Last week, the Ranking member of the Senate HELP Committee expanded his 340B investigation to include the nation’s two largest contract pharmacy companies. The senator sent letters to both CVS and Walgreens, seeking detailed information on a long list of topics, including:

• How much money they earn from the program, and through what fees/mechanisms
• How many covered entities they work with
• The relationship between CVS and their 340B TPA, Wellpartner

The letter highlighted that 340B does not limit the fees that contract pharmacies can charge covered entities or third-party administrators (TPAs), and that the two companies realize “significant profits” as a result. The letters are part of the senator’s ongoing probe into 340B, which began in September with letters to two major health systems and was expanded to two large community health centers in November. Sen. Cassidy has not specified how he intends to use any findings from his inquiries, and it remains unclear if his probe has the support of other members of the HELP Committee.

With one day to spare and a snowstorm looming, Congress approved its third Continuing Resolution (CR) for FY2024 last Thursday. Under the new CR, all health center funding (both mandatory and discretionary) for Section 330, the National Health Service Corps (NHSC), and Teaching Health Centers (THCs) has been extended at FY2023 levels through March 8. Operational funds for the Department of Health and Human Services (HHS) were also extended through March 8, while funding for four other Federal agencies, including the VA, will expire a week earlier, on March 1. March will be a busy time for lawmakers with expiration of the CR, Super Tuesday on March 5 and President Biden’s State of the Union on March 7.

Gov. Josh Shapiro praised a bipartisan effort to give medically vulnerable infants in Pennsylvania expanded access to potentially life-saving pasteurized donor human milk. Act 32 of 2023, Owen’s Law, took effect the week of January 15 and increases access to pasteurized donor human milk by expanding the number of health conditions eligible for Medicaid-covered donor human milk. The law will support supplementation of a mother’s milk and provide more options to support healthy growth for infants. Key components of the law include expanding the number of medical conditions that qualify for Medicaid coverage for pasteurized human donor milk; requiring the Department of Health (DOH) in consultation with the Department of Human Services (DHS) to produce a public information campaign on the availability of pasteurized human donor milk; and tasking DHS with creating and updating guidance about the usage of donor milk. Click here to learn more. Click here for the Medical Assistance Bulletin.

Multi-state compacts make licensing easier to navigate by streamlining the application process. Visit this page at Telehealth.HHS.gov to learn how multi-state licensing compacts work and specifics on the compact for your discipline, including physicians and nurses, allied and auxiliary health care workers, and emergency medical services personnel.  Get more telehealth resources, including funding opportunities, from HRSA’s Office for the Advancement of Telehealth.

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Along with the Office of Personnel Management, the Internal Revenue Service, and the Departments of Labor and Treasury, HHS seeks comments on proposed rules related to the Federal independent dispute resolution process established under the No Surprises Act. The proposal includes new requirements for disclosing information along with the initial payment or notice of denial of payment for certain items and services subject to surprise billing protections.  Initially opened in the Federal Register on November 3, 2023, the proposal was republished on Monday of this week; comments will be accepted until February 5.

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Last week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that advances federal efforts toward interoperability.  Through this rule, “impacted payers” of health plans designed by CMS – including, but not limited to, state issuers of Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service programs, Medicare Advantage organizations, and Qualified Health Plan issuers on Federally Facilitated Exchanges – are required to implement and maintain application programming interfaces.  Also known as APIs, these interfaces are relied on by the federal government to uphold global standards for the electronic exchange of health care information.  Beginning in 2026, impacted payers will also be required to streamline their processes for prior authorization (PA), a common practice of insurance organizations that requires providers to get advanced approval before delivering a service to patients.  They must send authorization to providers within 72 hours for urgent requests, and within seven calendar days for non-urgent requests.  Beginning in 2027, impacted payers must implement an approved application programming interface for prior authorization, where providers can access the list of covered items and services and get support with their requests. Additionally in 2027, hospitals, including Critical Access Hospitals, and Merit-based Incentive Payment System (MIPS) eligible clinicians will have to attest to using this electronic interface to submit PA requests as part of their Medicare Promoting Interoperability Program reporting requirements. While the use of various electronic exchange methods among hospitals and physicians has increased in recent years, the Government Accountability Office (GAO) recently found that use among small and rural hospitals is lower than that of other hospitals.  Federal officials and other stakeholders told GAO that these and other federal provisions could be helpful for small and rural providers because it could make the exchange of data less costly.

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced a new state-based model that focuses on community-based behavioral health practices for Medicaid and Medicare beneficiaries.  In Spring 2024, CMS will open the application process for the IBH Model; up to eight states will receive funding for activities and capacity building. The project period is expected to begin in Fall 2024 and run for eight years to implement an approach to community health that integrates mental treatment with primary and specialty care.  By the start of year 4, states may be selected to implement a Medicaid payment model that includes a per-beneficiary-per-month payment, and additional performance-based payments for model years 4-8.

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The Pennsylvania Department of Health is seeking feedback from providers across the state to guide the development of educational materials for communities at-risk of mpox transmission, as well as for providers. The Mpox Outreach & Education (O&E) Materials Questionnaire gives providers and team members the opportunity to provide insight into the types of materials that would be most beneficial for services providers and the communities your teams serve. Additionally, if you feel like materials should include messaging about both mpox and other STIs or HIV, please elaborate on that in the questionnaire as well.