CMS released a proposed rule that impacts the Medicaid Drug Rebate Program and other Medicaid drug pricing, reimbursement, and data collection issues. Among the proposals, addressing spread pricing by pharmacy benefit managers and identification of 340B drugs on managed care pharmacy identification cards are of the most interest to FQHCs. NACHC will host office hours later this month to go over the proposed rule – details to come. Comments on the rule are due by July 25.
The Pregnant Workers Fairness Act Goes into Effect Next Week
Mark your calendar: The Pregnant Workers Fairness Act (PWFA) goes into effect on June 27. Under the PWFA, employers with 15 or more employees must engage in the interactive process with pregnant employees and make reasonable accommodations for pregnancy, childbirth, and related medical conditions — as long as the accommodations do not pose an undue hardship on the employer. Read this article on the PWFA from HRMorning.
New Pennsylvania Human Services Federal Unwinding Reports Have Been Published
The Department of Human Services (DHS) has published two reports required by the Centers for Medicare and Medicaid Services on Pennsylvania’s Medicaid unwinding. The first report is a point-in-time baseline report with pending data. The second report is a monthly snapshot of data. Both reports are for the entire Medicaid population. A third document called the Continuous Eligibility Unwinding Plan explains how DHS will process all Medicaid and CHIP renewals. The May 2023 monthly report shows 247,827 total beneficiaries for whom a renewal was initiated during the reporting period with 254,287 due for renewal. Of those renewed and retained, 10,584 were renewed on an ex parte basis, 90,297 were renewed using a pre-populated form, 29,120 were transferred to Pennie, 24,144 individuals were terminated for procedural reasons and 100,142 renewals were not completed. To view these reports, visit the PA DHS Federal Unwinding Reports webpage.
The Office of Inspector General (OIG) is Set to Conduct Substance Use Disorder Treatment Survey
The HHS Office of Inspector General (OIG) is asking for participation by HRSA-funded health centers in an upcoming survey about substance use disorder (SUD) treatment. OIG is conducting a study examining the provision of SUD treatment at HRSA-funded health centers. They will survey a sample of 450 HRSA-funded health centers on issues related to medications for opioid use disorder, drug counseling, and mental health services. In addition, they will collect information on the barriers and successful strategies that impact the provision of these services. Visit their website for more information about this study (report expected in 2024) and OIG’s other work to improve access to SUD treatment. If your health center is selected to participate, you will receive an email from healthsurveyinquiry@oig.hhs.gov with important information about completing the survey. Please make sure your voices and experiences are heard. Your responses are crucial to help OIG develop recommendations for program improvements and to ensure access to SUD treatment.
HRSA Pediatric Specialty Loan Repayment Program Has Launched
A new program from HRSA’s Bureau of Health Workforce makes a $15 million investment to recruit and retain clinicians who provide health care to children and adolescents. Deadline to apply is July 20. The program is open to eligible clinicians providing pediatric medical subspecialty, pediatric surgical specialty, or child and adolescent behavioral health care, including substance use prevention and treatment services, and provides up to $100,000 in loan repayment support. Clinicians must commit to serving three years at an approved site in a health professional shortage area, medically underserved area, or to providing care to a medically underserved population.
Pennsylvania Seeking Stakeholder Input on Master Plan for Older Adults
Pennsylvania expressly values older adults and individuals with disabilities and is committed to building and maintaining an age- and disability-friendly commonwealth so that all Pennsylvanians may live with dignity and independence. To accomplish that goal, Pennsylvania is putting together a 10-year Master Plan designed to help transform the infrastructure and coordination of services for Pennsylvania’s older adults. You are invited to contribute what you think should be the plan’s priority goals, objectives, and initiatives to support the highest quality of life for older adults. As part of that plan, the Pennsylvania Department of Aging (DOA) conducts a stakeholder engagement process, which is arbitrated by the Long-Term Care Council and the Governor. The process will involve outreach and requests for input from anyone or any group with an interest or with some interaction toward aging- and disability-related services, programs, and infrastructure. The state will be holding in-person and virtual stakeholder meetings across the state, with a minimum of an in-person meeting in each county over the next six months. People are also invited to submit comments directly through the website or can email DOA at AgingPlan@pa.gov. FQHCs were very involved in the development of a similar plan in California and DOA is hoping that Pennsylvania’s FQHCs will be as well. More information on the master plan can be found at https://www.aging.pa.gov/publications/MasterPlan/Pages/default.aspx.
The National Community Health Worker Awareness Week Has Been Announced
The National Association of Community Health Workers (NACHW) launched a campaign to increase awareness of the Community Health Worker’s identity, their role, impact on underserved and vulnerable communities, and leadership. NACHW will mark National CHW Awareness Week Aug 28 – Sept 1, 2023. The campaign was developed to highlight and promote policies that respect, protect, and authentically partner with the CHW profession. The Awareness Toolkit has templates that include a road map to guide participants through the process, implement strategies to help celebrate this national event, and customizable key talking points, as well as a checklist to aid meaningful conversation about CHW work and sustainability. Sign up for the CHW Awareness Week Mailing List.
Still Protecting Patients through the No Surprises Act
Beginning Jan 1, 2022, the No Surprises Act began protecting consumers from unexpected out-of-network medical bills from emergency room visits, non-emergencies related to a visit to an in-network hospital and air ambulance services. If consumers don’t have health insurance, usually providers must give a good faith estimate of how much health care would cost. To help patients, encourage them to check their medical bills for errors, read explanations of benefits, apply for any medical bill financial assistance, and be sure to contact individual health plans and providers for appeals.
Pittsburgh’s Duquesne Medical School Receives Pre-Accreditation
Moving toward its fall 2024 launch, Duquesne University’s College of Osteopathic Medicine (COM) has received “pre-accreditation status” from the Commission on Osteopathic College Accreditation (COCA). Because of this status, the university has begun recruiting students to the medical college and has received over 1,000 applications. (Those applications are not available to be downloaded until July.) Duquesne’s COM is committed to educating physicians with an emphasis on primary care and serving the underserved. The move to pre-accreditation status marks an important step, as it demonstrates the college has made significant progress toward its goals, having first earned candidate status in January 2022. Construction of the COM building is now well underway, senior leadership is in place, and the college’s curriculum has met COCA guidelines. Read more.
HHS Announces New Flexibilities to Slow Medicaid Disenrollments
The U.S. Department of Health and Human Services (HHS) announced on June 12, 2023, new flexibilities to minimize the number of Medicaid and Children’s Health Insurance Program beneficiaries disenrolled during eligibility redeterminations. New flexibilities include allowing health plans to help Medicaid members complete renewal forms, allowing states to delay procedural terminations for one month to allow additional outreach, and allowing pharmacies and community-based organizations to facilitate reinstatement of coverage based on presumptive eligibility criteria. The flexibilities are noted in an HHS announcement and in a letter to state governors. Read more.