The Centers for Medicare & Medicaid Services (CMS) issued a final rule for the Medicare Advantage (MA) and Part D prescription drug programs that will improve experiences for dually eligible beneficiaries and provide greater transparency for the MA and Part D programs. The measures set forth in the Contract Year 2023 MA and Part D Policy and Technical Changes final rule build on the agency’s strategic pillars to be a responsible steward of public programs, as it continues to expand access to quality, affordable care and advance health equity for people with Medicare and Medicaid.

Expanding access to quality, affordable care and coverage is a priority for the Biden-Harris Administration. This rule finalizes provisions to provide more affordable access to care for 53 million Americans enrolled in Medicare health or drug plans. First, Medicare Part D beneficiaries will see reduced out-of-pocket costs for prescription drugs starting in 2024, resulting from a new requirement that Part D plans pass along the price concessions received from pharmacies at the point of sale. Second, the rule clarifies policies to provide beneficiaries enrolled in MA plans uninterrupted access to necessary services during disasters and emergencies, like the COVID-19 pandemic.

Medicare and Medicaid are distinct programs that operate independently, which can sometimes result in fragmented care for the approximately 11 million individuals dually enrolled in Medicare and Medicaid. Dual eligibility is also a predictor of social risk and poor health outcomes. Many dually eligible individuals experience challenges such as housing insecurity and homelessness, food insecurity, lack of access to transportation, and low levels of health literacy.

The final rule will help close health disparities by delivering person-centered integrated care that can lead to better health outcomes for enrollees and improve the operational functions of these programs.  The rule also requires all MA special needs plans to annually assess certain social risk factors for their enrollees because identifying social needs is a key step to delivering person-centered care.

Moreover, the rule also strengthens coordination between states and CMS in serving people dually eligible for Medicare and Medicaid. This includes codifying a mechanism through which states can require dual eligible special needs plans to use integrated materials that make it easier for dually eligible individuals to understand the full scope of their Medicare and Medicaid benefits.

Also, in support of the Biden-Harris Administration’s commitment to advancing health equity, CMS is reinstating the requirement that MA and Part D plans inform enrollees of the availability of free interpreter services.  Plans will be required to include a multi-language insert in all required documents provided to enrollees.  In addition, CMS is closing a loophole for dually eligible MA enrollees who have high medical costs that exceed the maximum out-of-pocket limit established by the MA plan.  This loophole had resulted in lower payment to providers serving dually eligible MA enrollees than providers serving non-dually eligible MA enrollees.

The rule also promotes sustainability of the Medicare program. CMS is reinstating medical loss ratio reporting requirements and expanding reporting requirements for MA supplemental benefits. This will improve transparency into MA and Part D plans’ underlying costs, revenue, and supplemental benefits, which will benefit beneficiaries and taxpayers.

“Fiscal stewardship is a central principle of the work we do every day,” said CMS Deputy Administrator and Director of the Center for Medicare Dr. Meena Seshamani.  “As responsible stewards of the program, this rule enables us to learn more about how the Medicare dollar is being spent on certain Medicare Advantage benefits, such as housing, food, and transportation assistance, in order to better understand how we can most effectively support the health and social needs of people with Medicare.”

The rule also strengthens CMS’ role as a responsible steward of the Medicare program by leveraging its authority to limit MA and Part D plans’ ability to expand existing contracts and/or enter into new contracts if they have previously been poor performers.  Additionally, CMS is improving application standards and oversight of MA applicants’ provider networks to ensure enrollees will have access to a sufficient network of providers before CMS will approve for the first time or allow an existing MA contract to expand.  CMS will also protect Medicare beneficiaries by holding plans accountable to detect and prevent the use of confusing or potentially misleading marketing tactics by third-party marketing organizations.

View a fact sheet on the final rule at: https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-advantage-and-part-d-final-rule-cms-4192-f

The final rule can be downloaded from the Federal Register at:https://www.federalregister.gov/public-inspection/2022-09375/medicare-program-contract-year-2023-policy-and-technical-changes-to-the-medicare-advantage-and

Ransomware is no longer a concern limited to major health systems. Regional hospitals and specialty clinics are battling malicious cyberattacks as ransomware groups grow more opportunistic, STAT reports. Small providers — from pediatrics clinics to child abuse prevention nonprofits are being attacked. Such an attack can be devastating for a health system of any size and scary for anyone relying on its care. But for smaller hospitals and practices, the costs — both to patients and to the bottom line — can be especially steep. Read more.

The Health Resources and Services Administration (HRSA) is reminding providers that they have created best practice guides for providers to reference how others in their field are using telehealth to connect with patients. These also include practical recommendations on billing, strategy, and more.

The Pittsburgh Tribune-Review reports on a new survey from researchers at the University of Pittsburgh that finds that hospital workers are thinking about leaving their jobs. The survey had 2,253 participants, which represented hospital workers (excluding doctors) who had worked at one or more of 11 Pittsburgh hospitals in 2021. Many workers have reported burnout, long hours, and feeling hopeless. Read more. Since many of the survey respondents indicated that their work was meaningful and that they wanted to take care of patients, perhaps Community Health Center job opportunities will be an attractive alternative to some.

Telehealth generally didn’t lead to duplicative care in late 2020, according to a study published this week. Patients treated for most acute conditions via telehealth were as likely or slightly more likely to need a follow-up visit as those who sought in-person care to start, the study in JAMA Network Open found. Telehealth patients with chronic conditions were less likely to need follow-up care. Telehealth patients with acute respiratory infections were more likely to require a follow-up visit than in-person patients, but this could reflect COVID-19-related concerns, according to the researchers.

Heart disease, cancer, and COVID-19 made up the top three killers in 2021, according to a Centers for Disease Control and Prevention (CDC) report. With some people not getting vaccinated and the emergence of the delta variant, COVID-19 was cited as the underlying cause of more than 415,000 American deaths.

On April 20, 2022, the Centers for Medicare and Medicaid Services (CMS) released an action plan on the first pillar of its Strategic Plan demonstrating its commitment to health equity. CMS’ health equity strategy will build on the Biden-Harris Administration’s commitment to advancing racial equity and support for underserved communities through the federal government, as described in President Biden’s Executive Order 13985. 

CMS calls on its private sector partners to engage with its health equity strategy to sustain long-term action. CMS plans to convene industry stakeholders to ensure progress on the initiatives. The first meeting will take place in summer 2022 and focus on ways to improve maternal health outcomes experienced by pregnant and postpartum people. CMS and experts will invite health care industry leaders to share best practices and commitments to strengthen maternal health. 

CMS defines health equity as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, and other factors that affect access to care and health outcomes. 

CMS is working to achieve health equity for all people served by its programs. CMS’ overarching goals for realizing health equity are: 

• Close the gaps in health care access, quality, and outcomes for underserved populations 
• Promote culturally and linguistically appropriate services 
• Build on outreach efforts to enroll eligible people across Medicare, Medicaid/CHIP and the Marketplace 
• Expand and standardize the collection and use of data, including on race, ethnicity, preferred language, sexual orientation, gender identity, disability, income, geography, and other factors across CMS programs 
• Evaluate policies to determine how CMS can support safety net providers 
• Ensure engagement with and accountability to the communities CMS serves in policy development and the implementation of CMS programs 
• Incorporate screening for and promote broader access to health-related social needs 
• Ensure CMS programs serve as a model and catalyst to advance health equity through our nation’s health care system, including with states, providers, plans, and other stakeholders 
• Use the framework under the CMS National Quality Strategy, aiming to promote the highest quality outcomes and safest care for all people 

Each Office/Center within CMS detailed key actions to take in their efforts to advance health equity: 

Center for Medicare

• Increase Graduate Medical Education slots to promote workforce training in underserved areas to improve access to care. 
• Develop expanded stratified reporting of Medicare Advantage (MA) and Part D Star Ratings measures and add a new health equity index to the Star Ratings to allow beneficiaries to assess plans based on health equity measures.  
• Propose to reinstate the requirement for MA and Part D plans to include a multi-language insert to inform beneficiaries of free language and translation services to advance culturally tailored services for all beneficiaries. 
• Propose new supplemental payment for Indian Health Service and Tribal hospitals. 

Center for Clinical Standards and Quality

• Propose a “Birthing-Friendly” hospital designation to help consumers choose hospitals that have implemented improvements in birthing practices. 
• Explore the development of health equity-focused measures in all care settings. 
• Directing quality improvement resources to populations identified for the greatest health disparities using social vulnerability index, area deprivation index, and food access data. 

Center for Medicare and Medicaid Innovation

• Address historical underinvestment through payment adjustments or enhanced benefits to expand access and improve care for underserved populations. 
• Improve rates of participation among safety net providers like community health centers and disproportionate share hospitals to ensure beneficiaries in underserved communities receive the benefits of CMMI’s innovative models. Incorporate equity in model design to ensure equity is the central focus. 
• Increase collection of sociodemographic data. 

Medicare-Medicaid Coordination Office

• Support providers in delivering disability-competent and accessible care. 
• Improve access to the Medicare Savings Programs through public outreach and partnership with states. 
• Improve coordination between Medicare and Medicaid for people dually eligible for both programs through proposed rulemaking to strengthen dual eligible special needs plans, elevate the voices of enrollees in plan governance, and better identify and address housing instability, food insecurity, and barriers to transportation. 

Center for Medicaid and CHIP Services

• Roll back restrictive practices that prevented access to coverage and care. 
• Improve access to continuous coverage and quality of care in the postpartum period by working closely with states to encourage uptake of 12 months of extended postpartum coverage for pregnant people. 
• Work with states to identify opportunities to connect justice-involved individuals with community-based services immediately upon release. 
• Expanded access to home- and community-based services (HCBS) through the American Rescue Plan (ARP). ARP provided states with a temporary 10% increase to federal funding for some Medicaid HCBS. 

Center for Consumer Information and Insurance Oversight

• Acted to decrease the number of single-issuer rural counties in the individual market by incentivizing issuers to enter service areas to increase choice and affordability for rural communities. 
• Consider strengthening Health and Human Services essential community provider requirements. 
• Increase federally facilitated Marketplace enrollment among underrepresented populations by 25% to reduce uninsured rate among underserved populations. 
• Consider new requirements for network adequacy for qualified health plans on the Marketplace for 2023. 
• Consider requiring issuers of qualified health plans in Marketplaces using the federal platform to offer standardized plans so consumers can compare options easily. 
• Promulgate new regulations under the No Surprises Act related to surprise medical bills and unexpected health care costs. 

Office of Minority Health

• Provide technical assistance through the CMS Health Equity Technical Assistance Program to support all stakeholders as they work together to embed health equity within CMS programs, policies, and operations. 
• Create and distribute provider training materials to help health care professionals understand the needs of those they serve. 
• Expand community outreach efforts to gain valuable insight from stakeholders to provide CMS with current information about the diverse needs of each community it serves. 

Office of Communications

• Continued support and outreach for Medicare beneficiaries on Medicare Savings Programs and other cost-savings programs. 
• Expand culturally competent and linguistically accessible education campaign outreach to increase reach in historically underserved communities. 
• Translate the “Medicare & You” handbook and other educational materials for Medicare beneficiaries into additional languages to increase accessibility of programs and resources. 

For further questions, please contact Alexa McKinley, NRHA Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team. 

Fairness in PA Housing Includes People of All Ages, Abilities, and Income Levels

The Pennsylvania Department of Human Services (DHS) believes that housing is a right for all Pennsylvanians. Our mission is to ensure that housing assistance is available to all, especially those who need it most.

April was National Fair Housing Month. April 11, 2022, marked the 54th anniversary of the enactment of the federal Fair Housing Act, which protects people from discrimination when they are renting or buying a home, getting a mortgage, seeking housing assistance, or engaging in other housing-related activities. Initially, the Fair Housing Act prohibited discrimination on the basis of race, color, religion, and national origin. Later, the Act’s protections were expanded to include discrimination on the basis of sex, gender identity, sexual orientation, disability, and familial status.

Pennsylvania has a variety of housing programs and services that can help older adults, people with disabilities, individuals and families with low incomes, or those who are at-risk of or experiencing, homelessness. These programs can connect individuals and families with local assistance in finding somewhere to live, in-home supports, home modifications, and more.

• Housing Quick Reference Guide | Spanish — DHS
• Supports and Services for People Experiencing Homelessness — DHS

What Type of Housing Assistance is Available?

Here are some of the types of services that exist:

• Housing search — Tools to locate housing in your area.
• Homeless shelters — Temporary residences for individuals and families experiencing homelessness.
• Short-term housing — Housing options that typically offer leases of less than six months.
• Relocation assistance — Assistance with downsizing and relocation.
• Assisted living facilities — A long-term senior care option that provides personal care support services such as meals, medication management, bathing, dressing and transportation.
• Housing modifications — Assistance with home improvements, modifications, and repairs that improve the accessibility, adaptability, and/or design of a home.
• Home and community-based supports — Services that provide assistance with a variety of activities to help individuals remain in their home or community.

Housing Resources for Pennsylvanians

• Pennsylvania Housing Finance Agency (PHFA) Housing Resources
  www.phfa.org
  In the Quick Start Housing Resources section, PHFA and the Self-Determination Housing Project’s Regional Housing Coordinators have compiled local housing and social services resources for every county across the Commonwealth, including variety of housing providers such as housing authorities, homeless services providers, access home modification programs, community action agencies, and more.
• PA Housing Search
  www.pahousingsearch.com | 1-877-428-8844
  This is a free, online rental and homeownership service that helps people search for housing by topics such as rent amount, area of interest, accessibility, or availability of public transportation. A bi-lingual, toll-free number is also available. On the website, you can also find additional statewide information and resources, including a rental checklist, rent calculator, information on services, transportation, FAQs related to renting, and much more.
• Public Housing Authorities
  www.hud.gov/pennsylvania
  If you need public housing assistance or information about public housing programs, such as Housing Choice Vouchers (HCVs), please contact your local public housing authority (PHA). The HCV program is the federal government’s major program that assists families with with low incomes, older adults, and individuals with disabilities obtain safe and sanitary housing in the private housing market. Pennsylvania’s list of PHAs and contact information can be found at the above link.
• PA LINK to Community Care
  www.dhs.pa.gov/PA-Community-Care
  Aging and Disability Resource Centers (ADRC) are a nationwide effort to assist older adults and individuals with disabilities who need help with activities of daily living. The ADRC in Pennsylvania is known as the Link. The PA Link can: easily connect you to local services through any LINK partner agency; help you explore existing options to ensure a secure plan for independence; assist you with applications to determine eligibility; and help you remain in, or return to, your community.
• Rural Development Multi-Family Rental Housing Search Tool
  rdmfhrentals.sc.egov.usda.gov
  The U.S. Department of Agriculture’s web-based rural housing search tool allows you to click on your county to find information about housing in your area.
• 2-1-1 United Way
  www.pa211.org | Call: 2-1-1
  PA 2-1-1 is a free resource and information hub that can connect you with customized health, housing, and human services information. By calling 211, you can receive information related to food, housing, employment, health care, along with a variety of other services. PA 2-1-1 also provides a 24/7 confidential phone service and website. For individuals facing a housing crisis, you can also ask for support in learning how to connect to your community’s Coordinated Entry lead and partner agencies. 2-1-1 provides this services in some communities, and can connect you to resources.
• DHS Emergency Rental Assistance Program 
  dhs.pa.gov/ERAP
  The Emergency Rental Assistance Program (ERAP) was created to help renters dealing with financial challenges related to the COVID-19 pandemic. For eligible households, the program offers rental and utility assistance to help Pennsylvanians avoid eviction or loss of utility service. Certain PA counties may still have funding available to help landlords and renters at risk of eviction or losing utility services because of the COVID-19 pandemic.

File a Complaint

Pennsylvania Human Relations Commission (PHRC)
In Pennsylvania, fair housing is enforced by the Pennsylvania Human Relations Commission (PHRC), under the Pennsylvania Human Relations Act (PHRA). The Act prohibits housing discrimination in the sale, rental, finance, or otherwise to deny or withhold any housing accommodation or commercial property from any person based on race, color, age, religion, national origin, ancestry, disability, sex, familial status, or use of a supportive/service animal for a disability. If you feel you have been the victim of illegal housing and commercial property discrimination, file a complaint or report a bias incident to PHRC:

• Call the Pennsylvania Fair Housing Hotline at 855-866-5718.
• Call 717-787-4410 | 717-787-7279 (TTY)
• Visit one of PHRC’s three regional offices.
  (Regional offices are currently closed due to COVID-19 precautions. Drop boxes for required forms are available in the lobby of the Philadelphia and Pittsburgh offices.)

Pennsylvania Attorney General
The Civil Rights Enforcement Section of the PA Attorney General’s Office protects and advances the rights of Pennsylvanians through the enforcement of state and federal civil rights laws. The office reviews every complaint of a civil rights violation to determine the proper response.

• Submit a Civil Rights Complaint
• View the Civil Rights Enforcement Section Brochure

Additional Fair Housing Resources

• Fair Housing in Pennsylvania — PA Department of Economic Development (DCED)
• Fair Housing and Lending — PA Attorney General