Thursday April 4 at 1:00 pm Eastern. Subject matter experts with the Centers for Medicare & Medicaid Services (CMS) will present the latest hospital price transparency policies and enforcement actions effective January 1, 2024, in a webinar produced by the Rural Health Information Hub (RHIhub).  These policies were effective January 1, 2021 and affect all hospitals operating in the United States.  For those who are unable attend, RHIhub keeps an archive of all webinars on its site.

Read more.

Named by the Centers for Disease Control and Prevention as one of the five leading causes of death for rural populations in the United States, unintentional injuries can be fatal or nonfatal injuries that are unplanned and often preventable.  This new resource from the Rural Health Information Hub (RHIhub) gives the how and why injuries are so prevalent, and then provides a collection of effective program models with resources for planning, funding, and sustainability.

Read the full article here.

HRSA increases loan repayment amounts by 50% for primary care providers who commit to practicing in high need and rural areas

Additional loan repayment available for primary care providers who commit to serve in shortage areas, demonstrate fluency in Spanish

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced that it has increased by 50% the initial loan repayment amount available to primary care providers—M.D.s and D.O.s, including OB-GYNs and pediatricians; nurse practitioners; certified nurse midwives; and physician assistants—who commit to practicing in areas with significant shortages of primary care providers.

With the growing cost of medical school and increased challenges in recruiting primary care providers to high need areas, today’s action will help rural and historically underserved communities attract providers to deliver critical primary care services. These providers could have as much as $75,000 forgiven in exchange for a two-year service commitment.

HRSA also is offering up to an additional $5,000 in loan repayment to all National Health Service Corps Loan Repayment Program participants who can demonstrate fluency in Spanish and who commit to practice in a high need area serving patients with limited English proficiency. Providers will demonstrate language proficiency through an oral exam administered through an accredited language assessment organization.

Individuals with limited English proficiency disproportionately experience poor health outcomes and often substandard provider experiences, including challenges understanding doctors’ questions and diagnoses and reading and using prescriptions, referrals, and follow-up directions. This announcement comes as HHS Secretary Xavier Becerra is in the midst of a Latino Health Tour, underscoring the Biden-Harris Administration’s commitment to improving the health of that community.

“At the Health Resources and Services Administration, we are committed to taking action to help ensure that everyone has access to primary health care,” said HRSA Administrator Carole Johnson. “We know the importance of having a culturally competent and consistent source of primary care for improving health and wellness, managing chronic diseases and prescriptions, and coordinating across care teams. Yet, too often in rural communities and historically underserved communities, primary care remains difficult to access. That is why we are increasing our incentives to encourage primary care providers to practice in high need communities by paying a greater share of their educational loans.”

Through HRSA’s National Health Service Corps Loan Repayment Program, primary care medical providers could previously receive a maximum of $50,000 in initial loan repayment in return for a two-year full-time service commitment to practice in an area with a shortage of health professionals. This amount is nearly the same as the program offered 30 years ago, yet average medical student debt has grown more than four-fold over that same time period.

Now, eligible primary care providers can receive up to $75,000 in initial loan repayment in return for a two-year full-time service commitment to practice in those same areas. Participants have the opportunity to receive additional funding for extending their service commitment.

Today’s actions build on a host of Biden-Harris Administration actions to grow and support the primary care workforce, including investments in:

• Training primary care providers through the HRSA community-based Teaching Health Center Graduate Medical Education Program that is training more than 1,000 residents in more than 80 community-based residency programs;
• Supporting the creation of new primary care residency programs in rural communities, which when fully accredited and operational will have up to 540 slots for physicians in specialties including family medicine, internal medicine, psychiatry, and general surgery;
• Conducting over 25,000 trainings for practicing primary care providers including pediatricians, OB-GYNs, nurse midwives, and other maternal health care providers to identify and treat mental health conditions among children and adolescents and pregnant individuals and new moms;
• Training primary care residents in the prevention, identification, diagnosis, treatment, and referral of services for mental health and substance use disorders to integrate behavioral health into primary care;
• Increasing access to care for patients with special needs by training primary care medical students, physician assistant students, and medical residents in caring for individuals with intellectual and physical disabilities; and,
• Training new primary care providers in culturally and linguistically appropriate care for individuals with limited English proficiency through language immersion programs and other methods.

To apply visit: The National Health Service Corps Loan Repayment Program.

CMS is pleased to announce the availability of a new Research Identifiable File (RIF) that utilizes the Medicare Bayesian Improved Surname Geocoding (MBISG) algorithm to predict the race and ethnicity of Medicare beneficiaries. This data file is available for public use through the Chronic Conditions Warehouse (CCW).

CMS developed the MBISG algorithm to enhance existing race and ethnicity data to better understand the Medicare population.

How does it work?

The availability of the MBISG in the CCW gives researchers an opportunity to have more accurate indirect estimates of the race and ethnicity data on the Medicare population for analysis. The MBISG data includes a set of probabilities that the person is a member of six racial and ethnic groups: American Indian or Alaska Native (AI/AN), Asian American and Native Hawaiian or Other Pacific Islander (AA and NHPI), Black, Hispanic, Multiracial, or White. MBISG probabilities are based on U.S. Census Bureau data on race and ethnicity distributions by surname and Census block group, as well as CMS’s race and ethnicity administrative data and additional administrative elements including first name, demographics, and coverage characteristics.

To better understand the likelihood a person would prefer materials in Spanish, the MBISG data also includes a Spanish Preference Category. This categorizes the predicted probability that each person with Medicare would prefer Spanish language material.

The MBISG data consists of a single file that contains the race and ethnicity probabilities of people with Medicare enrolled on March 1, 2023. This dataset is separate from CCW’s Master Beneficiary Summary File (MBSF), which is partitioned by calendar year. Researchers should note the MBISG dataset will overlap with MBSF files, but the cohort of people included in the MBISG dataset will not match exactly to any given MBSF calendar year dataset.

Get more information

CMS is committed to advancing health equity, including the availability, use, and accuracy of health equity data. To learn more about CMS efforts about health equity, review the CMS Framework for Health Equity and to find out more specifically about efforts around health equity data, review The Path Forward: Improving Data to Advance Health Equity Solutions

Need help?

The CMS Office of Minority Health offers a Health Equity Technical Assistance program to assist organizations, researchers, and those looking for help around health equity data collection and analysis, resources to embed health equity, and other resources to improve health equity efforts. Contact HealthEquityTA@cms.hhs.gov for more information.

In addition, the CCW offers information and contacts for those with questions regarding the data warehouse. If you have a question more information about the MBISG data, you can also contact the MBISG team directly at mbisg@cms.hhs.gov.

Sign up for our listserv to get the latest on health equity from the CMS Office of Minority Health.

Risant Health has announced the completion of its acquisition of Geisinger as its first health system dedicated to increasing access to value-based care and coverage. Together, the organizations will create a new value-based care platform that includes best practices, tools, technology, and services to support leading community-based health systems.

Risant Health’s goal is to expand and accelerate the adoption of value-based care in diverse, multipayer, multiprovider, community-based health system environments and improve the health of millions of people in communities across the country. Through this first acquisition, Risant Health brings together Kaiser Permanente’s integrated care and coverage expertise, and Geisinger’s experience in advancing value-based care in a model that includes various payers and a broad network of providers, while serving some of the most vulnerable and marginalized communities.

With the close of the Risant Health and Geisinger transaction, Jaewon Ryu, MD, JD, who has served as Geisinger’s President and CEO since 2019, will become the first CEO of Risant Health. As announced last month, Terry Gilliland, MD, will assume the role of president and CEO of Geisinger once Dr. Ryu’s transition to Risant Health is complete.

“Risant Health and Geisinger share a vision for the future of health care. Through Risant Health, we will leverage our industry-leading expertise and innovation to increase the country’s access to high-quality and evidence-based health care, which we know improves care quality and the patient and member experience,” said Risant Health’s board chair, Greg A. Adams. “We will also learn and benefit from Geisinger and the additional health systems that become part of Risant Health in the future, to help them grow in new ways, be more affordable, and bring value-based care to more people.”

As its inaugural health system, Geisinger will play an important role in shaping Risant Health’s strategy, platform, and operational model. Geisinger will maintain its name and mission, continue accepting patients covered by other health plans and continue offering its members a broad network of care providers in addition to Geisinger.

“Geisinger is proud to formally join Risant Health as its inaugural health system, which will accelerate our vision to make better health easier, more affordable, and more accessible for the communities we serve,” said Dr. Ryu. “Geisinger now can extend its vision, strategy, and impact to more Pennsylvanians because of the access to an expanded set of tools, expertise, and capital that joining Risant Health provides.”

As a part of Risant Health, Geisinger will build on its 109-year mission to care for rural and urban communities across Pennsylvania. Geisinger will have access to capital, technology, and resources to fuel improvements in facilities, drive innovation and investment in patient care and continued expansion of Geisinger Health Plan.

In the future, Risant Health’s investments to advance value-based care will accelerate Geisinger’s journey to make better health easier by offering Geisinger members enhanced health insurance options and patients easier access to Geisinger’s high-quality, innovative clinical programs and more robust health management technology, tools and programs.

Risant Health expects to acquire 4 to 5 more leading community-based health systems over the next 4 to 5 years.

Risant Health’s value-based platform will support its health systems with a set of technology, services, and capabilities designed to deliver superior health outcomes and a lower total cost of care in diverse business models.

Initial platform solutions will aid Risant Health organizations in delivering evidence-based care everywhere – the “best-of” knowledge to provide high value, effective care at the right time. Additionally, Risant Health will help health systems and their patients know how to easily understand, access, and navigate to the right care at the right time and place.

Risant Health’s acquisition of Geisinger Health was reviewed and approved by the appropriate federal and state agencies and the transaction closed on March 31, 2024.

About Risant Health
Risant Health is a nonprofit, charitable organization headquartered in Washington, D.C. with a transformative vision to improve the health of millions of people by increasing access to value-based care and coverage. Risant Health is dedicated to bringing together like-minded, nonprofit community-based health systems from across the country in order to deliver better health outcomes through value-based care approaches. Risant Health’s value-based platform will support its health systems with a set of technology, services, and capabilities designed to deliver superior health outcomes and a lower total cost of care in diverse business models. Risant Health was created in 2023. For more information about Risant Health, click here.

About Geisinger

Geisinger is among the nation’s leading providers of value-based care, serving 1.2 million people in urban and rural communities across Pennsylvania. Founded in 1915 by philanthropist Abigail Geisinger, the non-profit system generates $10 billion in annual revenues across 134 care sites – including 10 hospital campuses, and Geisinger Health Plan, with 600,000 members in commercial and government plans. The Geisinger College of Health Sciences educates more than 5,000 medical professionals annually and conducts more than 1,400 clinical research studies. With 26,000 employees, including 1,600 employed physicians, Geisinger is among Pennsylvania’s largest employers with an estimated economic impact of $14 billion to the state’s economy. On March 31, 2024, Geisinger became the first member of Risant Health, a new nonprofit charitable organization created to expand and accelerate value-based care across the country. Learn more at geisinger.org or follow on Facebook, Instagram, LinkedIn and X.

On Thursday, March 28, the Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) released the Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage, or “Junk Insurance,” Final Rules.

The Biden-Harris Administration is closing loopholes to prevent health insurance companies from misleading consumers into buying health plans that discriminate based on pre-existing conditions and that provide little or no coverage when consumers need it the most. Short-term, limited-duration insurance (STLDI) is a type of health insurance that is typically designed to fill temporary gaps in coverage when an individual is transitioning from one source of coverage to another. Unlike most health insurance plans, STLDI plans are not subject to the Affordable Care Act’s (ACA’s) critical consumer protections, including guaranteeing coverage for people with pre-existing conditions and prohibiting discrimination based on health status, age, or gender. This final rule will limit these “short-term” plans to truly short time periods, no more than four months instead of three years.

For more information on the final rules, you may read the fact sheet, here.

The Biden-Harris Administration, through the U.S. Department of Health and Human Services (HHS)’s Centers for Medicare & Medicaid Services (CMS), announced policies for the Affordable Care Act Marketplaces that make it easier for low-income people to enroll in coverage, provides states the ability to increase access to routine adult dental services, and sets network adequacy standards for the time and distance people travel for appointments with in-network providers. Finally, the rule will standardize certain operations across the Marketplaces to increase reliability and consistency for consumers. The 2025 Notice of Benefit and Payment Parameters final rule builds on the Administration’s previous work expanding access to quality, affordable health care and raising standards for Marketplace plans nationwide.

“More than 21 million Americans signed up for high-quality, affordable health care coverage through the ACA Marketplaces in 2024. We want to build on this success to make Marketplace plans even better,” said HHS Secretary Xavier Becerra. “This rule will allow coverage of routine dental benefits for the first time, expand requirements to ensure reliable access to health care providers, and ensure consumers with lower incomes can sign up for coverage when they need it.”

“Access to affordable, quality health care options remain a concern across the country and a top priority for CMS,” said CMS Administrator Chiquita Brooks-LaSure. “This rule includes groundbreaking ways to access health care services – such as addressing barriers for routine adult dental coverage for the first time and including considerations for how far people travel to see a health care provider. At CMS, we continue to explore ways to help Americans access high-quality coverage through the ACA Marketplaces.”

Increasing Access to Health Care Services

Adult Dental Services

CMS has expanded access to dental benefits by finalizing measures to allow states the option to add routine adult dental services as an essential health benefit (EHB). For the first time, and starting on January 1, 2027, every state will be able to update their EHB-benchmark plans to include routine non-pediatric dental services, such as cleanings, diagnostic X-rays, and restorative services like fillings and root canals, through the EHB-benchmark application process beginning in 2025.

Network Adequacy 

The final rule creates more consistent, nationwide standards on how far and how long a consumer must travel to see various types of providers in State Marketplaces and State-based Marketplaces on the Federal Platform (SBM-FPs). State Marketplaces and State-based Marketplaces must review a plan’s network information prior to certifying any plan as a qualified health plan (QHP), consistent with the reviews conducted by the Federally-facilitated Marketplaces (FFMs).

Making It Easier to Enroll in Coverage

Special Enrollment Periods

The rule extends the special enrollment period (SEP) for consumers with household incomes at or below 150% of the FPL (for the 2025 plan year, $38,730 for a family of three) to enroll in coverage in any month rather than only during Open Enrollment. Previously, this SEP was only available when enhanced subsidies under the IRA were available.

The rule also aligns the dates of Open Enrollment periods across almost all Marketplaces to generally begin on November 1 and end no earlier than January 15, with the option to extend the Open Enrollment period beyond January 15.

Additionally, the rule aims to prevent coverage gaps for those transitioning between different Marketplaces or from other insurance coverage by allowing those selecting coverage during certain SEPs to receive coverage beginning the first day of the month after the QHP is selected, as opposed to coverage beginning at a later date if the consumer enrolls between the 15th and the end of the month.

Streamlining the Enrollment Process

This rule includes multiple policies to standardize operations among the Federally-facilitated and State-based Marketplaces to ensure a more streamlined consumer experience, such as requiring Marketplaces to have live call center representatives available during call center hours of operation to assist consumers with QHP application submission and enrollment, generally holding Open Enrollment from November 1-January 15 (with the option for Marketplaces to extend Open Enrollment to a later date), and automatically re-enrolling people who are enrolled in a catastrophic plan for the next year, in order to prevent gaps in coverage.

For more information on the final rule, see the fact sheet at: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2025-final-rule

Click here to view the final rule: https://www.cms.gov/files/document/cms-9895-f-patient-protection-final.pdf

Each year, PPC creates interactive maps for the Pre-K for PA campaign, and the 2024 maps and corresponding fact sheets are now available. Data on pre-k is available at the statewide, county, school district, and legislative district levels.

The maps highlight the unmet need for high-quality, publicly funded pre-k at each geographic level, including data points such as the eligible child population, high-quality, publicly funded enrollment, and number of high-quality pre-k locations.

Statewide, of the 145,010 eligible children ages 3-4 living in Pennsylvania, only 46% have access to high-quality pre-kindergarten. With workforce challenges experienced in the sector, an additional 7,817 pre-k staff are needed to serve the remaining eligible children.

As part of an enacted 2024-25 budget, the Pre-K for PA campaign is asking the General Assembly to:

• Support an investment of $30 million in Pre-K Counts to increase the per-child rate to help address workforce challenges and inflationary pressures in the sector. For the Head Start Supplemental Assistance Program, the proposed investment of $2.7 million to increase the per-child rate should be examined so that it is parity to the Pre-K Counts rate increase. To achieve this, the needed investment should be $8.8 million in the Head Start Supplemental Assistance line.
• Ensure this is the first step, as additional investments will be needed in future years to mitigate teacher shortages in this competitive economy further and provide greater access to this once-in-a-lifetime opportunity for our preschool learners.

Click here to view the 2024 Pre-K Maps.