Data collected from 37 states and DC as of July 25 shows at least 3,724,000 Medicaid beneficiaries have been disenrolled from Medicaid according to NACHC’s National Enrollment Data Tracker. Overall, 37% of people with a completed renewal were disenrolled in those states that reported, while 63%, or 5.7 million enrollees, had their coverage renewed (five of the reporting states do not provide data on renewed enrollees). Of concern nationally is the anticipated number of individuals disenrolled due to procedural reasons such as not receiving renewal packets in the mail, not understanding the notices, or not returning the packets prior to the termination date. Specific state data for Medicaid and CHIP enrollment is available. Some states want to reduce Medicaid beneficiaries overall while others want to preserve coverage for as many people as possible. States also had varying timelines to initiate unwinding-related renewals which plays a factor in the numbers.

As part of President Biden’s commitment to ensure that our country is more prepared for a pandemic than when he took office, the Administration announced it is standing up the Office of Pandemic Preparedness and Response Policy (OPPR). This will be a permanent office in the Executive Office of the President (EOP) charged with leading, coordinating, and implementing actions related to preparedness for, and response to, known and unknown biological threats or pathogens that could lead to a pandemic or to significant public health-related disruptions in the United States. OPPR will take over the duties of the current COVID-19 Response Team and Mpox Team at the White House and will continue to coordinate and develop policies and priorities related to pandemic preparedness and response. OPPR will:

• Coordinate the Administration’s domestic response to public health threats that have pandemic potential, or may cause significant disruption, and strengthen domestic pandemic preparedness. This includes ongoing work to address potential public health outbreaks and threats from COVID-19, Mpox, polio, avian and human influenza, and RSV.
• Drive and coordinate federal science and technology efforts related to pandemic preparedness. Specifically, OPPR will oversee efforts to develop, manufacture, and procure the next generation of medical countermeasures, including leveraging emerging technologies and working with HHS on next-generation vaccines and treatments for COVID-19 and other public health threats. During the height of the pandemic, the Biden-Harris Administration made historic investments in COVID-19 vaccines, tests, and treatments that were made widely available. OPPR will continue to leverage these investments as it drives future progress in combatting COVID-19 and other public health threats.
• Develop and provide periodic reports to Congress. As required by statute, OPPR will develop and provide to Congress a biennial Preparedness Review and Report and an every five-year Preparedness Outlook Report.

The Senate Finance Committee marked up a Pharmacy Benefit Manager-focused bill on Wednesday, July 26. Thanks to the tireless advocacy of the National Association of Community Health Centers (NACHC), Primary Care Associations like PACHC, and Community Health Centers in affected states, bipartisan momentum is behind a fix to address a health center concern that the bill’s treatment of the 340B contract pharmacy definition was insufficient. NACHC has received assurances from Finance Committee leadership that health center concerns will be addressed in the final bill. Thank you all for your advocacy on this issue. Click here to watch a recording of the hearing.

A road map for regulatory actions being considered by Pennsylvania Governor Shapiro’s administration is published in the Pennsylvania Bulletin. The 44-page document lists regulations being drafted by state agencies covering a wide range of activities under state government oversight. The regulatory agenda establishes a timetable for when the regulations may be proposed but notes that the nature and complexity of regulation will affect that date. An executive order dating to 1996 requires a semi-annual publication of the agenda. The agendas are compiled “to provide members of the regulated community advanced notice of regulatory activity,” according to the notice by the governor’s office. “The agenda represents the Administration’s present intentions regarding future regulations.”

With the prospect that the state’s budget impasse could drag on for another two months appearing increasingly likely, county leaders are bracing for the impact of having to pay their bills when the state isn’t paying its bills. Tens of millions of dollars for county-level services for substance abuse, child welfare, mental health, and the intellectually disabled are expected to be held up in the coming days and weeks unless the state budget impasse is resolved, the Associated Press reports. State Senate Pro Tempore Kim Ward (R-Westmoreland) expressed that the Senate may return in August to pass the budget bill. However, the code bills, which provide the state government with how the state funds are to be allocated and spent, remain in the House. The House is not expected to return until the week of Sept. 26, after a special election on Sept. 19 for the House seat that is currently open due to Rep. Sara Innamorato’s (D-Lawrenceville) resignation.

  The National Conference of State Legislatures (NCSL) describes actions taken by states to address physician shortages in rural and underserved areas through graduate medical education (GME).  The article covers statewide collaborations and appropriations, Medicaid payments, and incentives for rural clinical training.

See which states and rural health projects got funded by the U.S. Department of Agriculture (USDA) Rural Emergency Health program.  This initiative supported 179 new grant recipients that will expand access to health care in 39 states and Puerto Rico.  Part of the American Rescue Plan Act passed by Congress in March 2021, the funding is intended to support rural hospitals and healthcare clinics, improve facilities, purchase new equipment, and help distribute fresh food to families, senior citizens, veterans, and people with disabilities.

The Centers for Medicare & Medicaid Services (CMS) issued a final payment rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration’s priorities to provide support to historically underserved and under-resourced communities and to promote the highest quality outcomes and safest care for all individuals. The fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule updates Medicare payments and policies for hospitals as required by statute; adopts hospital quality measures to foster safety, equity, and reduce preventable harm in the hospital setting; and recognizes homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting. This is consistent with the Administration’s goal of advancing health equity for all, including members of historically underserved and under-resourced communities, as described in the President’s January 20, 2021, Executive Order 13985 on “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.”

For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record users, the final rule will result in an increase in operating payment rates of 3.1%. This reflects an FY 2024 projected hospital market basket update of 3.3%, reduced by a statutorily required productivity adjustment of a 0.2 percentage point. Under the LTCH PPS, CMS expects payments in FY 2024 to increase by approximately 0.2% or $6 million.

“As part of CMS’ health equity goals, we are rewarding hospitals that deliver high-quality care to underserved populations and, for the first time, also recognizing the higher costs that hospitals incur when treating people experiencing homelessness,” said CMS Administrator Chiquita Brooks-LaSure. “With these changes, CMS is laying the foundation for a health system that delivers higher quality, more equitable, and safer care for everyone.”

Supporting Rural and Other Underserved Communities

In this final rule, CMS is finalizing a health equity adjustment in the scoring methodology for the Hospital Value-Based Purchasing (VBP) Program that rewards hospitals that serve higher proportions of dual-eligible patients for providing excellent care. The newly finalized scoring methodology allows the opportunity for hospitals to earn up to ten bonus points depending on their performance on existing quality measures and the proportion of dually eligible patients they treat. The rule is a first step toward promoting health equity in the Hospital VBP Program and as such, CMS received public comments on additional approaches for equity adjustments in the Hospital VBP Program for future years. These suggestions include using other methods of restructuring the scoring methodology and determining the best metric to identify underserved populations, which CMS will consider for future updates.

CMS is also finalizing a policy to recognize the higher costs that hospitals incur when treating people experiencing homelessness when hospitals report social determinants of health codes on claims, meaning that hospitals will generally receive higher payments when a patient is experiencing homelessness. In addition, CMS is finalizing the policy that allows rural emergency hospitals (REHs) to be designated as graduate medical education training sites. This policy will build upon the Biden-Harris Administration’s commitment to supporting care in rural and other underserved communities by enhancing the health care workforce opportunities in these areas.

Additionally, this final rule will codify the requirements for the additional information that eligible facilities are required to submit when applying for enrollment as an REH, as specified in law. The finalized policy is intended to increase access to essential health care services in rural communities and support the enrollment process for eligible facilities seeking the REH designation.

Promoting Patient Safety

CMS is finalizing proposals for the Hospital IQR and Medicare Promoting Interoperability Programs to adopt three electronic clinical quality measures beginning with the CY 2025 reporting period to foster safety and reduce preventable harm in the hospital setting.

Resources

• For a fact sheet on the final payment rule visit: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0
• The FY 2024 IPPS/LTCH PPS final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-16252/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the

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