Pennsylvania First Lady Frances Wolf and Agriculture Secretary Russell Redding were joined by Congressman Dwight Evans and food industry leaders to discuss how Pennsylvania’s $10 million Fresh Food Financing Initiative aims to address hunger, food insecurity and food apartheid in the commonwealth while simultaneously increasing market opportunities for Pennsylvania’s agriculture producers. The discussion will be livestreamed on Facebook at 2:00 PM.

“The Wolf administration continues to work to ensure that all Pennsylvanians have equal access to fresh, healthy food, because your zip code should not predetermine the quality of food on your dinner table,” said First Lady Frances Wolf. “The Fresh Food Financing Initiative COVID-19 Relief Fund is one of the many tools we have to combat food insecurity, and it is an exciting step in our fight for food equity across the state.”

In Pennsylvania, approximately 2.04 million Pennsylvanians experience chronic hunger and food insecurity every day during the COVID-19 pandemic. Food insecurity means not having access to reliable and nutritious meals. Since hunger and health are deeply connected, the effects of inadequate food are profound, including increased risks for chronic diseases, higher chances of hospitalization, poorer overall health and increased health care costs. Chronic hunger also affects cognitive function and our ability to learn and retain information.

The Fresh Food Financing Initiative COVID-19 Relief Fund — championed by Congressman Evans and funded through the CARES Act — is available to for-profit, nonprofit or cooperative entities impacted by COVID-19, including grocery stores, corner stores, convenience stores, neighborhood markets, bodegas, food hubs, mobile markets, farmers markets, on-farm markets, urban farms and food aggregation centers with a direct connection to direct-to-consumer retail outlets.

“Is food available? Is it safe, affordable, nutritious? This is food security. Food insecurity, a food apartheid, is what systemic racism has tragically created for many Pennsylvanians,” said Secretary Redding. “Corner stores in inner cities have candy bars, not fresh produce. I’m pleased that we are able to work to address this apartheid through the Fresh Food Financing Initiative by prioritizing Black, Indigenous, and People of Color communities and incentivizing retailers to provide fresh, local food. The program is stimulating economies, increasing market opportunities for farmers and improving local health.”

The goal of the FFFI COVID-19 Relief Fund is to provide grant support to food retailing businesses impacted by COVID-19 to ensure that amidst the pandemic, communities can maintain healthy food access. In recognition of the disproportionate impacts of both COVID-19 and food apartheid on communities made up of Black, Indigenous, and People of Color (BIPOC), and especially Black and African American communities, prioritization will be given to those businesses that are owned by and serve low-income BIPOC communities. Additional prioritization will be given to applicants with supplier diversity and increase business opportunities for Minority Business Enterprises, Women Business Enterprises, Service-Disabled Veteran Business Enterprises, Veteran Business Enterprises, Lesbian, Gay, Bisexual, and Transgender Business Enterprises; and Disability-Owned Business Enterprises.

“I appreciate the Wolf Administration’s continued strong support for the Fresh Food Financing Initiative, including this opportunity to bring stakeholders together to discuss how we can sustain and build on the program’s success,” said Congressman Dwight Evans (D-PA).

The live, virtual panel is an opportunity to highlight the Fresh Food Financing Initiative, build on the work of Governor Wolf’s Food Security Partnership, and discuss the interconnectedness of Pennsylvania’s robust agriculture industry and its ability to break down walls of inequity in Pennsylvania.

For more information on food security in Pennsylvania including information about resources and actions taken by the Wolf Administration and guidelines for the Fresh Food Financing Initiative COVID-19 Relief Fund, visit agriculture.pa.gov/foodsecurity.

Physician Fee Schedule Proposed Rule would make permanent certain telehealth and workforce flexibilities provided during the COVID-19 Public Health Emergency and improve healthcare for Americans in Rural Areas

The Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access that President Trump signed today. The Executive Order and proposed rule advance our efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas. Additionally, the proposed rule implements a multi-year effort to reduce clinician burden under our Patients Over Paperwork initiative and to ensure appropriate reimbursement for time spent with patients. This proposed rule also takes steps to implement President Trump’s Executive Order on Protecting and Improving Medicare for our Nation’s Seniors and continues our commitment to ensure that the Medicare program is sustainable for future generations.

Expanding Beneficiary Access to Care through Telehealth 

Over the last three years, as part of the Fostering Innovation and Rethinking Rural Health strategic initiatives CMS has been working to modernize Medicare by unleashing private sector innovations and improve beneficiary access to services furnished via telecommunications technology. Starting in 2019, Medicare began paying for virtual check-ins, meaning patients across the country can briefly connect with doctors by phone or video chat to see whether they need to come in for a visit. In response to the COVID-19 pandemic, CMS moved swiftly to significantly expand payment for telehealth services and implement other flexibilities so that Medicare beneficiaries living in all areas of the country can get convenient and high-quality care from the comfort of their home while avoiding unnecessary exposure to the virus. Before the public health emergency (PHE), only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July. For more information on Medicare’s unprecedented increases in telemedicine and its impact on the health care delivery system, visit the CMS Health Affairs blog here.

As directed by President Trump’s Executive Order on Improving Rural and Telehealth Access, through this rule, CMS is taking steps to extend the availability of certain telemedicine services after the PHE ends, giving Medicare beneficiaries more convenient ways to access healthcare particularly in rural areas where access to healthcare providers may otherwise be limited Improving Rural and Telehealth Access.

“Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for Americas seniors,” said CMS Administrator Seema Verma. “The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. Never one merely to tinker around the edges when it comes to patient-centered care, President Trump will not let this opportunity slip through our fingers.”

During the public health emergency, CMS added 135 services such as emergency department

visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. CMS is proposing to permanently allow some of those services to be done by telehealth including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments. CMS is seeking public input on other services to permanently add to the telehealth list beyond the PHE in order to give clinicians and patients time as they get ready to provide in-person care again. CMS is also proposing to temporarily extend payment for other telehealth services such as emergency department visits, for a specific time period, through the calendar year in which the PHE ends. This will also give the community time to consider whether these services should be delivered permanently through telehealth outside of the PHE.

Prioritizing Investment in Preventive Care and Chronic Disease Management

Under our Patients Over Paperwork initiative, the Trump Administration has taken steps to eliminate burdensome billing and coding requirements for Evaluation and Management (E/M) (or office/outpatient visits) that make up 20 percent of the spending under the Physician Fee Schedule. These billing and documentation requirements for E/M codes were established 20 years ago and have been subject to longstanding criticism from clinicians that they do not reflect current care practices and needs. After extensive stakeholder collaboration with the American Medical Association and others, simplified coding and billing requirements for E/M visits will go into effect January 1, 2021, saving clinicians 2.3 million hours per year in burden reduction. As a result of this change, clinicians will be able to make better use of their time and restore the doctor-patient relationship by spending less time on documenting visits and more time on treating their patients.

Additionally, last year, the Trump Administration finalized historic changes to increase payment rates for office/outpatient E/M visits beginning in 2021. The higher payment for E/M visits takes into account the changes in the practice of medicine, recognizing that additional resources are required of clinicians to take care of the Medicare patients, of which two-thirds have multiple chronic conditions. The prevalence of certain chronic conditions in the Medicare population is growing. For example, as of 2018, 68.9% of beneficiaries have 2 or more chronic conditions. In addition, between 2014 and 2018, the percent of beneficiaries with 6 or more chronic conditions has grown from 14.3% to 17.7%.

In this rule, CMS is proposing to similarly increase the value of many services that are comparable to or include office/outpatient E/M visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, physical and occupational therapy evaluation services and others. The proposed adjustments, which implement recommendations from the American Medical Association, help to ensure that CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients, like primary care and complex or chronic disease management.

Bolstering the Healthcare Workforce/Patients Over Paperwork

CMS is also taking steps to ensure that healthcare professionals can practice at the top of their professional training. During the COVID-19 public health emergency, CMS announced several temporary changes to expand workforce capacity and reduce clinician burden so that staffing levels remain high in response to the pandemic. As part of its Patients over Paperwork initiative to reduce regulatory burden for providers, CMS is proposing to make some of these temporary changes permanent following the PHE. Such proposed changes include nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives (instead of only physicians) to supervise others performing diagnostic tests consistent with state law and licensure, providing that they maintain the required relationships with supervising/collaborating physicians as required by state law; clarifying that pharmacists can provide services as part of the professional services of a practitioner who bills Medicare; allowing physical and occupational therapy assistants (instead of only physical and occupational therapists) to provide maintenance therapy in outpatient settings; and allowing physical or occupational therapists, speech-language pathologists and other clinicians who directly bill Medicare to review and verify (sign and date), rather than re-document, information already entered by other members of the clinical team into a patient’s medical record.

Public comments on the proposed rules are due by October 5, 2020.

For a fact sheet on the CY 2021 Physician Fee Schedule (PFS) proposed rule, please visit: https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4

For a fact sheet on the CY 2021 Quality Payment Program proposed rule, please visit: https://protect2.fireeye.com/url?k=2cb50d33-70e12418-2cb53c0c-0cc47a6d17cc-48198a1001590137&u=https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1100/2021%20QPP%20Proposed%20Rule%20Fact%20Sheet.pdf

For a fact sheet Medicare Diabetes Prevention Program- https://www.cms.gov/newsroom/fact-sheets/proposed-policies-medicare-diabetes-prevention-program-expanded-model-mdpp-calendar-year-2021

To view the CY 2021 Physician Fee Schedule and Quality Payment Program proposed rule, please visit: https://www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other

On July 31, CMS finalized three Medicare payment rules that further advance our efforts to strengthen the Medicare program by better aligning payments for Inpatient Psychiatric Facilities (IPFs), Skilled Nursing Facilities (SNFs), and hospices.

Inpatient Psychiatric Facilities:

The final rule updates Medicare payment policies and rates for the IPF Prospective Payment System (PPS) for FY 2021. In this final rule, CMS is finalizing a 2.2 percent payment rate update and finalizing its proposal to adopt revised Office of Management and Budget (OMB) statistical area delineations resulting in wage index values being more representative of the actual costs of labor in a given area. CMS is finalizing updates to allow advanced practice providers, including physician assistants, nurse practitioners, psychologists, and clinical nurse specialists to operate within the scope of practice allowed by state law by documenting progress notes in the medical record of patients for whom they are responsible, receiving services in psychiatric hospitals.

Skilled Nursing Facilities:

The final rule updates the Medicare payment rates and the quality programs for SNFs. These updates include routine technical rate-setting updates to the SNF PPS payment rates, as well as finalizes adoption of the most recent OMB statistical area delineations and applies a 5 percent cap on wage index decreases from FY 2020 to FY 2021. CMS is also finalizing changes to the ICD-10 code mappings that would be effective beginning in FY 2021 in response to stakeholder feedback. CMS projects aggregate payments to SNFs will increase by $750 million, or 2.2 percent, for FY 2021, compared to FY 2020.

Hospices:

For FY 2021, hospice payment rates are updated by the market basket percentage increase of 2.4 percent ($540 million). Hospices that fail to meet quality reporting requirements receive a 2 percentage point reduction to the annual market basket percentage increase for the year. The hospice payment system includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually. The final hospice cap amount for the FY 2021 cap year is $30,683.93, which is equal to the FY 2020 cap amount ($29,964.78) updated by the final FY 2021 hospice payment update percentage of 2.4 percent.

For More Information:

• IPF Final Rule and Fact Sheet
• SNF Final Rule and Fact Sheet
• Hospice Final Rule and Fact Sheet

NRHA Continues to Win Fight to Protect 340B Drugs for Rural Providers

The Centers for Medicare & Medicaid Services (CMS) proposed to cut Medicare Part B payments to hospitals for 340B-purchased drugs next year and in subsequent years by 6.2 percent below the current rate. However, as in the past, Critical Access Hospitals and rural Sole Community Hospitals were exempted from the cuts and will continue to be paid the default ASP plus 6 percent rate in the proposal. CMS made the announcement in its Hospital Outpatient Prospective Payment System (OPPS) proposed rule for calendar year 2021. Comments are due no later than 5:00 p.m. Eastern on Oct. 5.

Similar proposals for reductions that included cuts to rural providers have been proposed by CMS and Congress in the past. After extensive advocacy, NRHA was able to fight off proposed reductions to CAHs and SCHs. “Our challenge remains to protect this important program for all rural providers. 340B is vital in rural America and can mean the difference in providing services, employing staff, and keeping the doors open,” said Maggie Elehwany, Vice President of Government Affairs on NRHA.

Reimbursement for 340B drugs for disproportionate share hospitals (DSH), rural referral centers (RRC), and non-rural sole community hospitals (SCH) under OPPS would be set at average sales price (ASP) minus 34.7 percent, plus an add-on of 6 percent of ASP, for a net payment rate of ASP minus 28.7 percent. CMS has been paying these hospitals ASP minus 22.5 percent since 2018.

CMS derived the new, lower reimbursement rate from its survey in April and May of hospitals’ net average acquisition costs for drugs bought through the 340B program, including sub-ceiling price discounts. In the new proposed rule, CMS said, “Those survey data confirm that the ASP minus 22.5 percent rate is generous to 340B hospitals, and the survey data supports an even lower payment rate.”

A federal appeals court ruled 2-1 Friday that CMS had statutory authority to impose a nearly 30 percent cut to Medicare Part B drug reimbursement rates for 340B hospitals in 2018 and 2019. The reduction also is in place this year.

NRHA vows to be vigilant. CMS said it, “May revisit [its] policy to exempt rural SCHs, as well as other hospital designations for exemption from the 340B drug payment reduction, in future rulemaking.” Advocacy efforts and soliciting powerful stories from rural providers on their utilization of drug savings will be imperative during the next few months.

“We must continue to fight to protect 340B for CAHs, SCHs and expand it to all rural providers. We need all our members to join this fight,” said Elehwany.

On August 4, CMS finalized a Medicare payment rule that further advances our efforts to strengthen the Medicare program by better aligning payments for Inpatient Rehabilitation Facilities (IRFs). The final rule updates Medicare payment policies and rates for facilities under the IRF Prospective Payment System (PPS) for FY 2021. This final rule also includes making permanent the regulatory change to eliminate the requirement for physicians to conduct a post admission visit since much of the information is included in the pre-admission visit. This flexibility was offered during the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE), and the rule would make this flexibility permanent beyond the expiration of the PHE. In recognition of the interdisciplinary role that non-physician practitioners are currently performing with patients in the IRF, CMS is also finalizing that a non-physician practitioner may perform one of the three required visits in lieu of the physician in the second and later weeks of a patient’s care when consistent with the non-physician practitioner’s state scope of practice. Additionally, for FY 2021, CMS is updating the IRF PPS payment rates by 2.4 percent.

For More Information:

• Final Rule
• Fact Sheet