While officials and families continue to grapple with the drug crisis’s devastating effects, a new report has investigated which states are succeeding as far as rehabilitation efforts go. Pennsylvania was found to be among the top. Click here to learn more.

The state of Pennsylvania’s cost for health and human services has increased from $24.1 billion to $59.1 billion from 2006 to 2023. That is a 63% increase over the 17 years after adjusting for inflation. Health and human services have a significant role in the state’s budget, accounting for approximately 65% of the total general fund expenditures in 2023 according to a recent budget document released by the commonwealth. The state attributed the increase in costs to many variables, including the expansion of Medicaid in Pennsylvania in 2015, which added 900,000 more people to coverage. In 2022, the state extended Medicaid postpartum coverage from 60 days after the end of a pregnancy to one year. Click here to learn more.

The U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) Notice of Benefit and Payment Parameters (NBPP) for PY2025 proposed rule was issued in Nov 2023 for comment on proposed standards for issuers and marketplaces as well as requirements for agents, brokers, web-brokers, enrollment entities and assisters to help marketplace consumers. Pennie provided comments prior to the deadline on Jan 8. The proposed rules once finalized will take effect in 2025. The NBPP:

• Proposes new federal standards for certain marketplace operational procedures and would require state-based marketplaces (SBMs) to implement new network adequacy requirements
• Provides additional flexibilities for state implementation of Essential Health Benefit (EHB) standards
• Would remove certain administrative barriers that prevent individuals from gaining and maintaining coverage, while extending enrollment opportunities during the plan year
• Provides guidance for states on the federally-facilitated marketplace (FFM) and state-based marketplaces on the federal platform (SBM-FP) regarding the implementation of standardized and non-standardized plans and asks whether it should require state-based marketplaces (SBM) to implement standardized plans
• Would require state agencies, including marketplaces, to pay to use an optional federal income verification data check that Pennie currently uses

Pennie responded with support for:

• CMS providing State-based marketplaces (SBMs) the necessary flexibility to determine how to implement standardized options as states are in the best position to determine what will best meet the needs of their individual markets.
• The proposal to allow the inclusion of routine adult dental services as an Essential Health Benefit
• The proposal clarifying that issuers have the flexibility to extend monthly premium payment deadlines when they experience billing or enrollment problems due to high volume or technical errors or are directed to do so by applicable state or federal authorities.
• The proposal to allow all exchanges to accept an applicant’s attestation of incarceration status without having to electronically verify that a consumer is not incarcerated
• The proposal to make the Special Enrollment Period (SEP) for individuals with household income at, or below, 150 percent of the federal poverty level (FPL) permanent
• Keeping federal regulations agnostic as to which state entity establishes and enforces network adequacy standards, provided such standards meet or exceed any federal minimum standard

Pennie opposes CMS’s proposal to require SBMs that utilize the optional Verify Current Income (VCI), or Equifax, check within the Federal Data Services Hub (FDSH) to now pay for the service. Pennie currently utilizes this service as a secondary income verification source when the Internal Revenue Service (IRS) returns applicant income data that is inconsistent with the income attested on a Pennie application.

Pennsylvania’s insurance and digital services agency announced a new website where Pennsylvanians can request independent, external reviews of denied health insurance claims. The state-specific standards went into effect on Jan. 1, 2024, as part of Act 146 that was passed into law in 2022. When coverage for a service is denied, and after consumers complete the internal appeal process with their insurer, they may submit a request to the Pennsylvania Insurance Department using a new website developed by the Commonwealth Office of Digital Experience (CODE PA) for an independent external review to be completed by a certified independent review organization detailing why a service, treatment, or benefit should be covered by their health plan. Click here to learn more.

Pennsylvania state data shows that drug overdoses claimed at least 3,700 lives in Pennsylvania last year. Two of the 33 bills signed into law by Gov. Josh Shapiro in December deal directly with trying to help combat this ongoing drug overdose crisis. Act 66 aims to help address workforce shortages by offering regulatory flexibilities for treatment providers and in turn improve access to those who need their services. The bill allows certified registered nurse practitioners and physician assistants to fulfill the on-call physician requirements of a treatment program. The change would address massive physician shortages particularly seen in rural parts of the commonwealth. In addition, the law also increases counselor, counselor supervisor and counselor assistant caseloads in inpatient residential treatment settings to give providers more flexibility in how they can use their employees and expertise. It also waives clinical experience requirements so individuals with related advanced degrees can get to work immediately and help meet staffing needs. Act 43 expands fentanyl and xylazine drug testing in hospital emergency departments. Last April, the Shapiro administration moved to reschedule xylazine as a Schedule III drug, meaning it can’t be obtained over the counter. Xylazine had most commonly been used as an animal sedative, but its illicit use has grown in popularity among drug abusers.

The report explores Critical Access Hospital (CAH) involvement in collaborative community health networks, and features interviews with leadership from CAHs and local public health departments about the challenges and lessons learned from these collaboration.   The report was created by the Flex Monitoring Team, a FORHP-supported consortium of researchers who evaluate the impact of HRSA’s Medicare Rural Hospital Flexibility Program.

Read the full article here.

Eligible hospitals and Critical Access Hospitals (CAHs) participating in the Medicare Promoting Interoperability Program have until February 29 to complete a self-assessment in the safe use of electronic health records (EHR) for the reporting period ending December 31, 2023.  The Safety Assurance Factors for EHR Resilience (SAFER) Guides are recommended practices for hospitals to reduce patient safety risk related to EHRs.  For this reporting requirement, participants can attest yes or no to whether they have completed their self-assessment.  New for 2024, eligible hospitals and CAHs will be required to attest ‘yes’ to the self-assessment. 

Read the full article here.

By January 25.  The Medicaid And CHIP Payment and Access Commission (MACPAC) makes recommendations to Congress, to the Secretary of the U.S. Department of Health & Human Services, and to states on a wide array of issues affecting Medicaid and the Children’s Health Insurance Program (CHIP).  The U.S. Government Accountability Office is now accepting nominations for MACPAC commissioner appointments that will be effective May 2024.  Nominees may include individuals with direct experience as enrollees or as caregivers of enrollees in Medicaid or CHIP; individuals with expertise in federal safety net health programs, health finance and economics, actuarial science, health plans and integrated delivery systems, reimbursement for health care, health information technology; or other providers of health services, public health, and other related fields.  The commission seeks a mix of different professions as well as urban and rural representation.  Send letters of nomination and resumes to MACPACappointments@gao.gov.

Read the full article here.

Apply by March 31. Federal legislation under Section 126 of the Consolidated Appropriations Act, 2021, authorizes the Centers for Medicare & Medicaid Services (CMS) to distribute additional residency positions (also known as slots) for physician training in underserved areas. Eligible hospitals must use MEARIS, CMS’s online application system to apply by March 31 for 200 newly available slots. In a one-hour webinar on Wednesday, January 17, at 12:00 pm Eastern, experts will provide background information on Section 126.  The session is hosted by RuralGME.org, the FORHP-supported organization that helps hospitals plan and develop rural residencies, and will focus on considerations for rural hospitals.

Read the full article here.