Rural Health Information Hub Latest News

Trump Administration Backing Off Medicaid Rule that States Warned Would Lead to Cuts

The Trump administration will not move forward with a proposed Medicaid rule that states, hospitals, insurers, patient advocates and members of both political parties warned could lead to massive cuts to the federal health care program for the poor.

“The proposed Medicaid Fiscal Accountability Rule (MFAR) was designed to increase transparency in Medicaid financing and ensure that taxpayer resources support the health care needs of our beneficiaries,” Centers for Medicare & Medicaid Services Administrator Seema Verma said in a statement Monday.

“We’ve listened closely to concerns that have been raised by our state and provider partners about potential unintended consequences of the proposed rule, which require further study,” she added.

Verma said the rule is being withdrawn from the agency’s regulatory agenda, but it’s not clear if it will be added to future agendas.

The rule was intended to overhaul the complex payment arrangements states use to raise money for their Medicaid programs — funding that is then matched by the federal government.

The administration argues some states use questionable methods of raising funds so they can leverage more money from Washington. One approach used by states consists of taxing providers that stand to benefit from more Medicaid funds flowing into the state.

But governors and state Medicaid directors argue those long-standing arrangements are both legal and necessary as states look for ways to keep up with escalating health care costs.

Dozens of states wrote public comments to Verma, urging her to withdraw the proposal, including conservative states that are typically supportive of her work.

If finalized, the rule “would have forced states to face larger Medicaid shortfalls and to make bigger cuts harming beneficiaries and providers,” tweeted Edwin Park, a research professor at Georgetown University.

September 2020 CMS National Training Program Update

Find the care you need — Check Out Care Compare!

CMS launched Care Compare on Medicare.gov to make it easier to find and understand information about doctors, hospitals, nursing homes, and other health care services. Now you can compare location, quality, and price information for health care providers. New features let you filter on the items that are most important to you, so you can personalize your results. It’s now easier than ever to review and compare health care providers, even on your tablet or smartphone. For more information, watch the eMedicare: Improving Compare Tools webinar recording, Medicare Care Compare video or see the latest press release.

New / Updated Training Materials

Spanish 2020:Coordination of Benefits

Spanish 2020: Medicare Prescription Drug Coverage

To check all of our materials, go to CMSnationaltrainingprogram.cms.gov.

New / Updated CMS Products

Medicare Coverage of Durable Medical Equipment and Other Devices

Coordination of Benefits: Getting Started

NTP Virtual Workshops Recordings

Visit CMSnationaltrainingprogram.cms.gov/ntp-courses to access the following workshop recordings:

Medicare Basics, Enrollment, & Eligibility Webinar (Recorded 7/28/20)

Medicare Part A and Part B Webinar (Recorded 7/29/20)

Medicare Supplement Insurance (Medigap) Webinar (Recorded 7/30/20)

Medicare Prescription Drug Coverage (Part D) Webinar (Recorded 8/4/20)

Medicare Advantage Webinar (Recorded 8/5/20)

Medicare Appeals and How Medicare Works with Other Insurance (Recorded 8/6/20)

Programs for People with Limited Income and Resources (Recorded 8/11/20)

Medicare Plan Finder (Recorded 8/12/20)

Medicare Current Topics (Recorded 8/13/20)

CMS’ Actions in Response to COVID-19 (Recorded 8/19/20)

Preventing Fraud, Waste, and Abuse in Medicare and Medicaid (Recorded 8/18/20)

CMS’ Actions to Address the Opioids Crisis (Recorded 8/20/20)

Social Security Benefits (Recorded 8/25/20)

Medicare Plan Finder Demonstration and Tips – Repeat Session (Recorded 8/26/20)

Where Do I Find Online Resources…? (Recorded 8/27/20)

Did You Know?

  • A pneumonia vaccine can help prevent pneumonia, but only 67% of adults 65 and over have ever gotten it. Medicare Part B covers the pneumonia vaccine, which is given as 2 pneumococcal shots.
  • September is Prostate Cancer Awareness Month. Medicare Part B (Medical insurance) covers prostate cancer screening for all men over age 50 (beginning the day after your 50th birthday).
  • You can find the latest news about Medicare by visiting the CMS Newsroom.
  • Save the Date: October 8, 2020 – NTP Getting Ready for Medicare OEP Webinar

Pennsylvania Health Secretary: Technology Can Help Mitigate Spread of COVID-19, Add Your Phone to the Fight

A Message from Pennsylvania Secretary of Health, Rachel Levine, MD

Technology connects us to resources and plays a powerful role in our lives. And at no time is technology more important than during the COVID-19 pandemic.

Pennsylvanians listen to our press briefings, gather data from our enhanced statewide and early warning monitoring dashboards, and follow us on Facebook and Twitter for the most up-to-date information.

Still, COVID-19 continues to impact our state. Nearly 142,885 Pennsylvanians have been diagnosed with COVID-19 so far, and we are still seeing cases increase each day.

It is upon each of us to help mitigate the spread of COVID-19. Here in Pennsylvania, we are adding another tool in the toolbox residents can use to protect themselves and their loved ones:  COVID Alert PA, an app that uses Bluetooth technology to notify you of a potential COVID-19 exposure.

This app uses Bluetooth technology, the same technology that helps your phone connect with your car to play music or use wireless headphones. This technology does not track or collect any location data or personal data from your phone – only your phone’s proximity to other phones with the app enabled. It is strictly designed to notify you if you may have been in close contact with someone who tested positive for the virus. If you test positive for the virus, and you choose to confirm that information into the app, it will notify those that may have been in close contact with you.

Often, it can be difficult for someone to either name or even know all the close contacts they were exposed to while they were infectious — like a person you spoke to for 15 minutes at the bar or someone you sat next to on the bus. This is where COVID Alert PA becomes extremely useful and augments value to the state’s contact tracing efforts.

When an individual tests positive for COVID-19, a public health professional from the Pennsylvania Department of Health or a county and municipal health department contacts them to begin a case investigation. During the investigation the individual learns about their test results and is asked to recall who they have been in close contact with during their infectious period.

The public health professional also will encourage the COVID-19 positive individual to open the COVID Alert PA and enter a six-digit validation code. After the validation is complete, the app will alert other individuals who were within six feet of the COVID-19 positive individual for at least 15 minutes.

Anyone getting an exposure alert is provided with public health advice and resources to talk to a public health professional about next steps or how to find the nearest testing site.  People with a confirmed exposure are bound to have questions and concerns, and we want to provide the information people need to make informed decisions about their health and the health of the people closest to them.

Remember, all this is done through Bluetooth technology, which means no personal or identifying information will be collected through the app. The person notified will not know the identity of the person to whom they were exposed.

The Wolf Administration has taken additional measures to ensure the safety and well-being of Pennsylvanians. Now that the state is reopened, though mitigation efforts remain in place, there is still an opportunity for COVID-19 to spread, so we need to prepare ourselves by washing hands, wearing masks, practicing social distancing and downloading the COVID Alert PA app. The more people who download the app, the better our chances are of preventing an outbreak and keeping our communities healthy.

When the app is available later this month, please download it through the Google Play or Apple App Store and add your phone to the fight to help stop the spread of COVID-19.

Together, we can help ourselves, our loved ones and our neighbors across the commonwealth stay safe.

COVID-19 in Pennsylvania.: Child Abuse Doctors See Disturbing Trend as the Pandemic Continues

USA Today

Pennsylvania doctors who treat child abuse say they are seeing a wave of more serious injuries in younger victims.  It’s part of a disturbing trend they first observed in the spring: as the coronavirus continues to spread across the state, so does the number of severe injuries in abused children.

The virus didn’t recede in the summer as anticipated, nor did the abuse.

Penn State Children’s Hospital saw a wave of serious injuries that began in mid-June, according to Dr. Lori Frasier, chief of the hospital’s child abuse pediatrics division.  “We’re seeing a surge of some kind,” she said last month.  The hospital doesn’t provide specific patient numbers, but it is “seeing pretty serious physical abuse injuries,” Frasier said.

The children range in age from “young to very young,” she said, and often end up in critical condition in the intensive care unit.  “What really kills kids is head and abdominal trauma,” Frasier said. “That’s what they die from in those early 1- to 7-day periods.”

Fatal and nearly fatal

At least 155 children died or nearly died this year in Pennsylvania as a result of suspected child abuse or neglect, according to state data from Jan. 1 to July 15.  Those cases were referred to child welfare investigators, according to Ali Fogarty, communications director at the state Department of Human Services.  There were 144 children who died or nearly died in all of 2019 because of substantiated abuse or neglect, according to state data.  But, to clarify, measuring the differences between suspected cases and substantiated cases is not an apples-to-apples comparison.

In the cases last year, most abuse came at the hands of a parent, according to state data. The majority of victims were younger than 4 years old.  Overall, there were more than 5,200 substantiated cases of child abuse in Pennsylvania last year, with more than 40 percent of those cases attributed to sexual abuse. The rate of abuse in rural counties was more than double the rate in urban counties.  During the past five years, the number of fatalities and near fatalities in children has steadily increased from 95 in 2015 to 144 in 2019.

Waves of trauma

Penn State Children’s Hospital has seen waves of child abuse trauma in the past, even before a public health crisis changed American life.   But families are facing added pressure as the virus has a systemic effect in Pennsylvania, and that’s leading to more abuse, Frasier said.  Unemployment or having one parent at home to take care of the kids is a big source of stress, she said.  “They don’t feel like the pandemic has passed,” Frasier said.

There were 835 additional positive cases of Covid-19 and 20 deaths reported in Pennsylvania on Friday, bringing the statewide total to nearly 132,000. More than 7,600 state residents have died.  The state can track the number of positive cases and deaths, but the overall effect the virus is having on vulnerable children is unclear.   I don’t think we’ll have the full picture for a year,” Frasier said. “We’re right in the middle of it.”

‘A lot of stress’

St. Christopher’s Hospital for Children in Philadelphia saw an increase in severe injuries in the spring.  In July, Dr. Norrell Atkinson, section chief of the child protection program at the Level 1 trauma and burn center, started seeing an increase of toxic ingestions in young children.   “They come in with illegal substances in their system — opiates, marijuana, amphetamines,” she said.   Close to a third of the hospital’s cases are ingestions, and the patients are generally younger than 5 years old, Atkinson said.   “I’ve been at this hospital for two years,” she said, “and I haven’t seen a cluster like this.”

In most cases, the child lives in a home where the drugs are present and they are left unsupervised long enough to ingest the substances.  During June and July, the hospital saw cases often in which there were “supervision issues, and (parents and guardians) were more stressed and medicating differently,” Atkinson said.  The hospital doesn’t disclose the number child trauma cases treated, but all of the ingestion patients have survived, she said.  “We’re busier this year, and that could be due to a variety of factors, including the pandemic,” Atkinson said. “We’re not seeing decreased rates of abuse or neglect. We see a lot of stress.

Hidden dangers

The trend in Pennsylvania is in line with what’s occurring nationwide.  Doctors across the country are seeing more severe injuries in children in a week than they’re used to seeing in a month, according to medical providers at the American College of Emergency Physicians.  “The current pandemic is changing all of our lives in ways we can see, but the unseen may be even more vital than the seen,” said Dr. Jacque Johnsen, vice chair of the American College of Emergency Physicians. “Knowing additional risks to the most vulnerable patient populations at this time may save even more lives.”

The U.S. Centers for Disease Control and Prevention cited safety issues among its reasons that students should return to school in the fall.  “Extended school closures deprive children who live in unsafe homes and neighborhoods of an important layer of protection from neglect as well as physical, sexual, and emotional maltreatment and abuse,” the CDC reported.  Teachers and educational staff report suspected child abuse more than any other type of mandated reporter, according to state and federal data.

When students weren’t in classrooms in the spring, child abuse reports decreased. But severe child injuries increased, according to emergency room doctors.  The CDC cited an example of that in Washington, D.C.: The Washington, D.C. Child and Family Services Agency recorded a 62 percent decrease in child abuse reporting calls between mid-March and April this year compared to the same time period in 2019, but saw more severe presentation of child abuse cases in emergency rooms.

In Pennsylvania, Frasier said she’s “hoping against hope” the trend changes soon.  “I hope families reach out to resources and know they’re not alone,” she said. “I don’t want families to feel so isolated and stressed.”  And she doesn’t want to see another child with an injury that can’t be healed.

Candy Woodall is a reporter for the USA Today Network. She can be reached at 717-480-1783 or on Twitter at @candynotcandace.

Pennsylvania’s Statewide Kinship Navigator Program, KinConnector, Launches New Website

Kinship care is the full-time care, nurturing and protection of children by relatives or any adult who has a “kinship” bond with the children. These caregivers may include grandparents, aunts or uncles, siblings of the children requiring care, cousins or non-blood “relatives,” such as a teacher, coach or family friend.

Kinship care has been on the rise in Pennsylvania and the Pennsylvania Courts have produced this new video to help potential kinship providers learn about and understand kinship foster care, navigate the dependency court system and take the necessary steps to become a kinship parent.

Access the newly designed website here.

Update on State Child Care Budget and Policy in Pennsylvania

Pennsylvania Governor Wolf and the Office of Child Development and Early Learning (OCDEL) announced the distribution of $116 million in CARES funding to nearly 7,000 child care providers throughout Pennsylvania. This round of funding is the third distribution allocated to sustaining the child care sector during the current health crisis, with a total investment of $220 million, $104 million of which was distributed earlier this summer. The latest round of funding was largely based on findings from a research study undertaken by Penn State Harrisburg’s Institute of State and Regional Affairs, which studied the impact of the COVID-19 pandemic on Pennsylvania’s child care industry.

As part of his fall legislative agenda, Governor Wolf last week announced a proposed a $250 million investment in the child care sector to help families in need of child care for school-aged children due to hybrid K-12 programs in the 2020-21 school year. Wolf also proposed $27 million to expand access to child care deserts in Pennsylvania, or areas where few providers exist. Finally, $50 million in grants also was proposed for programs serving low-income communities and offering part-day school-age care.

OCDEL has also offered guidance for families and child care centers to ensure school-age children have access to reliable child care. The announcement provides guidance to non-licensed community-based entities and individuals planning to care for groups for school-age children during the 2020-21 school year. Additionally, OCDEL is directing an entity or person operating a non-licensed part-day school-age child care (SACC) program or Learning Pod to notify the Department of Human Services (DHS) and OCDEL if they intend to care for more than six school-age children for the school year.

A new change to child care subsidy payments recently announced by OCDEL also took effect this week. Due to the pandemic, OCDEL was making child care subsidy payments to providers based on the provider’s subsidy enrollment in March 2020. However, effective September 1st, OCDEL returned to pre-pandemic procedures, now basing subsidy payments on actual attendance.

Pennsylvania Governor Dedicates $15 Million to Connect Students to High-Speed Internet, Remote-Learning 

Continuing to help students learn during the pandemic, Pennsylvania Governor Tom Wolf is dedicating $15 million for schools to secure broadband, mobile hot spots, and other platforms that increase equitable access to remote learning.

“The COVID-19 pandemic has forced our schools to rethink and rework how to provide instruction to students who are learning completely at home or in a hybrid model,” said Gov. Wolf. “As schools reopen this fall, students need Internet connectivity, computers and other technology, and access to remote-learning platforms. This funding will help our students as we enter the new school year.”

The Coronavirus Aid, Relief and Economic Security (CARES) Act authorizes governors to determine the educational use of Governor’s Emergency Education Relief (GEER) Funds.

The initiative will employ a multi-pronged approach that includes the use of state library networks and other partnerships, including the Pennsylvania Technical Training and Assistance Network (PaTTAN).

Specifically, the funding will be used to:

  • Enable public libraries to coordinate work with the Internet Disaster Recovery Center to expand Internet connectivity in targeted county-wide geographic service areas identified as most in need. Expand the inventory of Wi-Fi hot spots and lendable technology through public libraries and addressing the technology deficit among libraries (estimated $1.4 million).
  • Strengthen and expand the existing 24/7 online homework help through the POWER Library Chat with a Librarian service and additional electronic resources (estimated $100,000).
  • Create and deploy Open Educational Resources (OER) for students and educators (estimated $500,000). OERs give students access to a wider range of instructional materials, including textbooks, videos and research, free of charge.
  • Establish a statewide datacasting initiative with Pennsylvania PBS to connect students to learning content who don’t have access to the Internet (estimated $8 million). Datacasting uses over-the-air TV signals to deliver educational content that can be used on computers without having to access the Internet. Using a datacasting antenna, students can download lesson plans, videos, and worksheets from their schools.
  • Distribute devices to be used in conjunction with datacasting technology for households without a connection to the Internet (e.g. datacasting antenna, laptops), and provide the technical supports and professional development to connect students to learning (estimated $3 million).
  • Distribute accessible/assistive technology, including but not limited to software, tablets, tablet mounts, screens, smart pens, hotspots, devices, for K-12 students with exceptionalities in collaboration with the PaTTAN system (estimated $2 million).

“In response to the pandemic, PDE and others have created new partnerships and strengthened existing ones to ensure Pennsylvania’s students continue to be served, whether that is academically, nutritionally, or socially and emotionally,” said Secretary of Education Pedro A. Rivera. “This new initiative is another way in which communities are working together to benefit our students.”

This initiative builds on the Department of Education’s efforts to support schools’ efforts to implement continuity of education plans during the 2019-20 academic year when schools closed unexpectantly as a result of COVID-19, which included Equity Grants and a partnership with Pennsylvania’s PBS stations to air standards-aligned programming across the state.

To date, the Wolf Administration has awarded $102.5 million in GEER funding to help keep students and educators safe and meet the unique challenges of COVID-19. In addition to the $15 million for connectivity, the Wolf Administration has directed $17 million for schools designated for Additional Targeted Support and Improvement under the federal Every Student Succeeds Act; $15 million for special education; $28 million to postsecondary institutions and adult basic education providers; $14 million to K-12 schools to support equity in continuity of education; $10.5 million to Career and Technical Education Centers; and $3 million for Preschool Early Intervention Programs.

New Guidance to Improve Care for Infants with Neonatal Abstinence Syndrome

Last week, the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin outlining the various service and financing options that state Medicaid and CHIP programs can use to improve care for infants with neonatal abstinence syndrome (NAS) and their families.  It also highlights Federal resources, tools, and models of care available to assist states, such as the HRSA Rural Health Integration Models for Parents and Children to Thrive (IMPACT) program.  Read more here.

Rural-Urban Differences Among Older Adults

Researchers at the University of Minnesota Rural Health Research Center created a chartbook with characteristics of older adults in rural counties, as well as rural-urban differences across four domains:  demographics, socioeconomic characteristics, healthcare access and use, and health characteristics. Read more here.