- Dr. Mehmet Oz Shares Vision for CMS
- CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid Partnership
- Social Factors Help Explain Worse Cardiovascular Health among Adults in Rural Vs. Urban Communities
- Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation: Request for Input
- Secretary Kennedy Renews Public Health Emergency Declaration to Address National Opioid Crisis
- Secretary Kennedy Renews Public Health Emergency Declaration to Address National Opioid Crisis
- 2025 Marketplace Integrity and Affordability Proposed Rule
- Rural America Faces Growing Shortage of Eye Surgeons
- NRHA Continues Partnership to Advance Rural Oral Health
- Comments Requested on Mobile Crisis Team Services: An Implementation Toolkit Draft
- Q&A: What Are the Challenges and Opportunities of Small-Town Philanthropy?
- HRSA Administrator Carole Johnson, Joined by Co-Chair of the Congressional Black Maternal Health Caucus Congresswoman Lauren Underwood, Announces New Funding, Policy Action, and Report to Mark Landmark Year of HRSA's Enhancing Maternal Health Initiative
- Biden-Harris Administration Announces $60 Million Investment for Adding Early Morning, Night, and Weekend Hours at Community Health Centers
- Volunteer Opportunity for HUD's Office of Housing Counseling Tribe and TDHE Certification Exam
- Who Needs Dry January More: Rural or Urban Drinkers?
New Brief Released on Minimally-Invasive Oral Care
Community Catalyst released a brief, “Minimally-Invasive Care: Policy Opportunities to Improve Dental Care Access and Affordability.” This resource provides an overview of state-level policies advocates can push for to ensure communities have access to comprehensive dental services, including minimally-invasive care, as well as federal policy considerations that will support its availability.
CMS has announced the final rules for the 2025 physician fee schedule, the hospital outpatient prospective payment system (OPPS) and the Ambulatory Surgical Centers. Within these rules, CMS is finalizing new coding and payment policies for advanced primary care management services, advancing maternal safety standards, removing barriers to expand access to care for those formerly incarcerated and others in underserved communities, and setting policies to reduce the use of opioids and to increase access to high-cost drugs in tribal communities.
Physicians will see finalized average payment rates reduced by 2.93% in CY 2025 compared to the average payment rates for most of CY 2024, while payment rates for hospital outpatient and ASC services will increase by 2.9% in CY2025.
You can find more at the links below. Please contact me at (insert) with questions or if you’d like to learn more.
FINAL FULL PACKAGE: Calendar Year (CY) 2025 Physician Fee Schedule (PFS) Final Rule CMS-1807-F
Web links:
- Press Release: https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-person-centered-care-and-health-quality-measures
- PFS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule
- MSSP Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule-cms-1807-f-medicare-shared-savings
- QPP Fact Sheet and FAQs: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3057/2025-QPP-Policies-Final-Rule-Fact-Sheet.pdf
- IRA Fact Sheet: https://www.cms.gov/inflation-reduction-act-and-medicare/inflation-rebates-medicare
- Federal Register: https://www.federalregister.gov/public-inspection/2024-25382/medicare-and-medicaid-programs-calendar-year-2025-payment-policies-under-the-physician-fee-schedule
Pennsylvania Black Maternal Health Caucus Co-chairs Lead Pennsylvania’s Momnibus Legislative Package
To address disparities in health care, on March 19, 2024, co-chairs of the Pennsylvania Black Maternal Health Caucus Reps. Morgan Cephas, D-Phila.; Gina H. Curry, D-Delaware; and La’Tasha D. Mayes, D-Allegheny, and caucus members introduced the Momnibus legislative package, which outlines a group of bills to decrease maternal morbidity and mortality in Pennsylvania.
The bills would:
- Require health-related boards within the Department of State to complete implicit bias training as part of continuing education requirements.
- Extend Medicaid coverage to doula services, as well as establish the Doula Advisory Board to set standards and requirements for doulas.
- Require health insurance to cover doula services.
- Require health insurance to cover blood pressure monitors for pregnant and postpartum enrollees.
- Expand Medicaid coverage of blood pressure monitors for pregnant and postpartum enrollees.
- Designate maternal health deserts to target investments in maternal health care services.
- Enhance access to mental health services for pregnant or postpartum patients.
- Establish a program to distribute essential resources to new mothers.
“Our Momnibus package is the culmination of years of work to address the critical issues surrounding maternal health and well-being,” Cephas said. “These core areas of increasing access to care, eliminating maternal health deserts, and addressing social determinants of health, guide our focus in this comprehensive platform. This caucus has done an amazing job of developing a multi-pronged approach to achieve health and maternal care equity for birthing people across the state no matter where they live.”
Curry said, “When my co-chairs Reps. Cephas, Mayes, and I created the PA Black Maternal Health Caucus back in October 2023, we knew we had no time to wait before we sprinted into action. In my district and all across the commonwealth, women have become victims of health care system closures. These closures have created an alarmingly increasing problem of maternal health deserts. Nineteen counties in Pennsylvania have hospitals that don’t provide obstetric services and don’t have accredited freestanding birth centers. Thirty-one counties don’t have a Newborn Intensive Care Unit. This is a horrifying reality and one that we want to change now.
“The Momnibus legislation does many things, but most importantly, it will bring forth into motion the beginning stages of good legislation that will prevent Black mommas and birthing folks and all mommas throughout the commonwealth from dying and create a Pennsylvania where the birthing journey will bring joy and healthy live birthing experiences, leading to happier and healthier children, mothers, families and communities for generations to come. When we actively address the devastation that has created fear and destroyed hope around Black maternal health, we are addressing the restoration of hope in the birthing experiences that are yet to come.”
Mayes said: “Prior to the birth of my daughter Charlotte, up until my partner Heather and I were admitted to the hospital, I worried about my partner’s health, especially as Black patients are at the highest risk for maternal mortality and morbidity and we were grateful to welcome our child into the world. This underlying fear that I felt is rooted in dangerous medical assumptions about Black bodies and implicit biases that put patients at risk, especially pregnant Black women. We must address these race-based and gender-based disparities to ensure health care is equitable for all moms, birthing people and all Pennsylvanians. Thanks to my co-chairs and members of the PBMHC, the Pennsylvania Momnibus package represents the groundbreaking opportunity to pass legislation that boldly addresses the maternal health care crisis in our commonwealth, reduces maternal morbidity and mortality, and ensures pregnant and postpartum patients have access to critical resources.”
The co-chairs, as well as Reps. Lisa Borowski, D-Delaware, Elizabeth Fiedler, D-Phila., and Mandy Steele, D-Allegheny, modeled Pennsylvania’s Momnibus legislation after federal bills introduced by U.S. Rep. Lauren Underwood, D-Illinois, and U.S. Sen. Cory Booker, D-New Jersey.
The news conference can be viewed here or above.
A gallery of downloadable photos from the event is available here.
CMS Issues New Hospital Maternal Health, Safety Standards: Things to Know
From Becker’s Clinical Leadership
To address the maternal health crisis in the U.S., CMS has issued new conditions of participation standards for hospitals that offer obstetrical services as part of its 2025 Hospital Outpatient Prospective Payment System rule shared Nov. 1.
The new requirements will ensure all Medicare- and Medicaid-participating hospitals offering obstetric services are “held to a consistent standard of high-quality maternity care that protects the health and safety of pregnant, birthing and postpartum patients,” according to a Nov. 1 CMS fact sheet.
Here are things nine to know about the new standards:
- Hospitals must meet the maternal health conditions to avoid termination from Medicare and Medicaid.
- CMS is finalizing a phased implementation plan for the new requirements to address potential burdens raised during public feedback. The planned implementation will start in 2026 and occur in three phases over two years.
- Among the new requirements for organization and staffing are:
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- Obstetric services be “well organized” and in line with nationally recognized stands of healthcare. Services should also be appropriately integrated with other departments in the facility.
- All obstetric units be supervised by an appropriately trained individual, such as an experienced registered nurse, nurse practitioner, certified midwife, physician assistant, MD or DO.
- Obstetric privileges should be granted for all providers in the unit in accordance with current hospital requirements.
- Requirements for service delivery are:
- Basic obstetric equipment be kept at the facility and readily available with respect to the facility’s scope, volume and complexity of services offered.
- Facilities have facility provisions and protocols for emergencies, complications and post-delivery care that are consistent with nationally recognized and evidence-based guidelines.
- Requirements for staff training are:
- Hospitals develop and ensure all obstetric staff have been trained on policies and procedures that improve the delivery of maternal care. Training must be documented and reviewed every two years.
- Hospitals use findings from quality assurance and performance improvement programs to revise procedures and protocols.
- Requirements for quality assurance and performance improvement programs are:
- Hospitals use its quality assurance and performance improvement program to collect and analyze data to develop action plans to address health disparities and improve outcomes among obstetric patients.
- If a maternal mortality review committee is available in a hospital’s geographical region, the hospital must incorporate publically available data into its quality assurance and performance improvement program.
- Requirements for emergency services are:
- All hospitals that provide emergency services have adequate provisions and protocols to meet the needs of obstetric patients, regardless of whether the facility provides obstetric services. The provisions and protocols must be consistent with nationally recognized and evidence-based guidelines.
- All emergency services staff have undergone documented training on the protocols and provisions.
- Facilities have provisions set aside for obstetric emergencies.
- Requirements for transfer protocols are:
- Hospitals have policies and procedures for obstetric patient transfer. All relevant staff must be trained on the transfer policies and procedures.
Rural Pennsylvania Impacted the Most by Medical Debt
Medical debt is an issue that disproportionately impacts rural Pennsylvanians. Efforts to reduce medical debt have been thwarted by legislators representing those communities. Read more.
The 340B Program Reached $66 Billion in 2023—Up 23% vs. 2022: Analyzing the Numbers and HRSA’s
Reality has again failed to support the spin surrounding the 340B Drug Pricing Program. For 2023, discounted purchases under the 340B program reached a record $66.3 billion—an astounding $12.6 billion (+23.4%) higher than its 2022 counterpart. The gross-to-net difference between list prices and discounted 340B purchases also grew, to $57.8 billion (+$5.5 billion). 340B purchases are now almost 40% larger than Medicaid’s prescription drug purchases. Hospitals again accounted for 87% of 340B purchases for 2023. Purchases at every 340B covered entity type grew, despite drug prices that grew more slowly than overall inflation. Read the article for full details and our analysis.
Big Gender Gap Seen in Health Center Visits
The 2025 Medicare Open Enrollment Period has Begun
Medicare Open Enrollment runs from Oct. 15 through Dec. 7. CMS has released resources for partners to use when encouraging patients to review their Medicare plan. Key resources includes an open enrollment and social media toolkit.
Pennsylvania Rolls Out Health Insurance Transparency Report, Process of How to Appeal Claim Denials
The Pennsylvanian Insurance Department announced that the 2024 transparency in coverage report is now available online, including helpful information for consumers on what to do if their insurance company denies their claim. The report also outlines data on claims, claim denials, and appeals information for health insurers doing business in the Commonwealth.
Pennsylvania Announces Annual Update to SNAP Benefit Amounts, Changes to Income Limits
The Pennsylvania Department of Human Services (DHS) announced increases to Supplemental Nutrition Assistance Program (SNAP) income and benefit limits in Pennsylvania, following a yearly adjustment from the USDA’s Food and Nutrition Service (FNS). DHS also announced that the replacement of stolen SNAP benefits – which DHS began offering in 2023 – has been extended to benefits stolen through December 20, 2024.