOH is thrilled to announce that our coalition has been named a 2024 Highmark Bright Blue Futures Rising Star!