“Narcan saves lives by reversing actual or suspected overdose to opioids,” Riverside University Health System CEO Jennifer Cruikshank, who is also serving as the hospital’s interim manager, said Thursday. “PVH plays a role in the critical infrastructure for our community. We are proud to be able to offer this free resource and access point from the hospital.”

Narcan, formally known as Naloxone, is an opioid antagonist nose spray that can arrest the effects of an overdose from fentanyl and other illicit drugs. It’s carried by fire crews and sheriff’s deputies countywide.

Palo Verde Hospital received more than 200 Narcan kits via the California Naloxone Distribution Project.

“A single dose of Narcan is administered as one spray into one nostril,” according to a hospital statement. “Each kit contains two nasal sprayers. Narcan should be stored in a cool, dry place. Given Blythe’s extreme summer heat, residents are strongly advised not to store Narcan in a vehicle, where high temperatures can degrade the medication and reduce its effectiveness.”

Residents can procure a free kit from staff in the hospital’s emergency room, which is the only functioning component of the medical facility, at 250 N. First St.

The hospital is under bankruptcy protection and a six-month management services agreement with the county, which is working to rectify the facility’s ongoing financial and operational challenges.

Without emergency services at the hospital, the area’s roughly 20,000 residents would lose access to “timely treatment for life-threatening conditions where minutes matter,” according to a county statement in January. Outside of the hospital, the nearest option for emergency healthcare is more than 70 miles away.

Preliminary county health department statistics indicated there were 229 suspected fentanyl-related fatalities countywide in 2025, compared to 351 confirmed poisonings in 2024, a roughly 40 percent decline.

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“Live music nourishes your soul and makes you feel truly alive,” says Chris Bro, host of the “Next” radio show in Maryland and a longtime fan of music festivals.

Making the most of the experience also means planning ahead for potential hazards like heat, dehydration and more, say regular festivalgoers and the medical pros who care for them.

The good news is music festivals are safer than ever, thanks to increased focus on on-site medical staff and equipment, says Matt Friedman, national medical director at CrowdRx, which provides medical care at over 20 major music festivals around the country each year.

Different festivals, different risks

Different types of festivals tend to have different types of medical emergencies, Friedman says. Much depends on the type of music, the length of the festival and the heat.

“Jazz music festivals tend have a low medical-usage rate, whereas a heavy metal event will have more blunt traumas from mosh pits and alcohol-related incidents,” he says.

Electronic dance music festivals tend to have friendly crowds, some of whom “occasionally overindulge or make poor decisions regarding stimulant drugs,” Friedman says. Classical music festivals, meanwhile, tend to have more cardiac events, given the older average age of attendees.

“You want to have fun, but it’s really important to stay aware,” says Armelle Gloaguen, a musician who attended classic festivals like Clearwater, founded by Pete Seeger, and Woodstock ’94.

“Be there for the music, not the drugs and alcohol, if you want to remember any of it. Don’t accept food or drinks from strangers, and be aware of your limits,” advises Gloaguen, who owns “Armelle for Kids,” which seeks to bridge cultures through music.

Know the rules, and download the app

Festivals’ rules vary, so before you head out, check the parking situation and the list of what you can bring.

For instance, Coachella, the annual festival in Indio, California, doesn’t allow chairs, outside food or umbrellas. At Tanglewood, in western Massachusetts, attendees are welcome to bring chairs and picnics, and umbrellas are fine; they just can’t be over 6 feet across.

Download a festival’s app and bring a portable phone charger.

Once there, scope out the terrain. Keep an eye out for the nearest cooling station and medical tent as you figure out where to sit.

Handling the heat

“First and foremost, we see a lot of heat-related illnesses, since temperatures in the desert can get pretty high and rise quickly,” says Julie Puzzo, assistant medical director of the emergency department at JFK Memorial Hospital, near Coachella.

“We see everything from heat cramps to heat stroke, which can be life threatening,” she says.

Hydrate consistently with electrolyte-containing beverages, she says.

Wear layers, a hat and other protective clothing, and avoid excessive alcohol. Opt for non-aerosol sunscreen, since many festival venues ban aerosol sprays.

Festivals where heat is an issue are sometimes equipped with mobile cold-water immersion tanks to cool people down quickly, Friedman says.

At multiday festivals, malnutrition can also be an issue, he says. “People are running on adrenaline for the first two days, but by day three they realize they are dehydrated and exhausted and haven’t eaten nutritious food since they arrived, and this exacerbates any other conditions they might have.”

His top safety tip: Stick with your friends so you can watch out for one another.

Leave sandals, heels and flip-flops at home

Both doctors urge attendees to wear comfortable, closed-toe shoes, since attending a festival can involve more walking that you might expect. And it’s easy to happen upon small stones or other sharp objects on the grounds.

“Trips and falls are common, and we see a lot of sprains and foot contusions,” says Friedman.

Glasses, ear plugs, maybe an inhaler

For anyone susceptible to respiratory problems, it’s a good idea to bring a backup inhaler, since dust-filled wind gusts can exacerbate breathing issues, Puzzo says.

Eye problems like corneal abrasions are not uncommon at festivals, says Friedman, who recommends bringing large sunglasses or even goggles if it’s likely to be dusty.

Outdoor venues can get buggy, too, so consider insect repellent.

Protect your ears by not standing too close to speakers, and bring earplugs, says Greta Stamper, an audiologist at Mayo Clinic in Jacksonville, Florida.

“It is also helpful to take listening pauses during festivals to allow your ears an opportunity to take a break. Having some quieter moments during the day can help your ears recover,” she says.

If you notice that your hearing is muffled or your ears start ringing, your ears are telling you it’s too loud, Stamper says.

And if you’re coming with kids, give them added protection with over-the-ear headphones, not just earplugs, Friedman says.

Pace yourself

“Musical festivals are a marathon, not a sprint, so be sensible and take care of yourself,” Friedman says.

As you kick back with friends, it’s easy to have a few drinks too many as the day wears on. Puzzo warns that drugs acquired at some big events might not contain what people think they do. This can be dangerous in any case, and is even more so if combined with extreme heat and alcohol.

Embrace the moment

Don’t forget, though, to find joy in the music and the scene.

Enjoy the unexpected, and making connections.

“If you want to talk to your favorite musician, the most meaningful thing you can do is to thank them and talk about a specific song you love and why,” says Gloaguen.

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Soboba’s Cultural Resource Department shared a huge bin of fresh organic produce from its Cultural Garden along with starter plants of basil, Japanese Chile and bell peppers. They also promoted “Gardening for Wellness” and explained some of the known benefits from the activity.

It can help reduce stress as the sights, smells and sounds of the garden are said to promote relaxation. Direct exposure to dirt and plants can help boost the immune system and reduce the likelihood of allergies and some illnesses. Those who grow their own fruits and vegetables are more conscious of maintaining a healthy diet. The gentle physical exercise experienced while gardening often can aid a disability or rehabilitation from an injury or illness. Working in a garden can increase all-around levels of physical activity which can possibly reduce the risk of high blood pressure, heart disease, diabetes, obesity, osteoporosis and other medical conditions. It can also improve mental health by reducing depression, anxiety and stress. A study revealed that regular gardening can reduce the risk of developing dementia by 36 percent.

Melissa Campos, representing MARs Whealthness, provided mini-meditation sessions using a sound bath. She also taught some of the younger visitors how to use effective breathing techniques by making a fun game out of it. The goal of the company is to create a positive community, optimize healing, connection and growth to inspire and cultivate the best version of one’s self. A co-founder, with three other partners, Campos is an education consultant, sound bath practitioner and a yoga teacher.

Campos got interested in pursuing this vocation because growing up she endured many health problems that affected her mind, body and spirit. When traditional medical professionals could not offer a diagnosis or solution, her mother took her to a holistic practitioner that changed her world. She began her whealthness journey through nutrition, movement, mindfulness, and other healing practices. Now she teaches others how to do the same. For more information on services, events, education wellness, retreats and more, please visit www.marswhealthness.com.

Sarah E. Vazquez is an artist who creates amazing linocut prints of her own designs. “I started doing ink illustrations and then found this other way,” she said. She posts and sells on Instagram @sevy-arte. She displayed many of her monochromatic art pieces which were thought provoking and detail oriented and elicited many positive comments from visitors to her table.

Around-Birth Collective was available to share resources and their mission of working towards improving perinatal health outcomes in the Inland Empire and North San Diego through collaboration, education and advocacy. They also offered free blood pressure screenings. Co-founders Tristen Orosco, Leslie McFarlane and Yuli Smith all have strong reasons for wanting to re-educate and re-introduce midwifery to today’s women.

“We created the collective together to improve perinatal outcomes in our communities,” Orosco said, adding that midwifery has increased since the pandemic. “We have great outcomes when it comes to out-of-hospital births.”

Orosco is a Payómkawish mother of two and a basket weaver. She lives in part of her traditional Payómkawichum homelands, now known as Temecula, where she raises her children with her husband, Rob. She has sought to increase midwifery access to Indigenous families through the Indian Health Clinics. She believes that continuity of care, especially during the postpartum period, can deeply impact families’ experiences and outcomes. With a physical presence in Temecula at Orosco’s Teméeku Midwifery, more information on the Collective can be found at https://aroundbirthcollective.podia.com.

Stephanie Sadaka, who owns Nutrishop with her husband John, shared with visitors how to make the most of nutrition, whether it is to achieve sports fitness, weight loss or overall wellness. Their Hemet store offers an Evolt 360 body scan which provides detailed data about the body through more than 40 measurements in just 60 seconds. The scan’s reading determines the difference between muscle, fat mass, water and more. This information is valuable in setting up a proper meal plan, which they can customize to help clients get to their goals faster. “We are more than a wellness store,” Sadaka said. “Some of our customers already know what they want but most want to be healthier and don’t know where to start.”

She said most people are lacking in protein so having a high-protein diet helps. Experts at Nutrishop can help devise a meal plan to show how to eat because one’s diet is where it all begins. More details can be found at www.NutrishopUSA.com/Hemet or @Nutrishop_Hemet.

Crystal Aguilar had a display with all types of bee products. From fresh honey to royal jelly, beeswax candles, body and lip balms and even honey lollipops, she was eager to share the benefits of bee pollen with all guests who stopped by her table. Bee pollen contains many vitamins, minerals and antioxidants, making it incredibly beneficial to one’s health. It is known to decrease inflammation, alleviate allergies, reduce stress, speed up wound healing, improve immunity and aid in digestion.

Her husband, Gus Chavez, has been a beekeeper for 23 years. “I do the honey part,” Aguilar said. The mother of three said Crystal Pure Honey is sold online and at farmer’s markets and small community events. “Our little gift sets are very popular,” she said. For more information or to shop online, please visit www.crystalpurehoney.com.

The Cahuilla Consortium has been in operation since 2010 in Anza and recently opened a second office in Hemet. Offering crime victim advocacy and a crisis center, the consortium also has started its “Shelf Care Book Club” which welcomes Tribal members to discuss stories highlighting MMIP awareness and historic/generational trauma that are written by Indigenous voices.

Formed through the joint efforts of the Los Coyotes Band of Cahuilla and Cupeno Indians, the Cahuilla Band of Indians and the Santa Rosa Band of Indians, the Consortium’s objective is to promote the safety and wellbeing of all Native communities. They work to end all victimization against Tribal people through advocacy and education efforts that include prevention, intervention and the fostering of resiliency. More information can be found at www.cahuillaconsortium.org.

Inter-Tribal Sports, or ITS, is in the process of softball signups with opening day scheduled for Sept. 7. Representatives also shared they are proud to be able to offer free access to those interested in receiving CPR and First Aid certification and training. For more information, call 619-594-4619 or visit www.intertribalsports.org. There was also information on how to pursue a career as an athletic training through https://CAATE.net.

Included among several other vendors was Riverside-San Bernardino County Indian Health Inc.’s Behavioral Health specialists, offering resources and information on their many valuable programs.

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CMS Releases Final Evaluation Report on Comprehensive Primary Care Plus Model

December 15: CMS released the final report on the evaluation of the Comprehensive Primary Care Plus (CPC+) Model. CPC+ was a primary care practice transformation model, supporting practices at varying levels of readiness in two tracks. The report found that during the five performance years of the model, participating practices transformed the way they provided many aspects of care. This transformation led to reduced outpatient emergency department visits, acute inpatient hospitalizations, and acute inpatient expenditures. However, these reductions were insufficient in either track to reduce total Medicare expenditures or achieve net savings, after accounting for increased expenditures in other areas and enhanced CPC+ payments. In both tracks, CPC+ practices that also participated in the Medicare Shared Savings Program at baseline successfully reduced acute inpatient expenditures and total expenditures.

CMS Takes Major Actions on Federal Independent Dispute Resolution (IDR) Process  

December 15: The Departments of Health and Human Services, Treasury, and Labor, including CMS representing HHS, (The Departments) reopened the Federal IDR portal for all dispute types, including previously initiated batched disputes, new batched disputes, and new single disputes involving air ambulance services. The Federal IDR process protects consumers against out-of-network balance billing by providing a process whereby providers (including air ambulance providers), facilities, and health plans can resolve payment disputes for certain out-of-network charges. Since August 2023, parts of the portal to submit Federal IDR disputes were closed due to recent court orders and opinions. The portal is now fully operational.

December 18: The Departments, including CMS representing HHS, issued a final rule on Federal IDR Process Administrative Fee and Certified IDR Entity Fee Ranges. This final rule amends existing regulations to provide that the administrative fees charged by the Departments to participate in the Federal IDR process, and the ranges for certified IDR entity fees for single and batched determinations, will be established by the Departments in notice and comment rulemaking, rather than in guidance. This rule also finalizes an administrative fee of $115 per party for disputes initiated on or after the effective date of this rule. It also finalizes a certified IDR entity fee range of $200-$840 for single determinations and $268-$1,173 for batched determinations for disputes initiated on or after the rule’s effective date. This rule and its associated fees are also effective for disputes initiated on or after January 22, 2024. Information is available on this fact sheet.

December 22: The Departments, including CMS representing HHS, posted a notification on the No Surprises Act website that the Departments intend to reopen the comment period for submitting comments on the proposed rule Federal Independent Dispute Resolution Operations. The Departments intend to publish a notice in the Federal Register with further details on reopening the comment period.

CMS Posts Reports on the Medicare-Medicaid Financial Alignment Initiative

December 20: CMS posted four reports on the Medicare-Medicaid Financial Alignment Initiative (FAI). This initiative is designed to integrate financing and service delivery for Medicare-Medicaid enrollees. CMS is partnering with states to test models intended to achieve those goals. CMS released the third evaluation report for the Rhode Island and South Carolina demonstrations and the third preliminary evaluation report for the Texas demonstration. CMS also released the third brief report for the New York Integrated Appeals and Grievances demonstration. Rhode Island and South Carolina show some improvements in utilization and quality results. Texas shows mixed utilization and quality results. The Rhode Island and South Carolina reports show increases in Medicare spending, while Texas shows no change. The New York Integrated Appeals and Grievances demonstration is described by plans, advocates, and the state as a key benefit for people with both Medicare and Medicaid.

CMS Issues Proposed Rule Establishing Appeal Processes for Certain People with Medicare

December 21: CMS issued a proposed rule that would establish appeal processes for certain people with Traditional Medicare who are admitted to a hospital as an inpatient but subsequently reclassified by the hospital as an outpatient receiving observation services. Additional information can be found on this fact sheet.

New Laboratory Regulation Adjusts Fees, Revises Requirements & Permitted Sanctions 

December 22: CMS, in collaboration with the CDC, released a final rule titled Clinical Laboratory Improvement Amendments of 1988 (CLIA) Fees; Histocompatibility, Personnel, and Alternative Sanctions for Certificate of Waiver Laboratories. The final rule adjusts laboratory fees to provide sustainable funding for the user-fee-funded CLIA program; revises certain requirements for clinical laboratories certified under CLIA; and provides additional discretion to CMS to impose alternative sanctions against non-compliant laboratories.

ICYMI: Comments Due Soon on Notice of Marketplace Benefit and Payment Parameters for 2025 Proposed Rule 

Comments are due January 8, 2024, on the Notice of Benefit and Payment Parameters for 2025 Proposed Rule. The rule proposes standards for issuers and Marketplaces and requirements for agents, brokers, web brokers, direct enrollment entities, and assisters that help Marketplace consumers. This proposed rule also includes several proposals impacting the Medicaid program, Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). Information on the proposed rule can be found here. 

Other Recent Releases: 

December 15: HHS to Improve Maternal Health Outcomes with New CMS Care Model that Expands Access to Services, Other Proven Maternal Health Approaches

December 18: Biden-Harris Administration Releases New Medicaid and CHIP Renewal Data Showing the Role State Policy Choices Play in Keeping Kids Covered 

December 20: HealthCare.gov Enrollment Exceeds 15 Million, Surpassing Previous Years’ Milestones

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Physicians have long emphasized individual actions to prevent chronic disease such as eating well, exercising, and avoiding smoking. But even as global smoking rates have dropped, the amount of chronic disease at the population level hasn’t fallen as much as public health researchers had hoped it would. Lately, investigators are studying how environmental factors, such as air pollution, might play a role in driving certain cancers, as well as lung and cardiovascular diseases. They found that air pollution particulate matter(link is external and opens in a new window)can trigger the start of a cancerous cell in lab animals, may reduce the effectiveness of certain cancer immunotherapies, and may weaken the immune systems of older people, making it harder for them to fend off respiratory infections.

Now, an interdisciplinary team of scientists is looking at an important way to intervene on air pollution and chronic disease: namely through improving indoor air quality. The project, one of eight funded by Columbia Mailman Centennial Grand Challenges grants, involves testing whether cleaner indoor air can reduce inflammatory biomarkers across two generations. The team is equipping New York City families with HEPA air purifiers and measuring biomarkers for chronic disease. They are also giving the families green cleaning products and an educational video about environmental and lifestyle risk factors and chronic disease risk reduction strategies.

Mary Beth Terry, a Columbian Mailman professor of epidemiology and one of the project leads, describes the work as a proof of concept that if successful could lead to new city policies that would bring air purifiers into public housing units, schools, and other buildings.

In addition to Terry, who is also the associate director of Population Science and Community Outreach at Herbert Irving Comprehensive Cancer Center, the other co-leaders of the project are Jeanine Genkinger, associate professor of epidemiology, and Rebecca Kehm, associate research scientist in the department of epidemiology.

What made you decide to focus on indoor air pollution?

We often think about particulate matter in outdoor air pollution, but most people spend 80 to 90 percent of their time indoors. And now with climate change, more and more people are forced to stay indoors because of extreme weather. Think about the wildfire smoke from Canada last summer that made outdoor air quality dangerous in many places. What we’re hoping is to show that a simple household intervention, using an air purifier, can reduce some chronic disease markers across a generation. We have been enrolling family members and will look how having an indoor air purifier affects adults and their children.

What’s the long-term goal?

If we can show this is an effective intervention then, hopefully, through city policies—these air purifiers are relatively inexpensive— we can see more of these devices in public housing, schools, and other indoor spaces. If we want to address health disparities, and we can show that indoor air pollution is just as important as outdoor air pollution, then we have a very inexpensive way to reduce and hopefully prevent many chronic diseases. We have health economists that are part of our team who will be able to show just how this intervention is a cost-effective way to lower disease rates.

You have many partners from different departments helping with the study and the interdisciplinary aspect of the work extends to master’s students, can you elaborate?

Students in the first semester of the MPH core curriculum train together, academically. The first group of students who worked on this project last summer were from Biostatistics, Population and Family Health, and Epidemiology. They each brought different skills to the table and there was more peer-to-peer support and cohesion. The students also worked closely with the Community Outreach and Engagement office at the Herbert Irving Comprehensive Cancer Center doing community outreach and engagement. So, they gained experience on this study, but then they also gained experience, in general, about how to work with different community partners and a better understanding of what community-engaged research entails.

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The COP28(link is external and opens in a new window) climate summit is now underway in Dubai during what is virtually certain to be the hottest year on record. The summit is also noteworthy for being the first to highlight the health impacts of climate change and work toward addressing them in a meaningful way.

Continuing through December 12, the UN-sponsored summit is the largest such gathering to date, with some 70,000 delegates, and world leaders, and senior officials from nearly every nation in attendance. Additional participants include business leaders, young people, Indigenous Peoples, journalists, and scientists, including faculty from Columbia University Mailman School of Public Health.

COP28 is welcoming a record number of ministers of health who will participate in the first-ever COP Health Day(link is external and opens in a new window) on December 3. A high-level session will seek to galvanize cross-sectoral collaborations to realize the health benefits of reducing greenhouse gas emissions. It will launch the COP28 Declaration on Climate and Health, reflecting countries’ priorities on the growing health impacts of climate change, and supporting the mainstreaming of health in the climate agenda. The session, which is hosted by the COP28 Presidency, the WHO, and the United Arab Emirates’ Ministry of Health and Prevention, also aims to secure funding pathways to safeguard and invest in health in a changing climate. Separately, WHO and the Wellcome Trust are hosting a Health Pavilion, to convene the global health community and key stakeholders across various sectors to ensure health and equity are placed at the center of climate negotiations.

The Global Consortium on Climate and Health Education (GCCHE) at Columbia Mailman, which boasts 300 members in 60 countries, is co-hosting a networking reception at COP28. Its goal: bring together health-focused governmental and non-governmental organizations, academic institutions, community organizations, youth organizations, and health professionals working at the nexus of health, climate, and environment, to facilitate idea-sharing and further collaboration. (Watch a short video about GCCHE here.) In addition to taking part in the networking reception, GCCHE Director Cecilia Sorensen, associate professor of Environmental Health Sciences at Columbia Mailman and associate professor of Emergency Medicine at Columbia Irving Medical Center, is also participating in an event organized by the WHO titled “Integrating Health into Climate Change Responses—the Role of Health Professionals.”

Ahead of traveling to Dubai, Sorensen said she was encouraged that health is being featured at this year’s COP for the first time. “Health is fundamental to the impacts of climate change, which are already deeply harming the health of vulnerable populations,” she said. “Further, by placing health at the center of agendas, there are incredible co-benefits which can be realized, both economically as well as through improvement of livelihoods globally.”

The COP meeting comes on the heels of a report(link is external and opens in a new window) by the non-profit organization Climate Central which finds that the past 12 months were the hottest on record. This year has seen extreme temperatures in the Southwest and West of the United States, as well as wildfire smoke that triggered air quality warnings and unhealthy conditions in New York and other parts of the U.S. A large study recently published in The Lancet(link is external and opens in a new window) finds that the climate is having a worsening effect on health and mortality worldwide with a large spike in heat-related deaths among older people.

Sorensen continued, “Our hope for COP is to see strong commitments from the international community to increase investment in and focus on health and to apply a health lens in all climate policy. This includes building capacity of the health sector to prevent, prepare for, and mitigate health impacts on communities and the health care sector itself.”

The Columbia Mailman School, which in 2008 launched its Climate and Health program, the first of its kind in a school of public health, participated in 2015’s historic COP21 in Paris, which saw the negotiation of the Paris Accords with its goals to limit global temperature rise. There, the School co-hosted a dinner with the White House to promote science and education around climate and health. Earlier that same year, President Barack Obama cited Columbia Mailman-led climate and health research.

Since 2008, faculty have contributed seminal studies on the health risks from intensified heat waves and hurricanes to the migration of insect-borne diseases and the nutrition impacts of climate change. This year, Robbie Parks, assistant professor of environmental health sciences, led research on the increasing lethality of hurricanes, especially for the socially vulnerable. Another study examined how elevated temperatures from global warming may contribute to rising drug and alcohol disorders.

“Never has there been a more fitting time for health to be on the agenda at COP, with recording-breaking heat waves, wildfires, tropical cyclones, floods, and drought worldwide causing devastating impacts on our lives,” said Parks, who is attending the summit. “The fact that health is front and center in Dubai means that during negotiations it will hopefully act as an effective lever to persuade the most entrenched parties that, without immediate action and funding on loss and damage and phasing out of fossil fuels, our very lives are at risk.”

Along with health, for the first time, food security will get a prominent seat at the table at COP28; leaders are expected to sign a special food declaration and the UN Food and Agriculture Organization will create a roadmap for how the world can feed a growing population while staying within the limits of the Paris Accords. Environmental Health Sciences Professor Lew Ziska, a plant physiologist with expertise in climate change, said, “Given the steady increase in hunger since 2019, and the risk to food systems from climate change, nutrition and public health should be the number one topic for discussion.”

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CMS Approves Mobile Crisis Intervention Services for People with Medicaid in the States of Washington and Montana

CMS recently approved mobile crisis state plan amendments (SPAs) for both Washington and Montana. Authorized under President Biden’s American Rescue Plan (ARP), mobile crisis intervention services provide rapid, critical services to people experiencing mental health or substance use crises by connecting them to a behavioral health specialist 24 hours per day, 365 days a year. This option will help states integrate these services into their Medicaid programs, a critical component in establishing a sustainable, public health-focused support network. The Washington SPA was approved October 10, and the Montana SPA was approved October 17.

CMS Releases Second Evaluation Report for the Medicare Advantage Value-Based Insurance Design (VBID) Model, Phase II

October 10: CMS released an evaluation report for implementation years 2020-2022 of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model. The model tested various changes put in place to improve the delivery and quality of care for Medicare Advantage enrollees, including how to reach more effectively those with low socioeconomic status. Two key findings are that model participation is growing, including for the hospice benefit, and that interventions like supplemental benefits and Part D cost-sharing reductions are increasingly focused on addressing the needs of those with low socioeconomic status. The model is part of CMS efforts to address patients’ health-related social needs, increase prescription drug affordability, and advance health equity.

CMS Publishes Update on the Executive Order to Lower Prescription Drug Costs

October 11: CMS published a blog highlighting the first anniversary of the Executive Order on Lowering Prescription Drug Costs for Americans. The blog provides a progress report on the three models being developed to improve prescription drug affordability and access for Medicare and Medicaid beneficiaries: the Medicare $2 Drug List Model, the Cell and Gene Therapy Access Model, and the Accelerating Clinical Evidence Model. Addressing drug affordability and accessibility for Americans remains a top priority for CMS and the Biden-Harris Administration.

CMS Releases Information on Three National Coverage Determinations:

CMS continues its commitment, through national coverage determinations (NCDs), to ensure that people with Medicare have access to emerging treatments and technologies that will improve health outcomes.

October 10: CMS announced that the final NCD on Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus (HIV) Infection would not be posted by the expected date of October 10. CMS received comments on the proposed NCD that expressed concern over the potentially complex transition of coverage of these preventive drugs from Part D to Part B.  CMS will work with Part D plans and pharmacies to facilitate an orderly transition as we work towards finalizing the NCD. A final NCD will be forthcoming. Information on the proposed NCD is found here.

October 11:  CMS issued a final NCD for Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting. This NCD resulted from a request from the Multispecialty Carotid Alliance (MSCA) for a reconsideration of a former NCD. The procedure restores blood flow when arteries are clogged due to peripheral artery disease. In the final NCD, CMS expanded coverage of PTA of the carotid artery with stenting for a broader population and allowed Medicare Administrative Contractors (MACs) to make reasonable and necessary determinations for any other beneficiary seeking coverage.  

October 13: CMS announced a final decision to remove the NCD for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease, permitting Medicare coverage determinations to be made by the MACs. Removing the NCD also removes the current limitation of one PET beta-amyloid scan per lifetime from the coverage requirements.

CMS Releases Tools and Resources  as Annual Medicare Open Enrollment Period Begins

October 15: The annual Medicare Open Enrollment period began October 15, 2023, and ends December 7, 2023, with coverage changes taking effect January 1, 2024. During this time, people with Medicare can compare coverage options, like Traditional Medicare and Medicare Advantage, choose health and drug plans for 2024, and learn about extra help available to those with limited income and resources to pay for Medicare drug coverage. Tools and resources are available at Medicare.gov.

CMS Approves Montana’s Expansion of Postpartum Coverage for a Full Year to People with Medicaid

October 16: CMS approved a state plan amendment for Montana to extend postpartum coverage for a full year for individuals enrolled in Medicaid. The opportunity to extend postpartum coverage was made possible under the American Rescue Plan and made permanent in the Consolidated Appropriations Act, 2023. Montana’s approval marks 38 states, D.C., and the U.S. Virgin Islands that have extended postpartum Medicaid coverage for an entire year. This approval supports the CMS Maternity Care Action Plan and Biden-Harris Maternal Health Blueprint.    

CMS Releases Million Hearts Cardiovascular Disease Risk Reduction Model Final Evaluation

October 17: CMS released the final evaluation report of the Million Hearts Cardiovascular Disease Risk Reduction Model. The report describes the model’s implementation and includes estimates of the model’s impact on heart attacks, strokes, survival, and spending. Over five years, the model reduced the incidence of first-time heart attacks and strokes by 3 to 4 percent in all-cause mortality among high- and medium-risk beneficiaries but did not measurably impact Medicare fee-for-service spending.

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NEW YORK (AP) — U.S. health officials plan to endorse a common antibiotic as a morning-after pill that gay and bisexual men can use to try to avoid some increasingly common sexually transmitted diseases.

The proposed CDC guideline was released Monday, and officials will move to finalize it after a 45-day public comment period. With STD rates rising to record levels, “more tools are desperately needed,” said Dr. Jonathan Mermin of the Centers for Disease Control and Prevention.

The proposal comes after studies found some people who took the antibiotic doxycycline within three days of unprotected sex were far less likely to get chlamydia, syphilis or gonorrhea compared with people who did not take the pills after sex.

The guideline is specific to the group that has been most studied — gay and bisexual men and transgender women who had a STD in the previous 12 months and were at high risk to get infected again.

There’s less evidence that the approach works for other people, including heterosexual men and women. That could change as more research is done, said Mermin, who oversees the CDC’s STD efforts.

Even so, the idea ranks as one of only a few major prevention measures in recent decades in “a field that’s lacked innovation for so long,” said Mermin. The others include a vaccine against the HPV virus and pills to ward off HIV, he said.

Doxycycline, a cheap antibiotic that has been available for more than 40 years, is a treatment for health problems including acne, chlamydia and Rocky Mountain spotted fever.

The CDC guidelines were based on four studies of using doxycycline against bacterial STDs.

One of the most influential was a New England Journal of Medicine study earlier this year. It found that gay men, bisexual men and transgender women with previous STD infections who took the pills were about 90% less likely to get chlamydia, about 80% less likely to get syphilis and more than 50% less likely to get gonorrhea compared with people who didn’t take the pills after sex.

A year ago, San Francisco’s health department began promoting doxycycline as a morning-after prevention measure.

With infection rates rising, “we didn’t feel like we could wait,” said Dr. Stephanie Cohen, who oversees the department’s STD prevention work.

Some other city, county and state health departments — mostly on the West Coast — followed suit.

At Fenway Health, a Boston-based health center that serves many gay, lesbian and transexual clients, about 1,000 patients are using doxycycline that way now, said Dr. Taimur Khan, the organization’s associate medical research director.

The guideline should have a big impact, because many doctors have been reluctant to talk to patients about it until they heard from the CDC, Khan said.

The drug’s side effects include stomach problems and rashes after sun exposure. Some research has found it ineffective in heterosexual women. And widespread use of doxycycline as a preventive measure could — theoretically — contribute to mutations that make bacteria impervious to the drug.

That kind of antibiotic resistance hasn’t materialized in San Francisco, but it will be important to watch for, Cohen said.

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When a Black baby is born in the United States, their fight to live a healthy life begins. Compared to the white baby in the delivery room next door, they’re more likely to be impoverished as children and chronically ill as adults.

Even if they succeed economically, they’re still expected to live fewer years than white Americans.

My project for the Center for Health Journalism 2023 National Fellowship will explore how reparations for Black Americans could shrink the health gap.

Health disparities did not arise by accident – and they’re not explainable by genetics. They’re the result of the nation’s legacy of policy-driven racism.

Redlining is a prime example.

When the federal government denied Black residents homeowner loans beginning in the 1930s, and allowed mortgage lenders to do the same, it divided more than neighborhoods. It also segregated resources such as grocery stores.

The refusal of markets to establish stores in Black and low-income communities led to the creation of “food deserts.”

Today, one-in-five Black residents lack access to affordable, fresh fruits and vegetables. Just 8% of Black people live in a census tract with a supermarket, compared to 31% of white Americans.

In previous reporting, I spoke with an Atlanta farmer who invested his retirement funds toward land to grow food. He’d become tired of watching Black residents struggle to access groceries.

The area had only one “grocery store within miles from the area of the farm,” he told me.

Research has linked the legacy of redlining to high rates of chronic disease, lower life expectancy,poor COVID-19 outcomes and other health challenges that disproportionately affect Black Americans. But redlining is just one example of how policy fueled health disparities; Black people live with the consequences of racist policies that go back centuries. 

While some community members, such as the farmer I mentioned, find ways to address the issues impacting their health and quality of life, others call on the government to atone for Black suffering through reparations.

The U.S. planned to give freed Black people 40 acres of land after slavery ended, but that promise was short-lived.  Although several other groups have received federal funds for past harms, not a single dime has been given to Black Americans.

That could change — and so could health outcomes.

The movement for reparations has picked up speed, particularly in California. In 2020, the state formed the AB 3121 Task Force to Study and Develop Reparations Proposals for African Americans.  The group’s work to create a state-level blueprint is arguably the furthest the U.S. has come to extending reparations in recent history. I will explore efforts to address health inequities in California through cash payments and other requests.

This project will look strongly at poverty-related mental health issues and how reparations may provide a remedy. Poverty is deemed a public health issue for a good reason. It can lead to stress and mental illness. It exposes people to violence, which can be traumatizing..

I will follow Black people with depression, anxiety and other illnesses. Additionally, I will look at the connection between generational poverty and post-traumatic stress disorder.

Reparations in the form of cash payments have the potential to ease the mind by increasing access to safer housing, better education, and healthy food. This could translate into overall better health.

The California task force and reparations advocacy groups aren’t asking for money alone — they also want policies to protect Black folks from future harm. That may involve removing lead in drinking water in redlined neighborhoods or reducing the rate of death among Black mothers and infants.  Such policies could benefit Black people who may not qualify for cash payments. I intend to explore the various requests from Black community members and organizations.

I also will look at the reparations conversation in the Christian community. During the civil rights movement, leaders such as Dr. Martin Luther King, Jr. advocated for eradicating poverty to end suffering. While his vision has yet to come to pass, some ministers today have taken up the cause to push for reparations, while others oppose reparations. It is important to explore the split on this subject within Christianity in America.

Lastly, I’ll include a reporter’s notebook examining my experience producing this project. The piece will also have my own family history: a tale of generations of men and women who lived, fought, and died in Pensacola, Fla., after fleeing nearby southern towns after slavery.

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By Columbia Mailman School of Public Health

The Southwest and West face a second week of extreme temperatures that have already claimed more than a dozen lives. Approximately one in three Americans received excessive heat warnings, watches or advisories last weekend, according to the National Weather Service. Globally, July was the hottest month on record, pushing the world closer to the critical 1.5-degree Celsius temperature rise threshold, the most optimistic target for limiting global warming.

Meanwhile, Canadian wildfires, preceded by doubts, continue to create smoke that carries thousands of miles, triggering air quality warmings and unhealthy conditions across wide swaths of the United States, reaching as far south as Miami, and communities across New England and the Northeast struggled to recover from recent powerful storms and flash flooding.

Environmental health scientists from Columbia University Mailman School of Public Health—home to the country’s first climate and health program in a school of public health—are working to study and address these challenges, both through original research and teaching front-line health workers and the next generation of public health leaders.

“There is no doubt that extreme weather and wildfires are happening with greater frequency because of climate change,” says Cecilia Sorensen, an emergency medicine physician and associate professor of environmental health sciences at Columbia Mailman School. Studies show that climate change has led to a 50 percent increase in the acreage burned. “We are especially concerned with vulnerable groups, including individuals with preexisting respiratory and cardiovascular conditions, the elderly, small children, and infants, people without stable housing, and those who work outside.”

Sorensen points to a slate of health risks from extreme weather. Exposure to wildfire smoke is dangerous for people with asthma and other respiratory conditions and prolonged time spent outdoors is a risk to everyone. High temperatures are most dangerous to the same vulnerable groups, including the elderly and those who work and live outside. Stormy weather introduces the risk of injury, such as from landslides and downed powerlines, and creates a breeding ground for mosquitoes and other infectious disease vectors. All these stressors disrupt lives and have a negative impact on mental health—as can the larger anxiety about climate change.

In situations of extreme weather, individuals should seek out guidance from their local authorities on cooling centers, road closures, masking guidance, and more. Air quality information is available online(link is external and opens in a new window) and offers a general framework for how safe it is to be outdoors. Sorensen adds her own advice: “Check in on your loved ones. Often our most valuable front-line responders are friends and family,” she says.

Sorensen leads the Global Consortium on Climate and Health Education (GCCHE), which is based at Columbia Mailman. With 310 medical, nursing, public health, and other health professions schools as members, GCCHE develops curricula and conducts trainings on climate and health around the world. She is a member of the Lancet Countdown on Health and Climate Change(link is external and opens in a new window) and serves on the National Academy of Medicine Action Collaborative for Decarbonization of the U.S. Health Sector(link is external and opens in a new window). She is the co-editor of the textbook Climate Change and Human Health: From Science to Practice.

In its trainings, GCCHE focuses on ways communities can protect themselves and build resiliency. These include early warning systems for extreme weather, rain gardens and other methods to mitigate flooding, cooling centers, and more.

Informing these trainings is research by Sorensen and other Columbia Mailman faculty scientists, including Darby Jack, Marianthi-Anna Kioumourtzoglou, Robbie Parks, Jeff Shaman, Lew Ziska, and others. These studies have linked elevated temperatures to injury deaths(link is external and opens in a new window), wildfire smoke to jump in ICU admissions(link is external and opens in a new window), tropical cyclones to elevated hospitalizations(link is external and opens in a new window) and death rates, including the specific illnesses involved(link is external and opens in a new window) and special risks to older adults(link is external and opens in a new window). They have also examined the effects of heat stress on kidney function of agricultural workers(link is external and opens in a new window), as well as the broader impacts of climate change on women’s health(link is external and opens in a new window) and on food security. Meanwhile, research continues to demonstrate the negative health impacts of the main driver of climate change—air pollution from fossil fuel combustion.

“Climate changing is stressing all of society, especially the most vulnerable,” says Sorensen. “It’s critical that we come together to protect ourselves as extreme weather becomes the new normal. At the same time, we need to push for a speedy transition to a green economy.”

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