SAMHSA’s updated toolkit provides guidance to a wide range of individuals on preventing and responding to an overdose. It also emphasizes that harm reduction and access to treatment are essential aspects of overdose prevention.

Last year, healthcare company bankruptcies increased to their highest level in five years, Modern Healthcare reports, citing Gibbins Advisors analysis. The advisory firm’s report, which looked at Chapter 11 bankruptcy case filings from 2019 to 2023, found 79 healthcare companies with more than $10 million in liabilities that filed for bankruptcy protection last year. Pharmaceutical and senior care companies made up nearly half of the list. The second-highest year for bankruptcies was 2019, with 51 companies filing.

Over the past several months, oversight of the COVID-19 Uninsured Program (UIP) by both the Health Resources and Services Administration (HRSA) and the HHS Office of Inspector General (OIG) has ramped up, according to Feldesman Leifer LLP (formerly Feldesman Tucker Leifer Fidell – FTLF). This increase in activity may be due to an OIG report issued in July of 2023 that stated, “[o]n the basis of our sample results, we estimated that nearly $784 million of $4.2 billion (or 19%) of UIP payments made to providers during our audit period for approximately 3.7 million of 19.2 million patients were improper.” In its response to the OIG audit report, HRSA states, among other things, that it will seek to recover improper payments to providers. In addition to the ongoing audits by the HHS OIG, the Division of Program Integrity of HRSA’s Provider Relief Bureau has recently begun random assessments of providers that received UIP funds using its team of contract audit firms. Central to the July OIG report are the terms and conditions that providers agreed to in order to bill the UIP fund for COVID testing and vaccine administration. In addition, the OIG has recently started audits of other providers including Health Centers focused on another, and rather unusual, provision of the terms and conditions. Health centers are urged to review the UIP terms and conditions, protocols for determining uninsured status as well as determine the amount of UIP payments received and how those funds were used and consider strategies to document, among other things, how your organization determined uninsured status and how it can document use of UIP funds. Read more.

With Medicare and Medicaid reimbursements on the horizon for services provided by Community Health Workers (CHWs), now may be a good time for organizations to consider hiring CHWs to assist patients/clients in accessing needed health and human services. Organizations hiring new-to-the-field CHWs can provide a full year of professional development to their CHWs by participating in Pennsylvania AHEC’s new state registered CHW Apprenticeship Program. Throughout the year, apprentices receive CHW training from Pennsylvania AHEC, structured on-the-job training, and intentional mentorship and supervision. At the end of the year, apprenticeship graduates will be qualified to be certified by the Pennsylvania Certification Board. Certification is expected to be a requirement for CHW services to be reimbursed. For more information, contact PA AHEC Program Manager Amanda Taylor Gehman.

1. How many people are currently on Medicaid in Pennsylvania? According to the most recent data from the PA Department of Human Services, as of December 2023, there are 3,287,641 million Medicaid recipients enrolled in the program.
2. How many have lost coverage since the end of the Medicaid Continuous Coverage requirement ended? Over 420,000
3. What is the transition plan once a beneficiary is no longer eligible for Medical Assistance? Will the transition be seamless to the beneficiary?

• When an individual’s Medical Assistance eligibility is terminated, they are sent a notice indicating why they were found to no longer be eligible and information on their appeal rights. If the closure is for a procedural reason, they may provide the missing information for up to 90 days after the case has closed and have their eligibility reconsidered and their case opened back to the date of closure if they are found to be eligible.
• If an adult is found to no longer be eligible for Medical Assistance due to financial reasons, they may be eligible for subsidized health care coverage on Pennie. Their case information is transferred automatically to Pennie and Pennie conducts outreach to the household with information about their coverage options and the level of subsidy they are eligible for.
• If a child is found to no longer be eligible for Medical Assistance due to financial reasons, they may be eligible for CHIP and will be transitioned into a CHIP category.

Pennie and the Pennsylvania Department of Revenue collaborated to connect uninsured tax filers to coverage through the Path to Pennie program. When uninsured tax filers complete their Pennsylvania state income tax return, they can fill out Tax Form REV-1882 – Health Insurance Coverage Information Request. The PA Department of Revenue will send the information provided on the form to Pennie to create an account. Pennie will then send a notice with three important pieces of information: an access code to open the newly created Pennie account; an estimate of financial assistance the consumer is likely to receive; and a 60-day Special Enrollment Period to apply, shop, and enroll in coverage.

Last summer, a group of six bipartisan Senators (called “the G6” for short) released a Request for Information (RFI) around several aspects of the 340B program. Last week, the G6 released a 50-page discussion draft of a bill for comprehensive 340B reform, entitled the SUSTAIN Act.

• Here is a link to a two-page overview of the 340B reform bill by the bipartisan group of six Senators, with a focus on issues of interest to FQHCs and Primary Care Associations (PCAs).
• A nine-page summary and explanation of the draft bill.
• A supplemental Request for Information by April 1 (incorporated into the summary document) around three of the most significant 340B issues: Contract Pharmacies; Patient Definition; and Hospital child sites.
• A letter to stakeholders that includes the following statement “We believe it is necessary to pass legislation in the 118th Congress that provides clarity, transparency, and accountability in the 340B program in order to ensure the program remains strong, long into the future.”

The balance of the Pennsylvania House is on the line for a fourth time in less than a year, with a special election next week in Lower Bucks County. Two candidates are running to replace longtime Democratic Rep. John Galloway, who resigned to become a magisterial district judge. The outcome of the Feb. 13 election will determine which party controls the House, currently tied at 101-101.

On Tuesday, Governor Shapiro delivered his much-anticipated budget proposal for the Commonwealth, setting forth his policy and spending priorities for the Commonwealth’s 2024-25 fiscal year. The combined operating budget – inclusive of state, federal and special funds – totals $125.3 billion, an increase of 6.1%. Central components from Gov. Shapiro’s speech and budget proposal include:

• Increasing the state minimum wage from $7.25/hour to $15/hour. Also, increasing minimum wage for tipped workers to $9.00/hour.
• Funding reduction to the Primary Health Care Practitioner program by $2.8 million (34%).
• Significant increases in funding and program changes for K-12 education.
• Broad shift in the distribution model and allocation of higher education funds, including: Using a single funding model for state-related universities (Penn State, Pitt, Lincoln, and Temple), and those receiving state support, and implementing a 5% funding increase for all state-related universities; Merging PA State System of Higher Education (PASSHE) schools with community colleges, with a combined increase in funding of 15% alongside a new formula for distribution of funding moving forward; Capping in-state tuition at these institutions at $1,000 a semester for students whose families make less than the state’s median income.
• Initiatives that build on the governor’s recently announced statewide economic development plan, with new and increased funding for various programs and initiatives.
• Legalization and regulation of Adult Use Cannabis, with imposition of a 20% tax on the wholesale price.
• $4 million to erase medical debt for thousands of Pennsylvanians.
• Implementation of a skills games tax on gross gaming revenue from electronic skill games machines of 42%.

More information on the Department of Human Services budget proposal will be provided in a DHS briefing Friday morning that PACHC will participate in. Shapiro administration leaders will next meet with legislators to respond to questions and make their case on the governor’s budget proposal as the process continues to negotiate a final state budget and associated code bills by the deadline of June 30, 2024.

Two new educational videos now available from the National Rural Health Resource Center highlight the prevalence of chronic obstructive pulmonary disease (COPD) in the country’s rural communities and the steps that critical access hospitals and other small rural hospitals can take to improve access to much-needed pulmonary rehabilitation services.

The videos, developed as part of the Federal Office of Rural Health Policy-funded Expanding Rural Access to Pulmonary Care Demonstration Project, are designed to help hospital staff, administrators, board members and community members better understand the seriousness of COPD in rural communities and the benefits of improving access to local pulmonary rehab programs.

The first video, Understanding COPD and Pulmonary Rehabilitation, provides an overview of COPD — its symptoms and causes — and explains how rural-based pulmonary rehabilitation services help to restore independence and quality of life in COPD patients.

The second video, How to Launch a Pulmonary Rehab Program, highlights the benefits — to hospitals and their community — of operating rural pulmonary rehab programs, and shares practical advice and tips on how critical access hospitals and small rural hospitals can successfully build and sustain their own pulmonary rehab programs. The video includes a look at two critical access hospitals — Sparta Community Hospital in Illinois and Hood Memorial Hospital in Louisiana — that opened pulmonary rehab programs in 2023.

By showcasing the voices and experiences of health care professionals who treat COPD and manage pulmonary rehab programs, patients who have benefited from access to rural-based pulmonary rehab services, hospital administrators who have guided new programs at their facilities, and consultants who have supported hospitals in developing their programs, the videos illustrate the real-life impact rural pulmonary rehab programs can have and demonstrate that these programs can successfully operate in rural communities.

Hospitals considering whether establishing new pulmonary rehabilitation services might be a good fit, can access other Center-created resources that may help inform their organization’s planning and decision-making processes:

• A Rural Hospital Guide to Improving Chronic Obstructive Pulmonary Disease
• Rural COPD Podcast Series
• Pulmonary Rehabilitation Campaign, part of the Customizable Communications Toolkit (which is referenced in these videos and includes free templates hospitals can use to educate patients and providers about pulmonary rehab services, and promote pulmonary rehab offerings)