The Individual and Small Group Affordable Care Act Health Insurance Proposed Rates for 2025 are available on the Pennsylvania Insurance Department’s (PID) Website. On average, the Pennsylvania Health Insurance Exchange (Pennie) insurers on the individual market requested a 7.9 % premium increase based on rising drug costs, increased labor costs in the healthcare industry, and the utilization of medical services. Of the current nine insurers, Ambetter, Capital Blue Cross, CIGNA, Geisinger, Highmark, Independence Blue Cross, Jefferson Health Plans, Oscar, and UPMC, three are requesting to expand into additional counties. These insurers are Geisinger, Jefferson Health Plans and Ambetter. A public comment period on these rate requests and filings will be accepted through Sep. 2 and can be emailed to ra-in-comment@pa.gov. Open Enrollment for Pennie is November 1,2024 through January 15, 2025.

Department of Health (DOH) Secretary Dr. Debra Bogen visited the University of Pittsburgh Medical Center’s Center for Addiction Recovery today to announce that the Shapiro Administration will distribute 50,000 xylazine wound care kits to provide care and relief for people with xylazine-associated wounds. “Xylazine’s emergence in Pennsylvania’s illicit drug supply is a major public health concern,” said Secretary Bogen. “Because the wounds caused by xylazine are more complicated and severe than those traditionally seen in people who use other drugs, there is a need for quick action, new medical protocols, and access to appropriate self-care wound supplies.”

Pennsylvania faces significant challenges related to substance use, some of which relate to the policies governing the services available. Overdose deaths continue to rise nationally, and the public health challenges are constantly evolving. The 2024 Salk Health Activist Fellowship will provide a focus for emerging health activists on effective policy change tactics to address the current substance use challenges in Pennsylvania. During the in-person program this fall in Pittsburgh, fellows will gain insight into the existing U.S. and Pennsylvania substance use policies, learn how to effectively lay out a case for change, explore strategic approaches to policy change, and gain tools for coalition building and maximizing media coverage. Fellows will also explore what substance use costs Pennsylvanians and consider how best to improve health outcomes through evidence-based policies and interventions.

The Centers for Disease Control and Prevention (CDC) is issuing a Health Alert Network (HAN) Health Update to provide additional information about the outbreak of monkeypox virus (MPXV) in the Democratic Republic of the Congo (DRC); the first Health Advisory about this outbreak was released in Dec. 2023. Since Jan. 2023, the DRC has reported the largest number of yearly suspected clade I mpox cases on record. While clade I MPXV is endemic, or naturally occurring, in DRC, the current outbreak is more widespread than any previous DRC outbreak and has resulted in clade I mpox transmission to some neighboring countries. Clade I MPXV has previously been observed to be more transmissible and to cause a higher proportion of severe infections than clade II MPXV. The ongoing global mpox outbreak that began in 2022 is caused by clade II MPXV, and cases continue to be reported worldwide. No cases of clade I mpox have been reported outside central and eastern Africa at this time. Because there is a risk of additional spread, CDC recommends clinicians and jurisdictions in the United States maintain a heightened index of suspicion for mpox in patients who have recently been in DRC or to any country sharing a border with DRC (ROC, Angola, Zambia, Rwanda, Burundi, Uganda, South Sudan, Central African Republic) and present with signs and symptoms consistent with mpox. These can include: rash that may be located on the hands, feet, chest, face, mouth, or near the genitals; fever; chills; swollen lymph nodes; fatigue; myalgia (muscle aches and backache); headache; and respiratory symptoms like sore throat, nasal congestion, and cough.

In accordance with the Pennsylvania Department of Human Services (DHS) rebranding and the Governor’s Office Customer Service Transformation Initiative, the Office of Medical Assistance Programs will be implementing changes to the old URLs to reach PROMISe hosted applications and websites. The old URLs, using a domain naming convention of dpw.state.pa.us, will be changing to dhs.pa.gov in phased implementations beginning August 7, 2024, and wrapping up in October 2024. Please review the attached pdf containing the impacted production environment URLs.

Members of Congress headed home for the summer last weekend, leaving the healthcare community in an all too familiar position: Wondering how key priorities will turn out after lawmakers failed to address them in the first part of the year. At the top of the list is money, with billions of dollars in cuts to physician pay and safety net hospitals funding set to begin in January, as well as appropriations for expiring programs such as community health centers. Congress has not completed its work on bills that would impose restrictions on pharmacy benefit managers, mandate transparency in multiple realms of healthcare, enact site-neutral payments for certain outpatient services, regulate artificial intelligence and cybersecurity, overhaul the 340B drug discount program, and extend COVID-19 pandemic-era authorizations for telehealth and hospital-at-home care.

– Thursday, August 15 at 2 pm Eastern. The National Association of Rural Health Clinics (NARHC) will host the free webinar with details on the recently released Centers for Medicare and Medicaid Services (CMS) Calendar Year 2025 Medicare Physician Fee Schedule (MPFS) proposed rule. This annual regulatory update contains Rural Health Clinic (RHC) specific proposals to eliminate productivity standards, remove hemoglobin/hematocrit from the six required lab services, reform care management billing, and allow RHCs to bill for administration of part B preventive vaccines at time of service, among other proposals. Additional time for Q&A will be provided. Advanced registration is required.

The Center for Health Care Strategies published a policy cheat sheet highlighting the Centers for Medicare & Medicaid Services’ coverage of intensive outpatient program (IOP) services.  As of January 1, 2024, Medicare now covers IOP services. IOPs are structured treatment programs that take place on an outpatient basis. IOPs are designed for individuals with mental health or substance use disorder (SUD) conditions, including those with co-occurring mental health and SUD conditions, who have treatment plans demonstrating a need for 9-19 hours a week of therapeutic services. The cheat sheet highlights the latest policy changes in IOP covered services, how changes impact dually eligible individuals, Medicaid-only enrollees, and new billing requirements and guidance for crossover claims.