Rural Health Information Hub Latest News

CMS Releases More Payment Increases

During the week of July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released rules finalizing Medicare payment adjustments for skilled nursing facilities (SNFs), hospices, and inpatient rehabilitation (IRFs) and psychiatric (IPFs) facilities for FY 2020. Under the final rules, Medicare payments to SNFs will increase by 2.4% in FY 2020 relative to FY 2019; payments to IPFs by 1.5%, or $65 million; payments to IRFs will increase by 2.5%, or $210 million; and payments for hospice facilities will increase by 2.6%, or $520 million.

Medicare Part D Premiums Decline

During the week of July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) announced the average basic premium for Medicare Part D plans is projected to decline in 2020 for the third year in a row, falling from $32.50 this year to $30 next year. CMS Administrator Seema Verma said the downward trend in Part D premiums stems from “actions that CMS has taken to strengthen the Medicare prescription drug program.”

CMS Finalizes Inpatient Payment Bump

During the week of July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) issued its Inpatient Prospective Payment System final rule for fiscal year (FY) 2020, which aims to address payment disparities for rural and urban health facilities and increase add-on payments for emerging technology and therapies. The 2,273-page final rule will affect about 3,300 acute care facilities and is expected to increase total Medicare spending on inpatient hospital services, including capital, by about $3.8 billion in FY 2020 when compared with FY 2019.

Researchers Estimate Societal Costs of the Opioid Epidemic

New supplement to The American Journal of Managed Care explores how the opioid epidemic affects society.

July 30, 2019

UNIVERSITY PARK, Pa. — The devastating consequences of the opioid crisis are far-reaching in the United States, impacting public health as well as social and economic welfare. Penn State researchers recently collaborated to address the issue in a supplement of The American Journal of Managed Care, titled “Deaths, Dollars, and Diverted Resources: Examining the Heavy Price of the Opioid Epidemic.”

According to Dennis Scanlon, distinguished professor of health policy and administration and director of the Center for Health Care and Policy Research at Penn State, the articles and commentaries in the special issue focus on the costs to governments, notably state governments.

“State and local governments have long shouldered the burden of the opioid epidemic and its costs to individuals and families,” said Scanlon. “They are at ground zero for the epidemic, where services for those being harmed by opioids are significant and costly, spanning well beyond healthcare for treatment and prevention.”

Scanlon, along with Christopher Hollenbeak, professor of health policy and administration at Penn State, authored the introduction to the special issue, noting, “We take an opportunity to raise several important broader questions we believe have not received enough attention but are critically important for learning from the current opioid epidemic and preventing the potential burdens that could be associated with the next epidemic.”

Topics in this special issue are diverse and include the costs of the opioid crisis on employment and labor market productivity, burdens on the child welfare system and special education, the increased costs to the criminal justice system, and the economic burden on state Medicaid programs.

“The supplement fulfills our initial goal of exploring the effects of the opioid crisis on societal costs,” Scanlon explained. “Each article in this special issue presents complex cost analyses of the implications of opioid misuse, shedding new light on the opioid epidemic at the state level, and adds to a growing body of literature about the opioid epidemic.”

For example, researchers found that in the United States between 2000 and 2016, opioid misuse reduced state tax revenue by more than $11 billion, including approximately $10 billion in lost income tax revenue and almost $2 billion in lost sales tax revenue. In another paper, researchers found that between 2007 and 2016, total costs to Pennsylvania’s criminal justice system from the opioid crisis was over $526 million.

“Each article in this special issue presents complex cost analyses of the implications of opioid misuse, shedding new light on the opioid epidemic at the state level, and adds to a growing body of literature about the opioid epidemic.”  — Dennis Scanlon, distinguished professor of health policy and administration and director of the Center for Health Care and Policy Research at Penn State

Meanwhile, total Medicaid costs associated with opioid-use disorder more than tripled between 1999 and 2013, reaching more than $3 billion. Additionally, total annual education costs for children born in Pennsylvania with neonatal abstinence syndrome associated with maternal use of prescription opioids was estimated at over $1 million. Finally, researchers also found increased costs of almost $3 billion to the child welfare system from 2011 to 2016.

“Due to these costs, every American will continue to experience loss from resources diverted to the epidemic that could have been made available for other uses had the epidemic been prevented,” said Scanlon.

Another unique aspect of the issue is the strong Penn State presence, as all authors are either faculty, staff, or current or former graduate students. Additionally, one of the commentaries is co-authored by Pennsylvania Secretary of Health Rachel Levine, who provides further perspective into the opioid crisis at the state level.

Other lead Penn State authors include Max Crowley, assistant professor of human development and family studies; Doug Leslie, professor of public health sciences and psychiatry; Paul Morgan, professor of education; Joel Segel, assistant professor of health policy and administration, and Gary Zajac, associate research professor.

Research contributions in the supplement were supported by the Commonwealth of Pennsylvania under the project “Estimation of Societal Costs to States Due to the Opioid Epidemic,” and as part of larger work supported under a Strategic Planning Implementation award from the Penn State Office of the Provost, “Integrated Data Systems Solutions for Health Equity.”

Funding for the production of this supplement was provided by Penn State’s Social Science Research Institute and by the Penn State Clinical and Translational Science Institute through the National Center for Advancing Translational Sciences, National Institutes of Health.

Comments Requested: Medicare Physician Fee Schedule Proposed Policy, Payment, and Quality Provisions for CY 2020

On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. Proposals that may be of interest to rural stakeholders include adding telehealth codes for bundled episodes of care in the treatment of opioid use disorders (OUDs); modifying the regulation on physician supervision of physician assistants (PAs) to give PAs greater flexibility; updating payment and/or codes for certain care management services; and implementing a new Medicare Part B benefit for OUD treatment services, including medication-assisted treatment (MAT), furnished by opioid treatment programs (OTPs).  Comments are due on September 27, 2019.  The full announcement can be accessed here.

Comments Requested: Proposed Updates to Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System

On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released proposed changes to the outpatient prospective payment system and the ambulatory payment system for the 2020 calendar year. The proposals on price transparency are highlighted with CMS proposing that all hospitals, including rural PPS hospitals and critical access hospitals (CAHs) make pricing information publicly available. Proposals also include reducing payment differences between certain sites of services, using the inpatient wage index values to address wage index disparities, and changing the generally applicable minimum required level of supervision from direct supervision to general supervision for hospital outpatient therapeutic services furnished by all hospitals and CAHs.  Comments are due on September 27, 2019.  The full announcement can be accessed here.

Reports on Rural, Minority Social Determinants of Health Released

The Rural & Minority Health Research Center (RMHRC) is one of ten HRSA/FORHP-supported centers for research and policy analysis.  In this series of policy briefs, the RMHRC provides data on social determinants of health (SDOH) for four minority groups living in rural areas: African American, Hispanic, American Indian/Alaska Native, and Asian and Pacific Islander.  For each of these groups, researchers used several national data resources such as the U.S. Census to determine rates for educational attainment, poverty status, disability, veteran status, nativity, access to computers and broadband, and access to health care.

The reports can be accessed here.

OIG Issues Report on ACO Strategies for Transitioning to Value-Based Care Using Lessons From the Medicare Shared Savings Program

As part of the transition to value-based care, Medicare Shared Savings Program Accountable Care Organizations (ACOs) have developed a number of strategies to reduce Medicare spending and improve quality of care. This report describes the strategies that selected ACOs have found successful in reducing spending and improving quality of care. These strategies involve working to increase cost awareness in ACO physicians, engaging beneficiaries to improve their own health, and managing beneficiaries with costly or complex care needs to improve their health outcomes. Other strategies that ACOs found successful involve reducing avoidable hospitalizations, controlling costs and improving quality in skilled nursing and home healthcare, addressing behavioral health needs and social determinants of health, and using technology to increase information sharing among providers. ACOs also report challenges in each of these areas and describe the ways they overcame them.

The Centers for Medicare & Medicaid Services (CMS) recently made changes to the Shared Savings Program. As CMS carries out this and other ACO programs and develops new alternative payment models, it should support the use of these strategies and other successful strategies that emerge. These strategies can apply not only to ACOs but also to other providers committed to transforming the healthcare system toward value.

The OIG recommend that CMS take the following actions to support efforts to reduce unnecessary spending and improve quality of care for patients: (1) review the impact of programmatic changes on ACOs’ ability to promote value-based care; (2) expand efforts to share information about strategies that reduce spending and improve quality among ACOs and more widely with the public; (3) adopt outcome-based measures and better align measures across programs; (4) assess and share information about ACOs’ use of the skilled nursing facility (SNF) 3-day rule waiver and apply these results when making changes to the Shared Savings Program or other programs; (5) identify and share information about strategies that integrate physical and behavioral health services and address social determinants of health; (6) identify and share information about strategies that encourage patients to share behavioral health data; and (7) prioritize ACO referrals of potential fraud, waste, and abuse. CMS concurred with all of our recommendations.

The full report can be found at

July 2019
U.S. Department of Health and Human Services
Office of Inspector General

New Report Details Community Impact and Benefit Activities of Critical Access, Small Rural, and Urban Hospitals

The Flex Monitoring Team has released a new report on the community impact and benefit activities of Critical Access Hospitals (CAHs), rural non-CAHs, and urban hospitals. The report enables State Flex Programs and CAH administrators to compare the community impact and benefit profiles of CAHs nationally to the performance of CAHs in their state.

The report may be found in the link below. Pages 1–5 provide national data with key findings and pages 6–95 provide state-specific tables. Shortcut links to each state’s tables are on the bottom of page 5.  The report can be accessed here.

National Health Center Week, August 4-10, 2019

For more than 50 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay. Today, there are nearly 1,400 HRSA-funded health centers, operating approximately 12,000 delivery sites, across our country.  Health centers deliver care to the nation’s most vulnerable individuals and families, including people experiencing homelessness, agricultural workers, residents of public housing, and the nation’s veterans.

Learn more about the Health Center Program. Visit for current and comprehensive data on health centers.  Join HRSA on Twitter and Facebook during Health Center Week as we celebrate the work that health centers do.