- Rural Children Struggle to Access Hospital Services, Say Researchers
- Outlining the Intersection between Health Care and Missing and Murdered Indigenous People
- Biden-Harris Administration Announces Critical More Than $1.5 Billion State and Tribal Opioid Response Funding Opportunities
- RPHARM Program Fulfills Need for Rural Pharmacists
- Farmers Don't Do Mental Health
- A Pilot Program in Rural Vermont Hopes to Build a Blueprint for Substance Abuse Recovery
- Rural Telehealth Extension Reintroduced in Congress
- Students From Across the State Emphasized the Need for Mental Health Resources in Rural Alaska During a Conference
- The South Was the Center of Rural Population Growth Last Year
- How HHS SUD Confidentiality Regulations Will Impact Rural Providers
- VA Announces Expansion of "Close to Me" Cancer Program as Part of the Cancer Moonshot, Bringing Cancer Diagnosis and Treatment Closer to Thousands of Veterans
- Navajo Psychiatrist Bridges Gaps Between Native American Culture and Behavioral Health Care
- Biden-Harris Administration Releases National Strategy for Suicide Prevention and First-Ever Federal Action Plan
- Biden Administration Sets Higher Staffing Mandates. Most Nursing Homes Don't Meet Them.
- Rural Communities Face Primary Care Physician Shortage
Medicare Finalizes Inpatient Hospital Payment Rules
CMS released the (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule on August 1, 2022. The rule establishes fee-for-service payment rates and policies for inpatient hospitals and LTCHs. For FY 2023, the hospital payment rate will increase by 4.3% resulting in a $2.6 billion hospital payment increase for FY 2023. CMS finalized graduate medical education policies to increase flexibilities for rural hospitals participating in residency training through rural track programs. Finally, the rule also builds on key CMS priorities to advance health equity. Policy efforts include three new health equity-focused measures in the Inpatient Quality Reporting program and a focus on improving maternal health outcomes with the establishment of a “Birthing-Friendly” hospital designation. The final rule will be effective on January 1, 2023.
Medicare Finalizes SNF, IRF, IPF, and Hospice Payment Rules
CMS released final rules for Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Inpatient Psychiatric Facilities (IPF), and Hospices. Each rule updates Medicare payment and quality measurement policies for Fiscal Year (FY) 2023, which begins October 1. Average payments for rural SNFs, IRFs, IPFs, and hospices in FY 2023 are projected to increase by 2.5%, 3.1%, 2.9 %, and 3.8%, respectively, compared to FY 2022.
Comments Requested on the Proposed Rule on Nondiscrimination in Health Programs and Activities
Last week, the U.S. Department of Health & Human Services released a proposed rule implementing Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. Proposals include clarification of nondiscrimination requirements that apply to activities offered via telehealth, and requiring staff to have training on effective communication for people with limited English proficiency and people with disabilities.
Comments are due by September 26.
Information Requested on How to Improve Medicare Advantage
The Centers for Medicare & Medicaid Services (CMS) seeks responses to a series of questions on how to improve Medicare Advantage in regards to improving health equity and serving rural populations, expanding access to care, promoting person-centered care, and engaging partners. In 2021, over a third of rural Medicare beneficiaries were enrolled in a Medicare Advantage plan.
Requests are due by August 31!
Creating Awareness for Disparities in Organ Donation
August is the month for bringing attention to the gap between the number of organ donors and the number of people who are African American, Hispanic, Native American, or Asian/Pacific Islander who need life-saving organs or tissues. Of more than 100,000 people waiting for organ transplants, nearly 60 percent are from multicultural communities. Researchers have cited low socio-economic status as a primary driver of racial disparities.The Rural location also presents barriers to patients needing transplants; those who are older, lack advanced education, are underemployed, or are Medicaid beneficiaries are less likely to get on waitlists.
HRSA Releases Nearly $60 Million to Improve Access to Care in Rural Communities
On August 8, the Federal Office of Rural Health Policy announced investments of nearly $60 million to grow the health workforce and increase access to quality health care in rural communities, including nearly $46 million in funding from President Biden’s American Rescue Plan. The Biden-Harris Administration is committed to improving health outcomes and promoting health equity in rural America. In 2021, thanks to President Biden’s American Rescue Plan, the Department of Health and Human Services invested over $16 billion to strengthen rural health.
Nearly $46 million in American Rescue Plan funding will support 31 awardees to expand health care capacity in rural and tribal communities through health care job development, training, and placement. This funding includes support for critical health workforce needs in rural areas such as dental hygienists, medical or dental assistants, community-based doulas, and other frontline health care workers.
Nearly $10 million will support 13 organizations through the Rural Residency Planning and Development Program to establish new medical residency programs in rural communities to increase the number of physicians training in rural settings. In addition, nearly $4 million will support 18 awards to improve patient health outcomes and quality and delivery of care throughout rural counties and improve access to care for rural veterans.
“Among the most important steps we can take to improve access to health care in rural communities, including access to behavioral health care, is to invest in growing the rural health care workforce,” said HRSA Administrator Carole Johnson. “Today’s announcements are another important part of the Health Resources and Services Administration’s strategy to advance health equity for the nearly 65 million people who call rural areas home.”
Approximately one in five Americans lives in a rural area, and rural communities are becoming even more diverse. However, health disparities between rural and urban areas tripled between 1999 and 2019, with rural residents experiencing higher rates of heart disease, respiratory disease, cancer, stroke, unintentional injury, and suicide; and higher risk of maternal morbidity and mortality. Access to quality health care is at the heart of these issues.
Today’s announcement reflects HRSA’s investments through the following programs:
- The Rural Public Health Workforce Training Network Programis awarding nearly $46 million to 31 community-based organizations to expand public health clinical and operational capacity through workforce development. Additionally, a technical assistance provider was awarded $500,000 to strengthen the ability for these networks to develop formal training and certification programs.
- The Rural Residency Planning and Development Programis awarding $9.7 million to 13 organizations to establish new rural residency programs in rural communities to train resident physicians in rural clinical settings.
- The Small Health Care Provider Quality Improvement Programis awarding $2.9 million to 15 community-based organizations improve patient health outcomes and quality and delivery of care throughout rural counties.
- The Rural Veterans Health Access Programis awarding nearly $1 million to 3 organizations to improve access to health care services for veterans living in rural areas. This program is a collaboration between FORHP and the Veterans Health Administration to strengthen partnerships between rural health providers and the VA system.
For a complete list of recipients, see https://www.hrsa.gov/rural-health/grants/rural-community/fy2022-awards.
Defining Rural America: The Consequences of How We Count
From the The Center on Rural Innovation (CORI)
There is a phrase often used in the world of rural development: “If you’ve seen one rural community, you’ve seen one rural community.”
It reflects the fact that the parts of our country referred to as rural America are a vast geography — stretching from coast to coast — made up of varied places with unique histories, landscapes, and peoples. This reality makes it extremely difficult to settle on a single set of characteristics that encapsulate rural America. Even the people who live in areas referred to as rural often disagree on what makes a place rural.
As we set off on this Rural Aperture Project, in which we will use data to help people see the opportunities, challenges, and inequities of rural places in a new light, we face the difficult task of defining rural America.
The challenges of definitions are felt by journalists, researchers, philanthropists, nonprofits, and governments who all rely on data to understand, make sense of, and make critical decisions about rural America and how resources are distributed. It can be tempting to shrug off the issue as too complicated to deal with, but doing so neglects the fact that the definitions we choose have real-world consequences — the ways that federal statistical agencies define rural have significant political and economic implications. Rural definitions affect the distribution of billions of dollars in federal funding each year, and shape the way that companies, banks, and philanthropies view communities and make investment decisions. We cannot separate the question of how rural America is defined from conversations around critical issues like education, health, racial equity, and economic opportunity in the U.S.
The goal of this story is not to argue that any one definition is best, but to show how these definitions impact narratives about rural America, as well as outcomes on the ground. We approach the issue from two perspectives:
- Demonstrating that using data based on different rural definitions can lead us to tell different stories about the state of rural America.
- Exploring how differences in definitions can create confusion about who is and isn’t eligible for federal funding that targets rural areas.
We hope that those who use data on rural America to tell stories, conduct research, distribute resources, make investments, or develop policy do so with greater awareness about how their choices define who is and is not counted, and with greater awareness of the impact of those choices.
Biden-Harris Administration to Begin Accepting Applications on September 6 for USDA ReConnect Program Round 4 Funding
More than $1 Billion from President Biden’s Bipartisan Infrastructure Law to be Invested to Increase Access to High-Speed Internet for People Living in Small Towns Across the Nation
U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small announced that the Department will begin accepting applications on September 6 for funding to expand access to high-speed internet for millions of people in rural America nationwide, part of the Biden-Harris Administration’s commitment to investing in rural infrastructure and affordable high-speed internet for all. USDA is making the funding available under the ReConnect Program, which received new funding from President Biden’s Bipartisan Infrastructure Law.
“High-speed internet connects people and businesses to new markets and helps people in rural America build brighter futures,” Torres Small said. “For too long, too many rural communities have been left out of the digital economy. This funding will help everyone in America – regardless of where they live – because rural people provide the everyday essentials our country depends on. Investments like the ones we are making through President Biden’s Bipartisan Infrastructure Law will help close the digital divide across rural America.”
USDA is making additional funding available for high-speed internet in Round 4 of the ReConnect Program. The Department will begin accepting applications on September 6 for up to $150 million in loans, up to $300 million in loan/grant combinations, and up to $700 million in grants. The Department will use funds appropriated under the Bipartisan Infrastructure Law, also known as the Infrastructure Investment and Jobs Act. The Bipartisan Infrastructure Law provides a historic $65 billion investment to expand affordable, high-speed internet to all communities across the U.S.
The application deadline is November 2.
USDA has made several improvements to the ReConnect Program for Round 4. Collectively, they increase the availability of funding in rural areas where residents and businesses lack access to affordable, high-speed internet. These include:
- Allowing applicants to serve areas where at least 50% of households lack sufficient access to high-speed internet.
- Adding a funding category for projects where 90% of households lack sufficient access to high-speed internet. For applications submitted under this category, no matching funds will be required.
- Waiving the matching funds requirement for: (a) Alaska Native Corporations, (b) Tribal Governments, (c) projects proposing to provide service in colonias, (d) projects proposing to serve persistent poverty counties and (e) projects proposing to provide service in socially vulnerable communities.
Additionally, to ensure that rural households that need internet service can afford it, all awardees under this funding round will be required to apply to participate in the Bipartisan Infrastructure Law’s Affordable Connectivity Program (ACP). The ACP offers a discount of up to $30 per month towards internet service to qualifying low-income households and up to $75 per month for households on qualifying Tribal Lands. The Department’s actions to expand high-speed internet access in rural areas are key components of the Biden-Harris Administration’s efforts to help America build back better in its recovery from the COVID-19 pandemic.
Background: ReConnect Program
To be eligible for ReConnect Program funding, an applicant must serve an area where high-speed internet service is not available at speeds of 100 megabits per second (Mbps) (download) and 20 Mbps (upload). The applicant must also commit to building facilities capable of providing high-speed internet service at speeds of 100 Mbps (download and upload) to every location in its proposed service area.
For additional information, see page 47690 of the August 4 Federal Register.
To learn more about investment resources for rural areas, visit www.rd.usda.gov or contact the nearest USDA Rural Development state office.
Under the Biden-Harris Administration, Rural Development provides loans and grants to help expand economic opportunities, create jobs and improve the quality of life for millions of Americans in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural, tribal and high-poverty areas. For more information, visit www.rd.usda.gov.
If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.
New CMS Rule Increases Payments for Acute Care Hospitals & Advances Health Equity, Maternal Health
CMS issued a final rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration’s key priorities to advance health equity and improve maternal health outcomes. As required by statute, the fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule updates Medicare payments and policies for hospitals, drives high-quality, person-centered care, and promotes fiscal stewardship of the Medicare program. In addition, the rule finalizes new measures to encourage hospitals to build health equity into their core functions. These actions will improve care for people and communities who are disadvantaged or underserved by the health care system.
The rule includes three health equity-focused measures in hospital quality programs and establishes a “Birthing-Friendly” hospital designation. CMS will award this new designation to hospitals that participate in a statewide or national perinatal quality improvement collaborative program and have implemented the recommended quality interventions.
For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record users, the final rule will result in an increase in operating payment rates of 4.3%. This reflects a FY 2023 projected hospital market basket update of 4.1%, reduced by a statutorily required productivity adjustment of a 0.3 percentage point and plus a 0.5 percentage point adjustment required by statute. This is the highest market basket update in the last 25 years and is primarily due to higher expected growth in compensation prices for hospital workers. Under the LTCH PPS, CMS expects payments in FY 2023 to increase by approximately 2.4% or $71 million.
“CMS is taking action to support hospitals, including updating payments to hospitals by a significantly higher rate than in the proposed IPPS rule. This final rule aligns hospital payments with CMS’ vision of ensuring access to health care for all people with Medicare and maintaining incentives for our hospital partners to operate efficiently,” said CMS Administrator Chiquita Brooks-LaSure. “It also takes important steps to advance health equity by encouraging hospitals to implement practices that reduce maternal morbidity and mortality.”
Advancing Health Equity:
Consistent with the agency’s definition of health equity, CMS is working to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all the people served by our programs, eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved, and providing the care and support that our enrollees need to thrive.
To address health care disparities in hospital inpatient care and beyond, CMS is adopting three health equity-focused measures in the IQR Program. The first measure assesses a hospital’s commitment to establishing a culture of equity and delivering more equitable health care by capturing concrete activities across five key domains, including strategic planning, data collection, data analysis, quality improvement, and leadership engagement. The second and third measures capture screening and identification of patient-level, health-related social needs — such as food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. By screening for and identifying such unmet needs, hospitals will be in a better position to serve patients holistically by addressing and monitoring what are often key contributors to poor physical and mental health outcomes.
In the near future, CMS is also interested in using measures focused on connecting patients with identified social needs to community resources or services. CMS sought comment on the proposed rule. In the final rule, CMS acknowledges the robust comments received on key considerations that inform our approach to improving data collection, to better measure and analyze disparities across programs and policies, and approaches for updating the Hospital Readmissions Reduction Program (HRRP) that encourage providers to improve performance for socially at-risk populations.
CMS is also discontinuing the use of proxy data for uncompensated care costs in determining uncompensated care payments for Indian Health Service and Tribal hospitals, and hospitals in Puerto Rico, and we are establishing a new supplemental payment to prevent undue long-term financial disruption for these hospitals and to promote long-term payment stability. CMS is also finalizing new flexibilities for graduate medical education for rural hospitals participating in rural track programs, which will help promote workforce development in rural areas.
Improving Maternal Health Outcomes:
CMS is creating a new hospital designation to identify “Birthing-Friendly” hospitals and additional quality measure reporting to drive improvements in maternal health outcomes. CMS is finalizing this designation following the release of the comprehensive CMS Maternity Care Action Plan.
The Biden-Harris Administration has championed policies to improve maternal health and equity since taking office. Earlier this year, Vice President Harris convened a first-ever White House meeting with Cabinet Secretaries and agency leaders, including Secretary Becerra and CMS Administrator Chiquita Brooks-LaSure, to discuss the Administration’s whole-of-government approach to reducing maternal mortality and morbidity. In December 2021, Vice President Harris announced a historic call to action to improve health outcomes for parents and their young children in the United States. Implementing this new hospital designation is part of the Biden-Harris Administration’s continued response to that call to action, as noted in the CMS Maternity Care Action Plan.
The “Birthing-Friendly” hospital designation will provide important information to consumers about hospitals with a demonstrated commitment to reducing maternal morbidity and mortality by implementing best practices that advance health care quality and safety for pregnant and postpartum patients.
Conditions of Participation Pandemic Reporting for Hospital and Critical Access Hospitals (CAH):
CMS proposed to continue the current COVID-19 reporting requirements for hospitals and CAHs as well as establish new reporting requirements for future public health emergencies (PHE). Based on public feedback, CMS is finalizing the proposed requirements for continued COVID-19-related reporting for hospitals and CAHs with a reduced number of data categories as an off ramp to the current PHE. CMS is not finalizing the proposed reporting requirements for future PHEs.
Continued Public Reporting of Patient Safety Metrics:
CMS uses quality measures to ensure safety and quality within the health care system and to pay providers through value-based programs. For the FY 2023 Hospital-Acquired Condition (HAC) Reduction Program, CMS proposed to pause — meaning not calculate and subsequently not publicly report — the data for the PSI-90 measure, which is a composite measure that covers multiple patient safety indicators, such as pressure sores, falls, and sepsis. CMS’ proposal reflected concerns about the impact COVID-19 would have on the ability to interpret data and was also sensitive to the risks of financially penalizing hospitals for factors potentially out of their control. CMS recognizes the importance of this measure for patients and providers and is finalizing the calculation and public reporting of the CMS PSI-90 measure results. CMS will include the measure in Star Ratings in alignment with the feedback we received. Although this measure will be publicly reported, it will not be used in payment calculations in the HAC to avoid unintentional penalties related to the uneven impacts of COVID-19 across the country.
More Information:
- Final Rule fact sheet
- Maternal Health fact sheet
- Final Rule
Oral Health Workforce Report Released by Pennsylvania Oral Health Coalition
PCOH has released a workforce report that finds a major decrease in dental workforce, including a staggering decrease in dental assistants. The “Access to Oral Health Workforce Report” uncovers that many Pennsylvania counties are struggling to maintain recommended worker levels. Since the onset of the COVID-19 pandemic, rural areas and Medicaid provider networks have seen the sharpest reductions in care providers. This will result in limited access and delayed care for Pennsylvanians, especially those in rural communities. The report also evaluates education and training programs, state tax and local income losses, the impact of COVID-19 relief programs, and dental – Health Professional Shortage Areas (d-HPSAs).