In order to continue to provide states that are pursuing state-based exchanges with appropriate technical support, the Department of Health and Human Services (HHS) is extending the deadline for blueprint applications to Friday, December 14. Originally states had to provide federal regulators a blueprint by November 16, as outlined in HHS' final rule. The deadline for a declaration letter for a state-based exchange remains Friday, November 16, 2012. In a November 9 letter sent to governors, HHS says it will approve or conditionally approve the state-based exchanges for 2014 by the statutory deadline of January 1, 2013.

HHS will accept declaration letters and blueprint applications for states that are pursuing state partnership exchanges and make approval determinations on a rolling basis. The final deadline for both the declaration letter and blueprint that would be effective for 2014 has been extended to Friday, February 15, 2013, says the letter. States will be able to apply to run these exchanges in subsequent years.

Most qualified health plans offered in exchanges must include the 10 categories of essential health benefits (EHB) mandated by the Affordable Care Act, which include rehabilitative and habilitative services. HHS is expected to release the final rule on EHB in the near future.

A new study reveals that black Americans display lower levels of vitamin D and greater pain sensitivity than do white Americans. A Vitamin D deficiency may be a risk factor for increased knee osteoarthritic pain in black Americans, the authors conclude. 

Clinical practice guidelines state that vitamin D levels less than 20 ng/mL represent deficiency, and levels between 21 and 29 ng/mL represent insufficiency. Given that low levels of vitamin D are linked to chronic pain and other health conditions, especially in black Americans, the research team set out to investigate if variations in vitamin D levels contribute to racial differences in patients with knee pain caused by osteoarthritis (OA).

Researchers at the University of Florida and the University of Alabama at Birmingham recruited 94 participants—45 black and 49 white patients with symptomatic knee OA—to complete questionnaires regarding their symptoms. The study group was 75% female and an average 56 years old.

In addition, study participants underwent testing that included sensitivity to heat and mechanical pain on the affected knee and the forearm. Researchers measured heat pain threshold as the point when patients indicate the sensation "first becomes painful" and pain tolerance when patients "no longer feel able to tolerate the pain." Mechanical pain measures were determined by the patients' response to pressure in the knee and forearm.

Findings indicate that despite living in a southern sunny climate, 84% of black participants had vitamin D levels less than 30 ng/mL compared with 51% of white subjects. Furthermore, the average vitamin D level for black Americans was 19.9 ng/mL (deficiency), compared with white Americans who averaged 28.2 ng/mL (insufficiency). Black participants reported greater overall knee osteoarthritis pain, and those with lower vitamin D levels displayed greater sensitivity to heat and mechanical pain (experimental pain).

"Our data demonstrate that differences in experimental pain sensitivity between the 2 races are mediated at least in part by variations in vitamin D levels," said lead author Toni Glover, MSN, ARNP. "However, further studies are needed to fully understand the link between low vitamin D levels and racial disparities in pain."

Healthcare 411, a new podcast series produced by the Agency for Healthcare Research and Quality (AHRQ), shares news and information about current research on important health care topics to help consumers with health care decision making.

Content provided by the Healthcare 411 Web site includes interviews that range from 60 seconds to 15 minutes on a variety of health topics. Programs remain available and searchable on the Healthcare 411 site. The site also hosts audio and video public service announcements produced by AHRQ and provides links to related consumer publications and other studies and guides funded by AHRQ.