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.

Change Healthcare was subject to a cyberattack in late February – and it has had a significant impact on health care operations across the country. Payments to hospitals, physicians, pharmacists, and other health care providers across the country were disrupted. Change Healthcare, which is owned by UnitedHealth Group (UHG), processes 15 billion health care transactions annually and is involved in one in every three patient records.

In order to help providers manage the impact of this attack, the U.S. Department of Health and Human Services (HHS) has compiled information, resources, and tools from health plans and payers for providers in need of assistance. In this document, providers will find information to help them connect with payers regarding impacts of the cyberattack, links to resources payers have set up (including guides to connect to alternate data clearinghouse services), information on advanced payments, and more.

If you have questions for HHS regarding the Change Healthcare cyberattack, please reach out to HHScyber@hhs.gov.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced additional actions it is taking to help people maintain coverage as states continue Medicaid and Children’s Health Insurance Program (CHIP) eligibility renewals, which restarted across the country last spring following a pause during the COVID-19 pandemic. Today’s actions will continue and extend a previously announced flexibility to make it easier for people to transition to Health Insurance Marketplace^®[1] coverage through 2024, help more people with Medicaid and CHIP navigate renewals, and reinforce important federal requirements that are crucial for protecting coverage in states during and beyond “Medicaid unwinding.”

CMS is extending a temporary special enrollment period (SEP) to help people who are no longer eligible for Medicaid or CHIP transition to Marketplace coverage in states using HealthCare.gov. The end date of this “Unwinding SEP” will be extended from July 31, 2024, to November 30, 2024, which will help more people leaving Medicaid or CHIP secure affordable, comprehensive coverage through the start of the next open enrollment period. This extension will be crucial to ensuring people remain covered, including in states that have given people additional time to renew their coverage, as CMS has recommended, to help eligible people stay enrolled. States with state-based Marketplaces can adopt similar extensions.

“The actions we are announcing today, like those we have taken over the past year, demonstrate that HHS is committed to ensuring Medicaid and CHIP coverage for all who are eligible. We are helping those who will now qualify for Marketplace coverage obtain it,” said HHS Secretary Xavier Becerra. “We encourage states to use all the strategies and resources we have provided them to carry out renewals of coverage. We will continue to monitor the renewal process and make sure federal requirements are being followed.”

“Protecting and strengthening access to health coverage in Medicaid, CHIP, and the Marketplaces is a top priority,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s steps will help make sure more families stay connected to the health care they need to thrive.”

CMS also released new guidance and other resources to help protect coverage. These include:

• Guidance on unwinding processes and tools for states reinforcing important federal renewal requirements that states must follow, developed in response to questions from both states and partners;
• Guidance to Medicaid managed care plans on completing signatures for enrollees so plans can help more people renew coverage; and
• New resources for partners to help families navigate their state Medicaid fair-hearing process, such as if someone was determined no longer eligible for Medicaid.

HHS continues to urge states to take up proven federal strategies that help more eligible people renew coverage and stands ready to support states in improving their renewals systems. As detailed in a new case study from the U.S. Digital Service (USDS), CMS partnered with USDS to engage with states across the country to reduce red tape, increase auto-renewal (ex parte) rates, address systems problems like the auto-renewal issue identified across 29 states last fall, and take up the dozens of strategies developed by CMS to help keep eligible children and adults covered. These efforts have helped increase auto-renewal rates nationally by about 85% – from about 25% in April 2023 to 47% in December 2023 and 46% in January 2024, as reported in the monthly Medicaid and CHIP renewals data published today. As just one state example, California increased auto-renewal rates from an average of about 34% from June 2023 to November 2023 to 66% in December 2023 after adopting CMS strategies and engaging with CMS and USDS.

Today’s actions build on the steps HHS and CMS have taken over the last year to protect health coverage during renewals, including making nearly two dozen strategies available to states to help eligible people renew Medicaid and CHIP, approving nearly 400 of these strategies across the country, conducting extensive outreach and advertising to raise awareness about renewals, creating a one-stop shop of federal resources on renewals for partners, and holding states accountable to federal Medicaid and CHIP renewal requirements. In addition, yesterday, CMS finalized a rule that builds on key lessons during Medicaid unwinding by streamlining and simplifying how people enroll in and renew Medicaid and CHIP coverage going forward. For example, while families in some states have faced barriers when transitioning a child’s coverage from Medicaid to CHIP during the unwinding process, this rule will require all states to make this transition more seamless in the future. This and other changes will help to ensure that millions of eligible children and adults can get and keep their coverage.

Roundtable with national nursing leaders explored latest survey findings and the future of the nursing workforce. New data is the first comprehensive federal survey of registered nurses — the largest health care profession in the United States — since the onset of the COVID-19 pandemic

Carole Johnson, Administrator of the Health Resources and Services Administration (HRSA), convened leaders last week from over 25 nursing and health care organizations for a roundtable discussion on the newly released findings of the National Sample Survey of Registered Nurses — the first comprehensive federal survey of nurses since the onset of the COVID-19 pandemic in the United States.

The survey is a comprehensive picture of the nursing workforce, the largest health care profession in the United States, conducted every four years by HRSA’s National Center for Health Workforce Analysis in collaboration with the U. S. Census Bureau. Nearly 50,000 nurses responded to the survey questions and reported on topics such as education, training, job satisfaction, as well as their experiences during the COVID-19 pandemic.

In her comments, Administrator Johnson underscored that nurses are the backbone of the health care system and how HRSA has used this survey for nearly 50 years to hear directly from nurses across the country about their experiences to strengthen patient care, identify opportunities to support nurses, and learn how we can best grow the health workforce. She also emphasized how the survey findings and feedback from participants reinforce the need to increase our investment in the nursing workforce and invest in innovative new training approaches. The Biden-Harris Administration has continuously focused on new investments to train more nurses and support the nursing workforce, growing HRSA’s nursing workforce budget by over 20%. The President’s Fiscal Year 2025 Budget proposes a $20 million increase in funding for nurse training, as well as $10 million to support innovation in health workforce training.

Dr. Michelle Washko, who leads HRSA’s National Center for Health Workforce Analysis, reported on the survey results, saying that while the survey captured nurses reporting leaving the field as a result of the pandemic, in aggregate the registered nurse workforce grew by about 400,000 since the 2018 survey. The nursing workforce is younger and becoming more diverse with greater percentages of people of color and of men since the previous survey. Job satisfaction of nurses remains high (80%), even though nurses reported high levels of burnout during the pandemic.

Participants at the roundtable discussed the importance of the new data and the investments HRSA is making to support growing the nursing workforce and retaining the current workforce. Several participants noted the important role of pathways for underrepresented students to become nurses and the need to support nurse training in clinical settings. Nurse faculty are a necessary part of the infrastructure that is needed to grow the workforce and address shortages. The need for faculty and preceptors is often identified as a factor that can limit growth of the nursing field. All participants underscored the impact that COVID-19 had on the nursing workforce and stressed the importance of innovative solutions to address burnout. Several participants noted the importance of exploring the root causes of the particularly acute challenges in recruiting and retaining nurses in certain settings and geographic areas, such as rural communities and historically underserved communities. Participants appreciated HRSA’s investments in nurse faculty and clinical preceptors as well as health workforce models like nurse residency programs in helping to address these issues.

HRSA supports the nursing workforce with financial assistance to individuals to help pay for nursing school through scholarship programs and loan repayment programs. In addition, HRSA funds nurse training grant and loan programs to support growing the nursing workforce including the important role nurses play in addressing health care priorities like improving maternal health, increasing access to primary care, and expanding behavioral health.

Leadership from the following organizations participated in the roundtable:

• AARP Center for Health Equity through Nursing
• American Association of Critical Care Nurses
• American Association of Medical Colleges
• American Association of Nurse Anesthesiology
• American College of Nurse-Midwives
• American Nurses Association
• Association of Clinicians for the Underserved
• Association of Women’s Health, Obstetric and Neonatal Nurses
• Center for Health Workforce Studies, University at Albany
• Center for Health Workforce Studies, University of Washington
• Children’s Hospital Association
• Colorado Nurses Association
• Delaware Nurses Association
• George Washington University, Mullan Institute for Health Workforce Equity
• Louisiana State Nurses Association
• Maryland Nurses Association, Inc.
• Mercer County Community College
• Michigan State University
• Missouri Nurses Association
• National Association of Hispanic Nurses
• National Black Nurses Association
• National Forum of State Nursing Workforce Centers
• National Organization of Nurse Practitioner Faculties
• Organization for Associate Degree Nursing
• University of Minnesota
• University of the District of Columbia
• Washington Center for Nursing

To learn more about the NSSRN or to download data and further analysis of the data, visit National Sample Survey of Registered Nurses (NSSRN).

Fifth Round Makes $700 Million Available to Bring Affordable High-Speed
Internet to Rural and Tribal Communities

The U.S. Department of Agriculture (USDA) Rural Development Under Secretary Dr. Basil Gooden announced USDA is accepting applications until May 21, 2024, for funding under the ReConnect Program.

This is the fifth round of funding under the program, which provides loans and grants to bring high-speed internet to the most remote and difficult-to-serve rural and Tribal communities in America.

A total of $700 million is available under four funding categories:

• Up to $200 million is available for loans.
• Up to $200 million is available for loan/grant combinations.
• Up to $150 million is available for grants.
• Up to $150 million is available for grants serving Alaska Native corporations, Tribal
  governments, colonias, persistent poverty areas and socially vulnerable communities.

Read full announcement.

From Becker’s Hospital CFO Report

Obstetrics and delivery services are one of the leading money losers of all hospital services, and a growing number of rural hospitals are closing obstetric departments to protect the financial viability of the overall enterprise, according to a recent analysis by Kaufman Hall.

About 40% of rural hospitals are losing money on obstetrics programs, according to a recent study conducted by the University of Minnesota Rural Health Research Center. Many obstetrics programs hemorrhage money, and they are generally among the first services that financially struggling or low-volume rural hospitals cut.

Several hospitals scaled back or eliminated labor and delivery services last year, and Becker’s has reported on 15 hospitals that have cut these services so far in 2024.

Ultimately, it’s a money problem. Rising costs and staffing shortages have hit rural hospitals particularly hard, but low Medicaid reimbursement is the biggest challenge for obstetrics departments.

“This is especially detrimental in rural areas where a higher number of births are covered by Medicaid,” Eric Fish, MD, president and CEO of Schneck Medical Center, in Seymour, Ind., told Becker’s. “In Indiana, over half of babies born on an annual basis are covered by Medicaid, which pays 57 cents on the dollar of the cost of providing care. This means hospitals, specifically in rural areas, are experiencing significant financial losses. Increasing Medicaid reimbursement is imperative to keep these services open and to preserve access in the future.”

Medicaid reimbursement rates set by states do not cover the full cost of providing obstetric services. This translates to financial losses for hospitals providing these services in rural areas, where a higher proportion of births are covered by Medicaid.

Given that Medicaid funds 50% of deliveries in rural areas, hospitals would receive significant financial respite from improved Medicaid reimbursement for these services.

“To help cover the losses associated with obstetrics, perhaps rural hospitals offering obstetrics could qualify for a special exception through Medicaid with an add-on payment program or an annual lump-sum payment, similar to [prospective payment system] hospitals that have received disproportionate numbers of low-income patients, based on the hospital’s disproportionate OB patient percentage,” Brett Altman, DPT, CEO of Atlantic, Iowa-based Cass Health, told Becker’s.

The other challenge, particularly in rural America, is the lack of staff and expertise when it comes to obstetrics nurses and physicians.

“We have spent upwards of $3 million annually for traveling obstetric nurses to keep our unit staffed 24/7/365, but it is the right thing to do for southwest Iowans in order to decrease the excessive mileage required to reach the nearest obstetrics unit,” Dr. Altman said. “Low volume obstetrics is not profitable and is one of the key drivers for why so many obstetric units have closed in rural areas as these hospitals hit financial headwinds in addition to concerns of competency.”

From Becker’s Hospital CFO Report

Jellico (Tenn.) Regional Hospital, a 25-bed critical access facility, closed March 9, making it the 36th rural hospital to shutter or no longer provide inpatient services since 2020, according to data compiled by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

The closures highlight the heightened financial challenges that rural hospitals face amid persisting workforce shortages, rising costs and leveling reimbursement. In addition, only 45% of rural hospitals now offer labor and delivery services, and in 10 states, less than 33% do, according to the Center for Healthcare Quality and Payment Reform.

Below are the 36 rural hospitals that closed since 2020, beginning with the most recent.

Editor’s note: Facilities with an asterisk (*) signify converted closures (facilities that no longer provide inpatient services, but continue to provide some services, such as primary care, skilled nursing care or long-term care).

• Jellico (Tenn.) Regional Hospital
• St. Mark’s Medical Center (La Grange, Texas)
• Herington (Kan.) Hospital
• Spectrum Health Kelsey Hospital (Lakeview, Mich.)
• Indiana University Health Blackford Hospital (Hartford City, Ind.)*
• Martin General Hospital (Williamston, N.C.)
• Patients Choice Medical Center of Smith County (Raleigh, Miss.)
• St. Margaret’s Health-Spring Valley (Ill.)
• UPMC Lock Haven (Pa.)*
• St. Margaret’s Health-Peru (Ill.) (OSF Healthcare expected to reopen the hospital this spring)
• Ascension St. Vincent Dunn (Bedford, Ind.)
• Blessing Health Keokuk (Iowa)
• Audrain Community Hospital (Mexico, Mo.)
• Callaway Community Hospital (Fulton, Mo.)
• Acoma-Canoncito-Laguna Service Unit (Acoma, N.M.)*
• Galesburg (Ill.) Cottage Hospital*
• MercyOne Oakland Medical Center (Oakland, Neb.)*
• Community HealthCare System-St. Marys (Kan.)*
• Perry Community Hospital (Linden, Tenn.)
• Northridge Medical Center (Commerce, Ga.)*
• Southwest Georgia Regional Medical Center (Cuthbert, Ga.)
• Shands Lake Shore Regional Medical Center (Lake City, Fla.)
• Cumberland River Hospital (Celina, Tenn.)
• Bluefield (W.Va.) Regional Medical Center*
• Saint Luke’s Cushing Hospital (Leavenworth, Kan.)*
• Shands Live Oak (Fla.) Regional Medical Center*
• Shands Starke (Fla.) Regional Medical Center*
• Williamson (W.V.a) Memorial Hospital*
• Decatur County General Hospital (Parsons, Tenn.)
• Sumner Community Hospital (Wellington, Kan.)
• Edward W. McCready Memorial Hospital (Crisfield, Md.)*
• Mayo Clinic Health System-Springfield (Minn.)*
• Central Hospital of Bowie (Texas)*
• UPMC Susquehanna Sunbury (Pa.)*
• Mountain View Regional Hospital (Norton, Va.)*
• Pinnacle Regional Hospital (Boonville, Mo.)