Last week, the Pennsylvania Workforce Development Association reinstituted their annual NextGen Youth Summit after a five-year hiatus to help Pennsylvania youth program providers collaboratively discover new opportunities for youth and young adults entering the workforce. Caitlin Wilkinson, Co-Director of the Pennsylvania Primary Care Career Center, represented PACHC and made some exciting new connections with the attendees that could lead to innovative collaborations that will help address Community Health Center workforce needs. Over the next few weeks, Caitlin will be meeting with these new connections but is happy to discuss individual health center needs or ideas in the meantime.

The Health Resources and Services Administration (HRSA) has announced Chantelle Britton as Director of the Office of Pharmacy Affairs (OPA) within the Office of Special Health Initiatives (OSHI). Britton will provide strategic leadership and oversight for the 340B Program and will guide OPA’s overall policy and implementation work. Britton has served as Acting Director of OPA since December 2023. She brings deep knowledge and experience with the 340B Program, drug pricing issues, health policy, access to care issues, safety-net programs, and HRSA’s federal and external partners to the permanent role. Prior to her appointment as Acting Director, Britton served for eight years as Senior Advisor in the Office of the Director of OPA.

Pennsylvania’s mandatory Managed Long Term Services and Supports (MLTSS) program, Community HealthChoices (CHC), was developed to enhance access and improve coordination of medical care. The Department of Human Services administers the Community HealthChoices program and is committed to increasing opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. Individuals 21 or older with Medicare and Medicaid may qualify for the CHC program. Pennsylvania’s CHC program was highlighted in this 2024 report.

Last week, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), finalized policies that continue to strengthen enrollee protections and guardrails to ensure Medicare Advantage (MA) and Medicare Part D prescription drug plans best meet the needs of people with Medicare. This final rule also promotes healthy competition, increases access to care, and protects enrollees from harmful marketing by limiting the distribution of personal beneficiary data by Third-party marketing organizations and ensures that MA organizations analyze their utilization management (UM) policies and procedures from a health equity perspective. The Medicare statute requires that CMS establish guidelines to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the MA or Part D plan intended to best meet the prospective enrollee’s health care needs. However, excessive compensation, and other bonus arrangements offered by plans to agents and brokers can result in individuals being steered to some MA and Part D plans over others based on the agent or broker’s financial interests, rather than the prospective enrollee’s healthcare needs. Additionally, the final rule generally prohibits contract terms between MA organizations/Part D sponsors and middleman Third Party Marketing Organizations (TPMOs), such as field marketing organizations, which may directly or indirectly create an incentive to inhibit an agent or broker’s ability to objectively assess and recommend the plan that is best suited to a potential enrollee’s needs. For more, see the final rule.

In mid-March, the Centers for Medicare and Medicaid Services (CMS) announced that they had updated their Medicare Learning Network (MLN) booklets for federally qualified health centers (FQHCs), rural health clinics (RHCs) and mental health services. The Medicare MLN booklets explain national Medicare policies on coverage, billing and payment rules for specific provider types. The telehealth related changes incorporate the extensions to pandemic telehealth flexibilities made by the Consolidated Appropriations Act (CAA), 2023, as well as changes to policy that were made in the 2024 Final Physician Fee Schedule. The major telehealth changes for the FQHC/RHC booklets include:

• An allowance for FQHCs and RHCs, starting Jan. 1, 2024, to bill remote physiologic monitoring (RPM), remote therapeutic monitoring (RTC), community health integration (CHI), principal illness navigation (PIN), and PIN-Peer Support (PIN-PS) by billing the general care management code, 0511. Previously, remote monitoring was considered bundled under the FQHC/RHC’s all-inclusive rate and not reimbursed separately at all.
• The booklet now specifies that FQHCs/RHCs can provide mental health visits using interactive, real-time telecommunication technology. However, the in-person visit mandated by the CAA, while currently waived, will go into effect Jan. 1, 2025.

The Pennsylvania Department of Human Services (DHS) issued a Request For Application (RFA) procurement for an Enrollment Assister Program to provide enrollment, outreach and educational services to Physical HealthChoices and CHIP consumers statewide. The duration of the procurement is for three years with one additional two-year option. The application deadline is April 23, 2024. The current vendor for the program is Maximus.

One year after the enrollment requirements were reinstated, Pennsylvania’s Medicaid program has dropped about half a million people, going from a record high of 3.7 million participants to 3.2 million as of February, according to state data. Now, state and local officials are examining their efforts to keep people enrolled in health insurance during this transition phase as they make plans to improve the renewal process going forward. State officials said they launched proactive outreach and awareness campaigns to prepare people for the reinstated renewal requirements by sending multiple messages through email, text and postal mail. They wanted to limit the various kinds of challenges people could face when reapplying, officials said, especially for those who had never gone through a renewal process before. Click here to learn more.

The Government Accountability Office (GAO) has released a report: “Health Centers: Revenue, Grant Funding, and Methods for Meeting Certain Access-to-Care Requirements” that highlights how Community Health Center revenue increased from $26.3 billion in 2017 to $42.9 billion in 2022. Senate HELP Committee Ranking Member Bill Cassidy, M.D. (R-LA) and House Energy and Commerce Committee Chairwoman Cathy McMorris Rodgers (R-WA) released a misleading statement about the report. Their press release emphasizes – in both the title and text – that health center total revenues increased by 60% between 2018 and 2022. The report is accurate, but fails to emphasize the reasons why health center funding has increased, including:

• Medicaid Enrollment Increases. Higher Medicaid enrollment led to higher Medicaid reimbursement. Seven states expanded Medicaid during this time period adding about 2.8 million additional patients.
• Temporary Funding Increases. A significant portion of the increased funding was temporary COVID-19 emergency funding that has now expired.
• Patient Volume Increases. Importantly, health centers are now serving 2 million more patients since 2017, increasing revenue.
• Inflation. The report does not adjust the revenue increases for inflation.

What the report doesn’t discuss is that the Medicaid Unwinding that started in 2023 has led to significant financial challenges for health centers; a recent NACHC survey found an average $600,000 loss per health center as a result of the unwinding. In addition, following expiration of the temporary pandemic funding, high inflation and workforce shortages are leaving health centers financially insecure. NACHC has released a statement providing additional context to media outlets and will provide resources to educate Hill offices about the financial pressure health centers face.

In response to the high degree of frustration they are hearing from healthcare providers across the continuum, the Shapiro Administration is working with stakeholders to identify strategies to streamline the insurer credentialing process. PA Insurance Department (PID) Commissioner Michael Humphreys and PA Department of Human Services (DHS) Secretary Val Arkoosh hosted a first meeting of providers, insurers, CAQH, and other stakeholders on Tuesday to discuss the issue and possible approaches to mitigate it. PACHC and several health center credentialing specialists participated. As the work continues, we will keep you informed of progress and opportunity for comment. PACHC is also separately working with PAMCO, the association representing Physical HealthChoices plans, and plan representatives on mitigation of credentialing issues, and particularly the responsiveness and timeliness of their dental and vision subcontractors. Questions or feedback? Please contact Andrea Wandling, Manager Member Relations and Human Resources, PACHC.