Pennsylvania Governor Josh Shapiro signed legislation into law that creates the first Alzheimer’s, Dementia and Related Disorders Division in the Commonwealth’s history to support older adults living with the disease and their caregivers. The Pennsylvania Department of Aging will provide oversight for the Division. Click here to learn more.

 In August of this year, the Centers for Medicare & Medicaid Services published revisions to the Conditions of Participation for hospitals and Critical Access Hospitals (CAHs). Hospitals and CAHs must electronically report data related to acute respiratory illnesses, including SARS-CoV2/COVID-19, influenza, and RSV, including confirmed infections of respiratory illnesses among hospitalized patients, hospital bed census and capacity (both overall and by hospital setting and population group [adult or pediatric]), and limited patient demographic information, including age. Beginning November 1, 2024, hospitals and CAHs must electronically report this information to the Center for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) or CDC-supported system. The CDC has posted instructions for Reporting Requirements, Frequency, and Pathway as well as data import templates, training slides, and additional resources.  This rule also finalized requirements that during a declared national, state, or local public health emergency for an acute infectious illness, the hospital and CAH must also electronically report data elements including facility structure and infrastructure operational status including hospital/emergency department diversion status, staffing shortages, supply inventory shortages (for example, equipment, blood products, gases), and relevant medical countermeasures and therapeutics (or both).

The Centers for Medicare & Medicaid (CMS) Services updated the Medicare Benefit Policy Manual, Chapter 13 with Calendar Year 2024 requirements and payment policies for RHCs and FQHCs.

– Comment by December 27. This proposed rule from the Centers for Medicare & Medicaid Services (CMS) would expand access to coverage of recommended preventive services, with a particular focus on reducing barriers to coverage of contraceptive services, including over-the-counter (OTC) contraceptives. As part of the proposed rule, most group health plans and health insurance issuers would be required to cover OTC contraceptives without cost-sharing or requiring a prescription. Plans and issuers would have to provide consumers with additional choices of covered contraceptives and drug-led combination products. The proposed rule includes several requests for comments aimed at gathering feedback on whether proposals related to coverage of recommended contraceptive items should be extended to other or all recommended preventive services.  CMS provides a fact sheet with brief background and summary of this proposal.

In the FY 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) finalized separate payments for the cost of establishing and maintaining access to buffer stocks of essential medicines for independent hospitals with 100 or fewer beds.  This new guidance explains how Medicare Administrative Contractors (MACs) will process these payments and the methods that hospitals can use to receive the payments.

In a new analysis, the Bipartisan Policy Center (BPC) examines the progress of a new provider type in the Medicare payment system that allows certain rural hospitals to avoid closure and continue serving their communities. Since January 2023, 30 hospitals have converted to the model that limits services to emergency and outpatient care.   The report highlights factors preventing facilities from choosing this option despite financial pressures and offers policy recommendations for making the REH a sustainable care delivery option.

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.

Integrating both virtual and in-person appointments can support the delivery of quality care. Discover information and resources on how to use a hybrid care approach. View the Best Practice Guide.

Lawmakers and telemedicine advocates say Pennsylvania’s new law will lead to increased health care access – and healthier Pennsylvanians. Read more.

On October 24, the Pennsylvania Department of Human Services (DHS) published the September 2024 Managed Care Enrollment Information. This report contains the number of consumers that are medical assistance eligible and managed care eligible at any time during the month. The data is based on capitation payments and therefore each consumer Medicaid paid for in the month is counted.