Health committees in the Pennsylvania House and Senate are working on a compromise agreement that will increase oversight of pharmacy benefit managers (PBMs). The Pennsylvania legislation would allow the state’s Insurance Department to regulate certain aspects of pharmacy benefit managers’ business that have been called anti-competitive. Read more. Included in this legislation is language that will prohibit PBMs from reimbursing qualified health centers participating in 340B less than they would reimburse similar entities that do not participate in the program. This is an evolving process so stay tuned for updates.

Legislation addressing worker shortages in healthcare and facilitating Pennsylvania’s entry into interstate compacts has been sent to Gov. Josh Shapiro to be signed into law. Sponsored by Rep. Frank Burns, D-Cambria, HB 2200 enables interstate licensing compacts to become operational. The legislation requires applicants in healthcare professions to submit fingerprints as part of their criminal history records check and lays out the process that Pennsylvania State Police and state licensing boards must follow in considering them. The change in law allows licensees to practice in other participating states with just one license. Without the fingerprinting process in place, previous efforts to implement the compacts were unsuccessful.

– Tuesday, July 16 at 2:00 pm Eastern. In this hour-long session, the Centers for Medicare and Medicaid Innovation will provide an overview of the new ACO Primary Care Flex Model (ACO PC Flex Model), which will focus on primary care delivery in the Medicare Shared Savings Program (SSP).  CMS has released a Request for Applications  and the application portal is open until August 1 for new or renewing ACOs who submitted an application to SSP by June 17, 2024.  CMS plans to announce applicants selected to participate in October 2024.  This model seeks to increase accountable care relationships for people with Medicare, especially those in rural and underserved communities.

– Monday, July 15 at 2:00 pm Eastern. The National Association of Rural Health Clinics (NARHC) will host the free, FORHP-supported webinar, with information on the Department of Health and Human Services (HHS) Office of Civil Rights and the Centers for Medicare & Medicaid Services final rule under Section 1557 of the Affordable Care Act Nondiscrimination in Health Programs and Activities and the RHC impacts, including:

• Requirement to post a notice of nondiscrimination.
• Requirements to post notice of availability of translation and auxiliary aid services in top 15 foreign languages.
• Requirement to establish and train employees on policies and procedures related to nondiscrimination.

Additional time for Q&A will be provided. Advanced registration is required.

– Comment by July 29. This week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for mitigating the impact of significant, anomalous, and highly suspect (SAHS) billing activity on the Medicare Shared Savings Program financial calculations in calendar year 2023. This proposed rule is part of a larger strategy to address significant, anomalous, and highly suspect (SAHS) within ACO reconciliation, and additional information will be forthcoming in the Physician Fee Schedule. Due to a recent, observed increase in Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) billing to Medicare for selected intermittent urinary catheter supplies in CY 2023, CMS  proposes to exclude use of these codes from any supplier in 2023 from ACO expenditure and revenue calculations.

This exciting new clearinghouse highlights the work of three different Rural Centers of Excellence on Substance Use Disorders (SUD), all of which are funded by FORHP’s Rural Communities Opioid Response Program (RCORP). Visitors to the website will find current information and technical assistance opportunities on SUD through a rural lens.

GiveCare Now, a statewide call for volunteer talent, including medical & dental professionals

Launching a statewide call for volunteer talent and medical professionals, the Free Clinic Association of Pennsylvania today announced a rebrand, as the organization is relaunched as the Pennsylvania Charitable Healthcare Coalition.

The organization represents charitable healthcare providers across Pennsylvania that fill a critical role, providing high-quality, free care for people who are under-insured or uninsured and lack access to care.

“Today, we’ve announced a rebrand that captures the essence of our life-changing work and launched a statewide call for volunteers to help us meet the growing needs of our communities,” said executive director Kristen Houser Rapp. “With more than 50 providers operating in the Commonwealth, free and charitable clinics deliver hope to people across Pennsylvania who lack access to healthcare. Without them, thousands of people would not have access to any type of care at all.”

Charitable healthcare providers are integral to keeping Pennsylvanians who do not qualify for Medicaid healthy, and help avoid medical debt from urgent care, emergency visits, and medications, as families move between health plans or lack other options.  While some clinics employ limited staff, the majority of clinical care is provided by volunteer talent.  

“Right now, and in the weeks and months to come, opportunities are available for volunteers to help provide care and give back to others,” said Rapp.  Anyone interested in volunteering should visit pacharitablehealth.org/volunteer, where PCHC can then connect them with a local clinic. PCHC is currently seeking volunteers that include:

• Doctors
• Nurses
• Pharmacists
• Dentists, dental assistants, & dental hygienists
• Mental health professionals
• Volunteers with administrative skills

Volunteer opportunities vary from clinic to clinic and by position.  All volunteers meet strict credentialing and background checks and receive training and support.

“I find that the best part of my day is always that I served in the clinic,” said Ridge Salter, M.D., a volunteer at Katallasso Family Health Center in York. “Volunteering my expertise has added so much professional fulfillment, and I know it has been an antidote — and a bit of an immunization — to burnout.”

In 2023 alone, PCHC member clinics provided at least 114,000 appointments for patients, averaging more than 3,000 per clinic.

“In the last year, hundreds of thousands of people in our state have lost their Medicaid coverage,” said Mary Herbert, MPH, MS, Clinical Director at The Program for Health Care to Underserved Populations/Birmingham Free Clinic in Pittsburgh.  “Despite their lack of state funding, free providers face the need to accommodate a major shift in the number of patients we serve, doing more than ever with limited resources.”

“PCHC’s member clinics and charitable providers fill a growing gap that many of our most vulnerable neighbors rely on for basic care, and volunteers are critical to this work,” said Highmark Foundation President Yvonne Cook. “The Highmark Foundation recognizes the vital work of charitable clinics and is proud to continue our partnership with PCHC through a $172,700 grant to further its mission to provide equitable, quality health care for all Pennsylvanians.”

 ABOUT THE PENNSYLVANIA CHARITABLE HEALTHCARE COALITION (PCHC)

PCHC is the support and advocacy organization for free and charitable healthcare providers who make up the healthcare safety net for uninsured and underinsured Pennsylvanians. Free and charitable clinics provide primary and preventative care such as medical screenings, chronic disease management, medication assistance, dental care and connections to other social services. Clinics do not receive state or federal funding and rely on community support. For information, testimonials from volunteers, and a searchable database of clinic locations, go to www.pacharitablehealth.org.