Read how the McKean County, Pennsylvania Department of Veteran Services in rural Pennsylvania has implemented a “collective impact” model designed to help veterans with federal benefits, employment, and medical care. The department collaborates with state and county representatives, advocates, and even the local airport to ensure veterans have access to necessary services.  Access the article here.

The Health Resources and Services Administration is seeking public comment on the information collection request, Bureau of Health Workforce (BHW) Substance Use Disorder (SUD) Evaluation. The evaluation purpose is to see if five programs aimed at increasing the access to the number of clinicians treating SUD have met their stated goals.   Click here to access the information.

The Census Bureau is seeking public comment on a new information collection called the Management and Organizational Practices Survey—Hospitals (MOPS-HP).  The survey will be used to collect data on management practices from chief nursing officers (CNOs) at general medical and surgical hospitals in an effort to identify factors affecting clinical and financial performance. Comments on the survey are due by March 27, 2020.  The information to submit comments can be accessed here.

The Centers for Disease Control and Prevention is seeking public comment on the National Hospital Ambulatory Medicare Care Survey (NHAMCS), which is used to collect information on healthcare facilities and visits for ambulatory care services in non-federal, short stay hospitals. Comments are due by March 30, 2020.  The proposed rules can be accessed here.

Recent research has found that not only are nearly 40% of surveyed physicians burned out, but 40% are also experiencing depression. For many reasons—stigma among them—these professionals are not getting mental health support. Physician health programs, in collaboration with professional societies, are trying to change that by working with state licensure boards and other groups.  Click here to access the article.

On January 29, 2020, Governor Tom Wolf presented a series of proposed 2020-21 budget items totaling more than $1.1 billion to support reducing the risks to Pennsylvanians of lead and asbestos, and remediating existing toxins in schools, day care centers, homes, and public water systems.

“Decades ago, well-intentioned Pennsylvanians constructed our homes, schools, waterways and other structures out of asbestos and lead because they were thought to be harmless, even superior materials,” Gov. Wolf said. “Now we know the serious harm both can cause. To build a better Pennsylvania, we first need to fix our foundation, which is why the five lead and asbestos removal initiatives I’m outlining today are so important.

Gov. Wolf’s proposed budget investments to address asbestos and lead include:

Expanding the Redevelopment Assistance Capital Program to Schools
Governor Wolf is proposing that up to $1 billion in grants from the Redevelopment Assistance Capital Program (RACP) be used for lead and asbestos remediation in schools, a problem plaguing many of the state’s aging school buildings and causing health concerns for students and their parents, teachers, and staff.

RACP is a commonwealth grant program administered by the Office of the Budget for the acquisition and construction of regional economic, cultural, civic, recreational, and historical improvement projects.

RACP projects are authorized in the Redevelopment Assistance section of a Capital Budget Itemization Act, have a regional or multi-jurisdictional impact, and generate substantial increases or maintain current levels of employment, tax revenues, or other measures of economic activity.

Leveraging CHIP Health Services Initiative                                                                   
The Department of Human Services is working with the Centers for Medicare and Medicaid Services for a Health Services Initiative (HSI) to improve the health of children and families in Pennsylvania by increasing funding of lead remediation activities in places where children have been exposed to high levels of lead.

Remediation projects could include paint, water, and other sources of contamination. We are currently contemplating enhancing funding opportunities for current HUD grant recipients statewide, but also building infrastructure in 1-2 new areas to increase the regions in Pennsylvania ready and able to assist in lead remediation efforts moving forward. Funding will also be made available for training and certification to increase the number of individuals who are EPA-certified to complete lead remediation in areas where there are shortages of individuals to do this work.

The plan is to have the program operational next state fiscal year. With a $4 million state investment, $10 million in federal dollars could be leveraged annually for an annual total of $14 million to support efforts around lead remediation.

Transferring PENNVEST Grant Funds       
Legislation recently passed in Congress allows a state to transfer amounts from its clean water state revolving fund to its drinking water state revolving fund in order to address a threat to public health as a result of heightened exposure to lead in drinking water. Specifically, a state may transfer no more than 5 percent of the cumulative amount of the federal grant dollars awarded for its clean water state revolving fund to its drinking water state revolving fund. It also requires that states coordinate with EPA to get their buy-in for the transfer.

By taking advantage of this new flexibility, PENNVEST may be able to free up to $90 million for Pennsylvania to address lead in drinking water by providing grants for lead service line replacement statewide. The amount transferred will not have a negative impact on future projects that could have been funded with that money and will be determined based on the amount of available dollars at the time the program begins.

PENNVEST has proposed to spend the next year working with communities to identify shovel-ready projects that can then be funded in 2021. Potential grant recipients will need to do testing, feasibility studies, and other consulting work next year to prep for projects.

Convening Lead Based Paint Hazard Reduction Program Grant Recipients              
The Lead Based Paint Hazard Reduction Program helps communities address housing-related health and safety hazards, in addition to lead-based paint hazards through the Lead Hazard control and Healthy Homes grants. The state, as well as several local communities, received notice of $22.5 million in funding awards in late September 2019. All recipients will target funds towards homes for low and very-low income families with children and will work with medical and social service providers.

At the most recent lead roundtable hosted by the commonwealth, the request was made for the state to convene all Pennsylvania recipients to ensure collaboration in implementation – a project the Department of Health is working to implement in the coming weeks under the direction of Gov. Wolf.

Implementing Lead Testing in School and Child Care Program Drinking Water Grant
Authorized under the Water Infrastructure Improvements for the Nation Act, the Environmental Protection Agency’s Lead Testing in School and Child Care Program Drinking Water Grant creates a program to assist with voluntary testing for lead in drinking water at schools and child care programs. The grant opportunity was announced in 2018 and applications were due this year however, award notices have not yet been issued.

Pennsylvania submitted a grant application, which included the support of PENNVEST and the departments of education, environmental protection, health, and human services. If awarded, approximately $1.7 million in funds will be used to develop and implement a lead testing program in schools and child care facilities throughout the state. This testing will include the prioritization of facilities serving younger children (ages 6 and under), underserved and low-income communities, and facilities that are older and more likely to contain lead plumbing.

Funding will support the testing of 3,000 schools and child care facilities.

Gov. Wolf was joined by Sen. Vincent Hughes and Rep. Jason Dawkins, who provided remarks, as well as numerus other legislators and advocates in support of these budget proposals.

“Far too much of Pennsylvania is toxic and unsafe as a result of lead and asbestos,” Sen. Hughes said. “Our homes, childcare centers, and schools suffer from serious disrepair and long-term neglect. Thank you, Gov. Wolf, for making a significant financial commitment to clean up these vital, necessary and fundamental places in our community. We intend to win on your proposal and to use that victory to propel us to a long-term even more robust investment.”

“I’m inspired by the plan and bold leadership that the Governor has displayed today with this announcement,” Sen. Jay Costa said. “Children across the state have been exposed to dangerous chemicals and crumbling facilities for years, and we know that it impacts their physical and mental health for their entire lives. Governor Wolf’s programs outlined today will save future generations of children from these problems.”

“The unhealthy dangers of lead contamination are proven without any doubt, and lawmakers should enthusiastically support the governor’s initiative,” said Rep. Frank Dermody. “It will make a critical difference in many thousands of lives.”

“Our children deserve to learn and our teachers deserve to teach in schools that don’t make them sick,” Rep. Jason Dawkins said. “This is something that we can all agree on. But for far too long, our children, teachers and anyone else who has entered school buildings in Philadelphia have literally taken their own lives in their hands. Why? Because often lead and asbestos were lurking inside. My delegation colleagues and I are overjoyed at the news that Gov. Wolf will be making investments in lead and asbestos remediation projects in our schools. Finally, we can take the steps to make our school buildings safe places to learn and to teach.”

Gov. Wolf first introduced his Lead-Free PA initiative in August 2019 to call attention to the need for a law requiring universal blood level testing of children according to federal guidelines, and to convene regional task forces to address specific local needs.

A Lead-Free PA task force convened in December to gather the input of communities and their partners toward compiling a complete list of needs so that funding, when allocated, goes directly to programs and initiatives that produce swift and measurable results toward protecting Pennsylvanians.

“Together, these programs have the potential to assist thousands of Pennsylvanians with living healthier lives free of lead and asbestos danger,” Gov. Wolf said. “We have the opportunity to correct the past, and to build a brighter future. Pennsylvania should be a place free of lead and asbestos.”

MEDIA CONTACT: J.J. Abbott, 717-783-1116

CMS resets the federal-state relationship modernizing Medicaid to deliver better outcomes

On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the Healthy Adult Opportunity (HAO), which is an optional demonstration initiative.  It is designed to give states unprecedented tools to design innovative health coverage programs tailored to the unique needs of adult beneficiaries, while holding states accountable for results and maintaining strong protections for our most at risk populations.

These innovations deliver on the Trump Administration’s promise to improve health outcomes and care for our most vulnerable. The Healthy Adult Opportunity puts patients first through state flexibility, accountability, and patient protections. It is designed to provide states with an opportunity to meet the needs of their  adult beneficiaries under age 65 who aren’t eligible on the basis of a disability or their need for long-term care and for whom Medicaid coverage is optional for states.  Other low-income adults, children, pregnant women, elderly adults, and people with disabilities will not be directly affected – except from the improvements that result from states reinvesting savings to improve and sustain Medicaid for everyone.

“Vulnerable populations deserve better care. Data shows that barely half of adults on the Medicaid program report getting the care they need,” said CMS Administrator Seema Verma. “This opportunity is designed to promote the program’s objectives while furthering its sustainability for current and future beneficiaries, and achieving better health outcomes by increasing the accountability for delivering results. We’ve built in strong protections for our most vulnerable beneficiaries, and included opportunities for states to earn savings that have to be reinvested in strengthening the program so that it can remain a lifeline for our most vulnerable.”

For the first time, participating states will have more negotiating power to manage drug costs by adopting a formulary similar to those provided in the commercial market, with special protections for individuals with HIV and behavioral health conditions. In exchange for increased flexibility offered through the Healthy Adult Opportunity, states must accept increased accountability for the program’s results.

The Healthy Adult Opportunity also provides the opportunity for a full array of flexibilities that CMS has historically provided through section 1115 demonstrations – in addition to some that are entirely new – and outlines them in a streamlined application template. These include flexibilities to waive requirements like retroactive coverage periods and the ability to engage beneficiaries through nominal premiums and cost-sharing. Subject to comprehensive expectations for minimum standards for approval of a Healthy Adult Opportunity demonstration, states will also have the opportunity to customize the benefit package for those covered and make needed program adjustments.  This will be in real-time without lengthy federal bureaucratic negotiations or interference.

Key federal benefit and eligibility protections as well as due process and civil rights remain in place and beneficiaries will still have important protections through minimum benefit requirements, eligibility protections, and limits on out-of-pocket expenses.

The Healthy Adult Opportunity establishes financial metrics to ensure states are driving affordability and quality, with savings shared between the federal government and state governments to protect taxpayers. States participating in the Healthy Adult Opportunity will be required to report on a set of key quality measures. In a new initiative specific to Healthy Adult Opportunity, states will report real-time performance indicators to CMS for detection of any potential beneficiary quality or access issues that need to be quickly addressed.

All proposals that states submit in response to this demonstration will still need to comply with existing transparency and public notice requirements, and states will need to ensure adequate public notice before any prospective changes are implemented.

The State Medicaid Directors’ letter can be viewed here: https://protect2.fireeye.com/url?k=f1182f1c-ad4d260f-f1181e23-0cc47adb5650-c30736484f733316&u=https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/smd20001.pdf

To view the fact sheet, please visit: https://www.cms.gov/newsroom/fact-sheets/healthy-adult-opportunity

To view the Medicaid facts and figures, please visit: https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-figures

To more formally recognize the value of Community Health Workers in the workforce and enhance recognition of CHWs, a new CHW certification is now being offered by the Pennsylvania Certification Board (PCB).

A time-limited (one-year) grandparenting process for those who meet the Certified CHW (CCHW) requirements and wish to obtain the new full certification is being provided. The grandparenting period will end December 31, 2020.

The requirements to become grandparented are:

• One year of full-time volunteer or paid employment or 2000 hours of part-time volunteer or paid employment as a Community Health Worker. Employment or volunteer experience must have been obtained within the last five (5) years.
• Sixty (60) hours of supervision of the volunteer or paid employment specific to the CHW domains (listed below).
• Seventy-five (75) hours of education/training relevant to the field of community health.
• Complete the CCHW Grandparenting Application.

CCHW Domains

Community Health Concepts; Advocacy and Capacity Building; Care Coordination; Health Literacy and Education; Safety and Self-Care; Cultural Competency; Communication and Interpersonal Skills; Ethical Responsibilities and Professionalism.  Summary of CCHW Domains (.pdf document)

The new CCHW certification will be valid for two years. A recertification process will be required every two years to maintain the CCHW credential. Recertification requires obtaining 30 hours of relevant education/training.

Once the grandparenting period ends on December 31, 2020, the 75 hours of education/training must be received from an approved CHW training program. A PCB CHW Advisory Council will create a process for this in 2020.  CCHW Grandparenting Application (.pdf document)

Questions about the new CCHW credential should be directed to the PCB:
Phone: 717-540-4455 | Email: info@pacertboard.org

The following organizations participated in the development of the new certification process:

• Pennsylvania CHW Steering Group and Task Force
• CHW Subject Matter Expert
• Pennsylvania Certification Board