- Fact Sheet: The Biden-Harris Administration Highlights Investments in Rural America, Invites Public Nominations for Rural Innovators Initiative
- Rural Victims of Intimate-Partner Violence Need More Resources and Support, Study Finds
- A Tribe in Maine Is Using Opioid Settlement Funds on a Sweat Lodge to Treat Addiction
- Fact Sheet: USDA, HHS Announce New Actions to Reduce Impact and Spread of H5N1
- Call for Experts: Forum on Aging, Disability, and Independence
- Bill to Expand Definition of 'Village' Qualifying for Water Funds Passes Alaska House
- Child Care Workers Caught in Middle of Michigan's Broken Child Care System
- Few Options Available for Substance Abuse Treatment in the Big Bend
- In Rural Texas, ERs Are Facing a Growing Mental Health Crisis
- Ways and Means Members Put Forth Solutions to Strengthen Telehealth Access and Improve Health Care for Rural Communities
- Sage Memorial Hospital in Navajo Nation Constructs New Facility to Improve Health Care
- How the State, Tribes and Federal Government Are Working to Curb SD's Syphilis Epidemic
- Rural Children Struggle to Access Hospital Services, Say Researchers
- RPHARM Program Fulfills Need for Rural Pharmacists
- A Pilot Program in Rural Vermont Hopes to Build a Blueprint for Substance Abuse Recovery
FDA Youth Vaping & E-Cigarette Toolkit Released
The Food and Drug Administration (FDA) has released a free toolkit about vaping and e-cigarettes for professionals working with youth. The toolkit contains fast facts about youth vaping as well as tips for how adults can help teens quit vaping. It is available to order, download, or print through the FDA.
Pennsylvania Medicaid Changes Coming. Help Spread the Word, Access Oral Health Resources
PCOH is distributing resources for Medicaid HealthChoices members and dental providers to explain the upcoming changes to the HealthChoices program. Pennsylvania is updating the contracts they have with insurance/health plans that serve PA Medicaid members and some of the current plans that providers may participate with will no longer be available in certain regions. Changes go into effect on September 1, 2022.
Please share the resources with your networks to ensure members and providers understand the upcoming changes. The member resource will also be available in Spanish.
Click here to request printed resources.
Click here for the member resource.
Click here for the provider resource.
Registration is OPEN for the CMS 2022 National Training Program Virtual Workshops
Registration for the 2022 Centers for Medicare & Medicaid Services (CMS) National Training Program (NTP) virtual workshops is open. Session dates are listed below.
Select the hyperlinked event title(s) to register for each event you’re interested in attending. You’ll be prompted to login to the NTP virtual workshop webpage: https://cmsnationaltrainingprogram.cms.gov/. To login, use the same email address and password you use to register for all NTP webinars. If you don’t have an account, you’ll need to create one before registering. After you register for an event, you’ll get an email confirmation which will include a calendar appointment. Please email NTPHelp@cms.hhs.gov if you need help with your account or registration. Sessions will start at 1 p.m. and conclude no later than 3:30 p.m. (ET). Sessions will be recorded for later viewing.
August 2022
2 – Social Security
Description: This workshop will explain retirement, disability, supplemental security income, and survivors benefits and how they can affect Medicare.
3 – Medicare Enrollment, Eligibility, Part A and Part B
Description: This workshop will explain Medicare coverage—who’s eligible, how and when to enroll, Medicare Part A and Part B, the services they cover, and associated costs.
4 – Medicare Supplement Insurance (Medigap)
Description: This workshop will discuss how Medicare Supplement Insurance policies (also known as Medigap) work with Medicare, what Medigap policies cover, how they’re structured, and when to buy a Medigap policy.
9 – Medicare Drug Coverage
Description: This workshop will explain drug coverage under the different parts of Medicare and describe how Medicare drug coverage (Part D) works, coverage rules, eligibility, enrollment, and Extra Help.
10 – Medicare Advantage
Description: This workshop will explain Medicare health plan options other than Original Medicare with a primary focus on Medicare Advantage (sometimes called Medicare Part C).
11 – Preventing Medicare & Medicaid Fraud, Waste, & Abuse
Description: This workshop will define health care fraud, waste, and abuse, identify causes of improper payments, and discuss the processes and organizations in place to prevent and detect Medicare and Medicaid fraud.
16 – Coordination of Benefits
Description: This workshop will explain different payers’ responsibilities when people have both Medicare and certain other types of health and/or prescription drug coverage.
17 – Where Do I Find? (Online Resources)
Description: This workshop will identify key websites, like Medicare.gov, associated resources, and tools to help our partners, stakeholders, not-for-profit professionals, and volunteers (who work with consumers and their families) help others make informed health care coverage decisions.
18 – Medicaid & the Children’s Health Insurance Program (CHIP)
Description: This workshop will explain Medicaid, the Children’s Health Insurance Program (CHIP), and review considerations for those with both Medicare and Medicaid (sometimes called dual eligibles or duals).
23 – Medicare Scenarios (Casework Session)
Description: This workshop will walk through examples of Medicare coverage scenarios in a casework format to evaluate the case, review possible resources and options, and discuss appropriate solutions.
24 – CMS and SAMHSA: Federal Partners addressing Behavioral Health
Description: This workshop will outline the Centers for Medicare & Medicaid Services’ (CMS) new Behavioral Health Strategy from the Centers for Medicare & Medicaid Services (CMS) which covers multiple elements including access to prevention and treatment services for substance use disorders, mental health services, crisis intervention, and pain care. The Workshop will also include program updates from the Substance Abuse and Mental Health Services Administration (SAMHSA).
25 – Medicare Plan Finder
Description: This workshop will demonstrate how to shop and compare Medicare plan options using the Plan Finder tool on Medicare.gov.
30 – Medicare Current Topics
Description: This workshop will explain some of the Centers for Medicare & Medicaid Services’ (CMS’) current priorities, initiatives, and recent programmatic updates.
31 – The Public Health Emergency (PHE) and CMS Programs (this topic is subject to change)
Description: This workshop will explain temporary flexibilities to CMS Programs in response to the Public Health Emergency (PHE) declaration for COVID-19, coverage for COVID-19-related treatments, vaccination efforts, and transition activities to prepare for the end of the PHE.
September 2022
1 – Marketplace to Medicare: What You Can Expect
Description: This workshop will focus on considerations if you’re enrolled in a Health Insurance Marketplace® plan and qualify for Medicare. It will explain the programs that can help you pay for Medicare, Periodic Data Matching (PDM), and Medicare and the Marketplace resources.
Session materials will be available for download at the time of the event.
NOTE: Registration requests will be considered on a first-come, first-serve basis until each session reaches capacity. The number of attendees from the same organization may be limited. If any session reaches capacity, we’ll work to schedule an additional offering for a later date.
HRSA Announces One-year Hold on HPSA Redesignations
On July 7, the Health Resources and Services Administration (HRSA) announced a one-year hold on Health Professional Shortage Area’s (HPSA) that had been proposed for withdrawal. After months of significant advocacy, NRHA applauds HRSA for taking this decisive action. As rural communities rebound from the COVID-19 pandemic, added strains on the workforce would be extremely detrimental. We look forward to continuing to work with HRSA to ensure the rural health workforce grows.
441 Rural Hospitals at Risk of Losing Services or Closing
From Becker’s Healthcare
Out of 2,176 rural hospitals, 441 face three or more risk factors, putting them at risk of service reduction or closure, according to a May 4 Bipartisan Policy Center report.
Eight things to know:
- There were 116 rural hospital closures between 2010 and 2019.
- Federal relief over the past two years helped stabilize facilities and the pace of closures slowed.
- That assistance was temporary, however, and rural hospitals continue to struggle financially and have had difficulty recruit nurses and other healthcare employees.
- Financial risk factors rural hospitals face include negative total operating margin, negative operating margin on patient services alone, negative current net assets and negative total net assets.
- Rural hospital closures can significantly reduce access to healthcare services and also affect the availability of healthcare workers.
- The Bipartisan Policy Center recommends providing rural hospitals across-the-board Medicare spending reductions until two years after the federal COVID-19 public health emergency ends.
- It recommends permanently authorizing the Medicare Dependent Hospital program and making rural low-volume payment adjustments permanent.
- It recommends updating or rebasing Sole Community Hospital and Medicare Dependent Hospital payment structures to ensure reimbursements are in line with current costs.
Read the full report here.
CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care
On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care — particularly in rural and underserved areas. These proposed changes play a key role in the Biden-Harris Administration’s Unity Agenda — especially its priorities to tackle our nation’s mental health crisis, beat the overdose and opioid epidemic, and end cancer as we know it through the Cancer Moonshot — and ensure CMS continues to deliver on its goals of advancing health equity, driving high-quality, whole-person care, and ensuring the sustainability of the Medicare program for future generations.
“At CMS, we are constantly striving to expand access to high quality, comprehensive health care for people served by the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s proposals expand access to vital medical services like behavioral health care, dental care, and cancer treatment options, all while promoting access, innovation, and cost savings in the Medicare program.”
“Integrated coordinated, whole-person care — which addresses physical health, behavioral health, and social determinants of health — is crucial for people with Medicare, especially those with complex needs,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.
The proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the CY 2022 PFS conversion factor of $34.61. This conversion factor accounts for the statutorily required update to the conversion factor for CY 2023 of 0%, the expiration of the 3% increase in PFS payments for CY 2022 as required by the Protecting Medicare and American Farmers From Sequester Cuts Act, and the statutorily required budget neutrality adjustment to account for changes in Relative Value Units.
Modernizing Coverage for Behavioral Health Services
In the 2022 CMS Behavioral Health Strategy, CMS set goals to remove barriers to care and improve access to, and the quality of, mental health and substance use care. To help address the acute shortage of behavioral health practitioners, the agency is proposing to allow licensed professional counselors, marriage and family therapists, and other types of behavioral health practitioners to provide behavioral health services under general (rather than direct) supervision. Additionally, CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient’s primary care team.
CMS is also proposing to bundle certain chronic pain management and treatment services into new monthly payments, improving patient access to team-based comprehensive chronic pain treatment. Lastly, CMS is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.
Expanding Access to Accountable Care Organizations
ACOs are groups of health care providers who come together to give coordinated, high-quality care to their Medicare patients. The Medicare Shared Savings Program covers more than 11 million people with Medicare and includes more than 500,000 providers.
CMS is proposing changes to the Medicare Shared Savings Program that, if finalized, represent some of the most significant reforms since the final rule that established the program was finalized in November 2011 and ACOs began participating in 2012. Building on the CMS Innovation Center’s successful ACO Investment Model, CMS is proposing to incorporate advance shared savings payments to certain new Medicare Shared Savings Program ACOs that could be used to address Medicare beneficiaries’ social needs. This is one of the first times Traditional Medicare payments would be permitted for such uses and is expected to be an opportunity for providers in rural and other underserved areas to make the investments needed to become an ACO and succeed in the program. CMS is also proposing that smaller ACOs have more time to transition to downside risk, further helping to grow participation in rural and underserved communities. CMS is also proposing a health equity adjustment to an ACO’s quality performance category score to reward excellent care delivered to underserved populations. Finally, CMS is proposing benchmark adjustments to encourage more ACOs to participate and succeed, which would help achieve the goal of having all people with Traditional Medicare in an accountable care relationship with a healthcare provider by 2030.
Improving Access to Colon Cancer Screening
Colon and rectal cancer were the second-leading cause of cancer deaths in the United States in 2020, with higher colorectal cancer death rates for Black Americans, American Indians, and Alaska Natives. To reduce barriers to getting a colonoscopy, CMS is proposing that a follow-up colonoscopy to an at-home test be considered a preventive service, which means that cost sharing would be waived for people with Medicare. Additionally, Medicare is proposing to cover the service for individuals 45 years of age and above, in line with the newly lowered age recommendation (down from 50) from the United States Preventive Services Task Force.
Proposing Payment for Dental Services that are Integral to Covered Medical Services
Medicare Part B currently pays for dental services when that service is integral to medically necessary services required to treat a beneficiary’s primary medical condition. Some examples include reconstruction of the jaw following accidental injury or tooth extractions done in preparation for radiation treatment for jaw cancer. CMS is proposing to pay for dental services, such as dental examination and treatment preceding an organ transplant. In addition, CMS is seeking comment on other medical conditions where Medicare should pay for dental services, such as for cancer treatment or joint replacement surgeries, as well as on a process to get public input when additional dental services may be integral to the clinical success of other medical services.
More Information:
- PFS fact sheet
- Quality Payment Program fact sheet
- Medicare Shared Savings Program Proposals fact sheet
- Blog
- Proposed rule
CMS Launches COVID-19 Toolkit for Pediatricians and Family Physicians
This toolkit has resources for pediatricians and family physicians who want to help increase confidence in and uptake of COVID-19 vaccines among their patients and in the communities they serve. Developed in partnership with the American Academy of Pediatrics, it includes information from CDC and new, culturally tailored materials from the HHS COVID-19 Public Education Campaign and its team of multicultural experts.
See https://wecandothis.hhs.gov/resource/pediatricians-and-family-physicians-toolkit for resources.
Pennsylvania Announces PHE Suspension and Waiver Extension
Pursuant to the March 26, 2020, declaration of disaster emergency relating to COVID-19, the Pennsylvania Department of State requested, and the Governor approved, nearly 100 regulatory suspensions and waivers. Many of those suspensions and waivers have already expired.
Act 21 of 2021 was signed into law on June 11, 2021. It provided for an extension of active suspensions through September 30, 2021, unless terminated sooner than September 30 by the agency that issued the suspension.
The Department expired a number of its suspensions on August 17, August 31 and September 15, 2021. The remaining suspensions and waivers that were set to expire on September 30, 2021, were extended to March 31, 2022, by Act 73 of 2021, and then further extended to June 30, 2022, by Act 14 of 2022. Pursuant to the authority provided in Act 14 allowing agencies to terminate their own waivers and suspensions sooner than June 30, the Department expired additional waivers on May 23, June 6 or June 20.
On June 30, 2022, Act 30 of 2022 was signed into law, further extending active suspensions until October 31, 2022. All remaining suspensions and waivers of the Department, identified below, will now expire on October 31, 2022.
All waivers and suspensions that have expired to date are also provided below.
Please note that the waiver related to the issuance or extension of nurse temporary practice permits (TPPs) during the pandemic already expired, and therefore is not among the group of waivers that were extended by Act 14. As holders of those TPPs were advised previously, all such TPPs expired March 31, 2022.
CMS Proposal Details How to Become New Rural Hospital Designation
From Fierce Healthcare
The Biden administration released a proposed rule that grants more regulatory flexibility for small, rural hospitals in a bid to curb a worrying trend of facility closures.
The Centers for Medicare and Medicaid Services’ proposed rule released on June 30, 2022 outlines the conditions of participation for a facility to become a Rural Emergency Hospital, which enables a facility to offer emergency care, observation and other outpatient services.
“The availability of the new Rural Emergency Hospital provider type will maintain access to essential healthcare services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure in a statement.
CMS’ goal for the new designation is to enable small facilities in rural areas and critical access hospitals to “right-size their service footprint and avoid potential closure,” according to a fact sheet on the rule
An emergency hospital can offer additional medical and outpatient services that don’t exceed an annual per-patient average of 24 hours, the fact sheet added.
Overall, the conditions of participation closely align with current conditions for critical access hospitals. However, CMS is seeking comments on specific standards for the rural facilities, such as whether the agency should require a facility to also provide outpatient surgery services if surgical labor is necessary.
“CMS is also requesting comments regarding whether it is appropriate for a [rural emergency hospital] to allow a doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a clinical nurse specialist, with training or experience in emergency medicine, to be on call and immediately available by telephone or radio contact and available on-site within specified timeframes,” the fact sheet said.
The rule does not outline the payment rates for such rural emergency hospitals, but CMS hinted that information will likely be included in the 2023 Outpatient Prospective Payment System-Ambulatory Surgical Center payment rule set to be released in July.
The new designation was created in a spending bill last year intended to help stem a deluge of hospital closures in rural areas. HHS said that, since 2010, there have been 138 rural hospitals that closed, with 19 closing down in 2020 alone.
Provider relief funding to help offset the financial impacts of the COVID-19 pandemic helped to temporarily stave off closures, said George Pink, a professor with the University of North Carolina’s Rural Health Research Program, during a webinar Wednesday sponsored by the Bipartisan Policy Center.
The proposed CoP are detailed at: https://public-inspection.federalregister.gov/2022-14153.pdf
The due date for comments is August 29, 2022.
A Health Advisory on Harmful Algal Blooms in Pennsylvania Waters Has Been Released
The Pennsylvania Department of Health (PA DOH) has released a Health Alert Network Advisory regarding harmful algal blooms (HABs) throughout Pennsylvania’s water bodies during the warmer months. Exposure to HABs can cause sickness in animals and humans so you need to follow waterbody advisories or closures, stay out of water that is discolored, smells bad, or that has the presence of a visible foam, algal mats, or a paint-like appearance. Healthcare providers should assess for possible HAB exposures when caring for patients’ symptoms following recreational water activities. Report potential HAB exposures or illnesses. Report a suspected HAB or for additional information contact the PA DOH.