The Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking public comment on its proposal to modify regulations regarding medications for the treatment of opioid use disorder. In addition to updating definitions and standards for Opioid Treatment Programs (OTP), these changes – such as allowing for methadone treatment through audio-visual telehealth – would make flexibilities made during the Public Health Emergency permanent.  Telehealth access to OTPs can help address barriers for rural patients, such as long travel times for treatment. Comments due by February 14.

Recently, HRSA issued a proposed rule that would revise the current 340B administrative dispute resolution (ADR) final rule (Dec. 14, 2020) with a new process. The ADR process is an administrative process designed to assist covered entities and manufacturers in resolving disputes regarding overcharging, duplicate discounts, or diversion, as outlined in the statute. Eligible entities for the 340B Drug Pricing Program include a number of rural healthcare facility types. Comments due January 30

  The Office of Disease Prevention and Health Promotion has a number of ongoing initiatives such as Healthy People that set public health objectives at the federal level.  The newest is the Federal Plan for Equitable Long-Term Recovery and Resilience which lays out a government-wide approach to fixing broken systems and focusing resources on communities that have been marginalized.  The strategy forms around Seven Vital Conditions for Health and Well-Being in each community – the social determinants of health that public health stakeholders are working to achieve.

 CFOs and other administrators from 20 rural hospitals were interviewed about telehealth services and how they make decisions about adopting them.   Among the key takeaways:  although CFOs believed telehealth has some financial advantages, they did not believe that telehealth improved their hospitals’ financial situations.

 The National Rural Recruitment & Retention Network forms 3RNET, a nonprofit that connects professionals to healthcare jobs in rural and underserved areas.  This week, 3RNET and the National Association of Rural Health Clinics (NARHC) announced a new partnership that connects both organizations’ websites. Job openings at Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) added to 3RNET’s website are automatically added to a job board on NARHC.org through a website integration powered by 3RNET. Health professionals can view available RHC and CAH jobs across the country on 3RNET and on NARHC at the two links above; RHC and CAH employers can apply to post jobs at both sites by visiting by visiting: https://www.3rnet.org/For-Employers/Employer-Registration-Form.

The National Maternal and Child Oral Health Resource Center (OHRC) has released a new resource, “Opioids and Pregnant Women: Information for Oral Health Professionals.” This resource provides guidance for dentists about prescribing opioids to pregnant women, if pain management is needed.

Click here to download the resource.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), proposed a rule to strengthen Medicare Advantage and Medicare Part D prescription drug coverage for the tens of millions of people who rely on the programs for health care coverage. The proposed rule improves protections for people with Medicare, expands access to behavioral health care, and promotes equity in coverage. The proposed rule also implements a key provision of the Inflation Reduction Act to make prescriptions drugs more affordable for approximately 300,000 low-income individuals who will benefit in 2024.

“We are taking feedback from thousands of Americans and turning it into concrete action to strengthen Medicare for the millions of Americans who rely on it,” said HHS Secretary Xavier Becerra. “From streamlining prior authorization to cracking down on misleading marketing, we are committed to ensuring that everyone can have peace of mind and get the health care they need.”

“We continue working tirelessly to implement President Biden’s Inflation Reduction Act. Yesterday, thanks to the new law, we are taking action to lower costs and expand access to affordable prescription drug coverage for hundreds of thousands of people with Medicare, including communities of color and those living on fixed incomes,” the Secretary continued. “CMS released a proposed rule today that takes important steps to hold Medicare Advantage plans accountable for providing high quality coverage and care to enrollees,” said CMS Administrator Chiquita Brooks-LaSure. “The rule also strengthens Medicare prescription drug coverage and implements an important provision of the Inflation Reduction Act to help more people with Medicare who have modest incomes afford their prescriptions.”

A July 2022 Request for Information on Medicare Advantage drew almost 4,000 comments regarding improvements to the program. We thank stakeholders for their thoughtful feedback, and the policies in this proposed rule are informed by the feedback received.

In this rule, CMS proposes significant changes to strengthen protections for people enrolled in or seeking coverage from Medicare Advantage plans or Medicare Part D prescription drug plans, including through improvements to prior authorization, coverage guidelines, and plan marketing requirements. The rule proposes clarifications and revisions to regulations governing when and how Medicare Advantage plans develop and use coverage criteria and utilization management policies to ensure Medicare Advantage enrollees receive the same access to medically necessary care they would receive in Traditional Medicare. The rule also proposes policies to streamline prior authorization requirements and reduce disruption for enrollees. It does this by requiring that a granted prior authorization approval remain valid for an enrollee’s full course of treatment, requiring Medicare Advantage plans to annually review utilization management policies, and requiring coverage determinations be reviewed by professionals with relevant expertise. These proposed policies complement proposals in CMS’ recently announced Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P).

Additionally, the proposed rule focuses on protecting people exploring Medicare Advantage and Part D coverage from confusing and potentially misleading marketing while also ensuring access to accurate and necessary information to make coverage choices. The proliferation of certain television advertisements generically promoting Medicare Advantage enrollment has been a topic of concern. To address this, CMS proposes to prohibit ads that do not mention a specific plan name as well as ads that use words and imagery that may be confusing, or use language or logos in a way that is misleading, confusing, or misrepresents the plan. CMS also proposes to codify guidance protecting people with Medicare or exploring Medicare coverage from misleading marketing and ensure they are not pressured into enrolling into plans that may not best meet their needs. Further, CMS is proposing to strengthen the role of plans in monitoring agent and broker activity.

“People exploring Medicare coverage options deserve peace of mind that they are receiving honest, transparent, and accurate information about health coverage options and have access to the care they need. These proposed protections are commonsense and critical to the physical, mental, and financial stability of millions of people who choose a Medicare coverage option each year,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare.

CMS remains committed to emphasizing the invaluable role that access to behavioral health plays in whole person care. In line with CMS’ Behavioral Health Strategy and the Administration’s strategy to address the national mental health crisis, CMS proposes to strengthen behavioral health network adequacy by adding clinical psychologists, licensed clinical social workers, and prescribers of medication for opioid use disorder to the list of evaluated specialties. CMS also proposes new minimum wait time standards for behavioral health and primary care services and more specific notice requirements from plans to patients when these providers are dropped from their networks. Finally, CMS proposes to require most types of Medicare Advantage plans include behavioral health service in care coordination programs, ensuring that behavioral health care is a core part of person-centered care planning.

Additionally, the proposed rule reinforces CMS’ commitment to advancing health equity and driving quality in health coverage. For the first time, CMS proposes establishing a health equity index in the Star Ratings program that would reward excellent care for underserved populations by Medicare Advantage and Medicare Part D plans. The rule also proposes updates to the Medicare Part D medication therapy management (MTM) program to improve access, including a proposed requirement that plans include all 10 core chronic diseases identified by CMS — including HIV/AIDS — in their MTM targeting criteria. Plans would also be required to provide culturally competent care to an expanded list of populations and to improve equitable access to care for those with limited English proficiency, through newly proposed interpreter standards and the requirement that materials be provided in alternate formats and languages. Finally, the proposed rule would balance the emphasis between patient experience, complaints, and access Star Ratings measures and health outcomes Star Ratings measures to more effectively focus both on patient-centric care and on improving clinical outcomes.

In order to implement section 11404 of the Inflation Reduction Act (Pub. L. 117-169), CMS proposes to expand eligibility under the low-income subsidy (LIS) program. Under the IRA provision and proposal, individuals with incomes up to 150% of the federal poverty level and who meet statutory resource requirements will qualify for the full LIS beginning on or after January 1, 2024. This change will provide the full LIS to those who would currently qualify for the partial LIS, improving access to affordable prescription drug coverage and lowering costs. As a result of this change, eligible enrollees will have no deductible, no premiums (if enrolled in a “benchmark” plan), and fixed, lowered copayments for certain medications.

The proposed rule can be accessed at the Federal Register at https://www.federalregister.gov/public-inspection/current. Comments on the proposed rule are due by February 13, 2023.

The Centers for Disease Control and Prevention (CDC) recently issued a new Clinical Practice Guideline for Prescribing Opioids for Pain. This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients over 18 years of age. It updates the previous CDC guideline and includes recommendations for managing acute (duration of less than one month), subacute (duration of 1–3 months) and chronic (duration of more than three months) pain.

Click here for more information.