Rural Health Information Hub Latest News

2024 Advance Notice for Medicare Advantage and Medicare Part D Prescription Drug Programs Has Been Released

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Advance Notice for Medicare Advantage (also known as Medicare Part C) and Medicare Prescription Drug Programs (also known as Medicare Part D). The notice includes payment updates and star rating updates for both parts of Medicare, a one-time growth rate adjustment for Medicare Advantage, and technical updates to the Medicare Advantage risk adjustment model. Also included are significant Medicare Part D changes required by the Inflation Reduction Act of 2022 and which will go into effect next January including reduced cost-sharing for insulin, eliminated cost-sharing for preventive vaccines, eliminated cost-sharing for Part D prescription drugs in the catastrophic phase, and expanded eligibility for full cost-sharing and premium subsidies under the Low-Income Subsidy program. The comments are due by March 3, 2023.

Read About New Research Regarding Telehealth Recovery Coaching for Post-Discharge Engagement

Researchers looked at records for 917 patients who engaged with a peer recovery coach via telehealth after discharge from emergency departments for opioid use.  The investigation focused on one Indiana-based hospital system that included six hospitals located in cities and seven that had rural Critical Access Hospital designations.  Of the findings showing value to rural patients, living in a strictly rural area was associated with an 80 percent greater rate of successful follow-up.

The U.S. Environmental Protection Agency Announced There Would be Two Billion Dollars in Funding For Clean Drinking Water in Rural Communities

  Last week, the U.S. Environmental Protection Agency announced new investments in safe and clean water specifically for small, rural, and disadvantaged communities.  The funding is part of the Bipartisan Infrastructure Law that includes several initiatives to address environmental harms such as polyfluoroalkyl substances – known as PFAS – found in water, air, fish, and soil that are linked to harmful health effects.  See Funding and Approaching Deadlines below for ongoing opportunities from the EPA.

USDA Rural Development Announces Six Value Added Producer Grant Awards in Pennsylvania

U.S. Department of Agriculture (USDA) Rural Development State Director Bob Morgan announced that USDA is awarding six grants to agriculture producers in rural Pennsylvania.

“Ag producers are vital to the system that helps feed Pennsylvanians. Any time we can support them is a success for us as an agency,” Morgan said. “I am glad these grant funds are getting to operations for them to expand their markets and increase revenue.”

The grant awards total $894,290 for six projects in four Pennsylvania counties through the Value Added Producer Grants program.

The projects in Pennsylvania awarded funds today are listed below.

  • North Mountain Pastures LLC in Perry County was awarded a grant of $250,000 to help with processing costs as the farm goes through a growth phase over the next three years. The goal is to increase sales by reaching new customers through a strategic marketing campaign built around on-line marketing of direct-shipped meats. This is anticipated to increase its customer base by approximately 800 and its revenue by approximately $719,711 over a three-year period.
  • Roots to River Farm LLC in Bucks County was awarded a grant of $250,000 for processing and marketing an herbal fortified wine, made from its farm-grown fennel. This wine is aromatized with radicchio and herbs, along with a proprietary blend of spices and citrus. Funds will also be used for marketing the new product and securing a foothold in the increasingly competitive American aperitif market. This includes costs for advertising, web re-design and social media management. This project is anticipated to increase its customer base by roughly 6,000 and increase its revenue by approximately $215,000 over three years.
  • Katydid Hill LLC in Schuylkill County was awarded a grant of $250,000 for processing, packaging and marketing activities related to producing herbal tea blends grown on the farm. The goal is to increase sales through the expansion of the company’s market and product line. This project will serve a socially disadvantaged independent producer and is anticipated to increase its customer base by roughly 35,000 and its revenue by approximately $439,000 over a three-year period.
  • Manoff Market Cidery LCC in Bucks County was awarded a grant of $45,000 for processing and marketing activities to help launch a hard cider product into the Bucks County, Greater Philadelphia, and New Jersey areas. The goal of the project is to increase retail sales by promoting its products through print, visual and social media advertisements. This project is anticipated to increase its customer base by roughly 4,000 and its revenue by approximately $231,000 over a 15-month period.
  • Tinicum Farm Collective LLC in Bucks County was awarded a grant of $49,420 for processing, packaging and marketing activities to expand production of the popular and distinct Heirloom Pumpkin Pie to a wider wholesale market in the Greater Philadelphia Region. The goal is to increase sales to customers by providing a retail-ready product that will become the cornerstone of the farm and bakehouse. This project will serve a socially disadvantaged independent producer and is anticipated to increase its customer base by seven retail outlets and its revenue by approximately $45,000 over a one-year period.
  • Crooked Row Farm in Lehigh County was awarded a grant of $49,870 to process, market and sell hot pepper sauces, dried pepper powders, marinades, salad dressings, culinary oils, teas, and soaps made from its farm grown herbs and specialty peppers. Funds will also be used to enhance its online marketing capability. This project is anticipated to increase the farm’s customer base by 1,500 and its revenue by approximately $193,000 over a 12-month period.

Rural Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid

Zachary Levinson , Jamie Godwin , and Scott Hulver
Published: Feb 23, 2023

Policymakers have had ongoing concerns about the financial health of rural hospitals and the implications  for access to care and the local economy. Rural hospital finances improved during the COVID-19 pandemic as a result of government relief funds. However, industry reports suggest that the outlook for the hospital sector as a whole deteriorated in 2022 as these funds have gone away and due to ongoing effects of the pandemic (such as labor shortages), rising prices, and investment losses. Concerns about the viability of rural hospitals have been cited as one factor that could potentially motivate lawmakers to expand Medicaid in the eleven states that have not already done so. These non-expansion states collectively account for about one-third (34%) of rural hospitals, based on our analysis of 2021 hospital cost report data.

In this data note, we provide a background on rural hospital finances and use hospital cost report data to describe operating margins among rural hospitals before and during the COVID-19 pandemic (see Methods for details). We find that median operating margins among the rural hospitals in our analysis increased earlier in the COVID-19 pandemic, likely as a result of government relief funds, but that these facilities face renewed financial challenges, especially in states that have not expanded Medicaid (Figure 1). Among rural hospitals in non-expansion states, median operating margins were 2.1 percent during the July 2021-June 2022 period and were -0.7 percent when excluding documented relief funds. In Medicaid expansion states, median operating margins dropped, but remained positive even after excluding documented relief funds.

Read more.

Pennsylvania Governor’s Administration Opens a Pennsylvania Health Resource Center in Beaver County 

Gov. Shapiro has mobilized a whole-of-government response and is committed to providing the resources and care Pennsylvanians impacted by the Norfolk Southern train derailment need.

The Shapiro Administration announced today that the Pennsylvania Department of Health (DOH) is opening a Health Resource Center in Darlington Township, Beaver County for residents of Beaver and Lawrence counties who have health concerns following the Norfolk Southern train derailment in East Palestine, OH on February 3, 2023. The Pennsylvania Department of Environmental Protection (DEP) and the Pennsylvania Department of Agriculture will also be on hand at the Center to help interested residents sign up for free, independent water testing and to provide guidance on food and animal safety, respectively.

The Pennsylvania Department of Health (DOH) is working with local leaders and healthcare providers to open the center starting Tuesday, February 28 at the Darlington Township Building, 3590 Darlington Rd., Darlington, PA 16115. The Center will be open weekdays from 10:00 AM to 8:00 PM, and is scheduled to operate through March 10.

“Today, my Administration is taking another step to ensure the health, safety, and well-being of every Pennsylvanian affected by the Norfolk Southern train derailment,” said Governor Shapiro. “Starting Tuesday, Pennsylvanians who are concerned about the impacts of the derailment on their health will have an additional resource to turn to, where they can talk to public health experts right in their own community from the Pennsylvania Department of Health and Department of Human Services, to receive treatment should they need it. From the beginning of our response to Norfolk Southern’s derailment, my Administration has worked hand-in-hand with first responders and emergency management personnel, our partners in Ohio, and the federal government to ensure our citizens in Western Pennsylvania have the resources and information they need to be safe and healthy.”

The Shapiro Administration has been working closely with leaders from both parties to help protect Pennsylvania communities affected by the Norfolk Southern train derailment — and the input and support from Sen. Elder Vogel, Sen. Camera Bartolotta, and Rep. Jim Marshall has been critical in opening this Health Resource Center.

DOH is inviting healthcare providers in the region to join an educational webinar to provide information on what they should be looking for in patients who visit their offices, and how to address any health concerns from residents affected by the derailment aftermath. Healthcare providers, including family/primary care physicians and nurses, emergency department staff, and urgent care providers who are seeing patients with health concerns related to the derailment – and who are interested in joining the webinar – can register online here.

On Sunday, February 26, DOH began partnering with the U.S. Department of Health and Human Services (HHS) to conduct door-to-door visits, starting with residents who were evacuated within the one-mile radius of the train derailment. They are conducting Assessment of Chemical Exposure (ACE) surveys that include discussing symptoms, experiences, and concerns about the impact of the train derailment. If residents aren’t available, information will be provided, and clinicians will schedule a follow-up visit. The ACE surveyors are expected to reach other residents in the coming days and weeks, including residents who visit the Health Resource Center.

Health, environmental, and safety officials from Pennsylvania, Ohio, and multiple federal agencies are working together to continually monitor air and water quality in the region. Monitoring has been in place since the incident began. Pennsylvania continues to see no concerning air or water quality readings following this incident.

The Shapiro Administration announced DEP will conduct its own independent water sampling to closely monitor water contamination risks.

Visit the Pennsylvania Emergency Management Agency’s (PEMA) online train derailment dashboard for details about the derailment response.

New Report: Bank Branch Closures and Banking Deserts in PA, NJ, and DE

A new Philadelphia Fed report finds that the loss rate of bank branches in the Third District states of Pennsylvania, New Jersey, and Delaware more than doubled during the pandemic. Here are some of the highlights from the study.

  • The three states combined experienced a net loss of 627 branches and a significant increase in the number of banking deserts, census tracts without nearby bank branches, during the pandemic.
  • The number of lower-income, non-White, or rural banking deserts increased from six to 11 from 2019 to 2022.
  • The share of low- and moderate-income (LMI) individuals living in banking deserts increased by 30 percent.

Increasing bank branch closures are a cause for concern, as banking deserts can limit opportunities for lower-income residents to improve their financial health and accrue wealth.

Read the report.

Looming Cuts to Emergency SNAP Benefits Threaten Food Security in Rural America

On a cold morning in early February, Tammy King prepared and loaded boxes and bags of vegetables, fruits, milk, frozen meat, and snacks into cars lined up outside the Friends in Service Helping food pantry, known in rural northeastern Nevada as FISH.

The beginning of the month is busy for the food pantry, King said, because people who receive benefits from the federal Supplemental Nutrition Assistance Program, known as SNAP, come to stock up on free food that helps them stretch their monthly allotments. The food pantry, one of a few in this city of about 20,000 people, serves more families now than at any point in King’s 20 years of working there, she said. In January, FISH provided food boxes to nearly 790 people.

But King and other food bank managers fear that demand will spike further in March, when officials roll back pandemic-era increases to SNAP benefits. The program, administered by the Department of Agriculture, provides monthly stipends to people with low incomes to spend on food. Before 2020, those payments averaged a little more than $200 and were hiked by a minimum of $95 during the pandemic.

Officials estimate families King works with will see a 30% to 40% decrease in SNAP payments as emergency allotments tied to the public health emergency halt in 32 states, including Nevada. Other states, such as Georgia, Indiana, Montana, and South Dakota, have already ended the emergency allotments.

The cuts to SNAP benefits will uniquely hurt people living in rural America, said Andrew Cheyne, managing director of public policy for GRACE, a nonprofit run by the Daughters of Charity of St. Vincent de Paul focused on reducing childhood hunger. A higher percentage of people depend on SNAP in rural areas compared with metro areas. And those areas already have higher rates of food insecurity and poverty.

“We have so many households who simply aren’t going to know that this is happening,” Cheyne said. “They’re going to go to the grocery store and expect to have money in their account and not be able to buy the food they need to feed their families.”

And as the fallout from those cuts hits, food pantry managers in rural areas find themselves on the front lines trying to fill gaps in their communities. They and food policy experts fear it won’t be enough. For every dollar worth of groceries a food bank distributes to a community, SNAP delivers $9.

Read more.

Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers

On February 9, the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 will end on May, 11, 2023. COVID-19 remains a significant priority for the Biden-Harris Administration and over the next several months, the Centers for Medicare & Medicaid Services (CMS) will work to ensure a smooth transition.  During the PHE, CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care during the PHE for health care providers and their beneficiaries.

Some of the flexibilities that were created during the pandemic were recently expanded by the Consolidated Appropriations Act, 2023.  Others, while critical during our initial responses to COVID-19, are no longer needed. CMS has made further updates to our CMS Emergencies Page with useful information for providers – specifically around major telehealth and individual waivers – that were initiated during the Public Health Emergency (PHE).

Please reference the following guidance in response to the PHE ending May 11, 2023:

Provider-specific fact sheets about COVID-19 Public Health Emergency (PHE) waivers and flexibilities:

CMS COVID-19 Waivers and Flexibilities for Providers include:

  • Physicians and Other Clinicians
  • Hospitals and CAHs (including Swing Beds, DPUs), ASCs and CMHCs
  • Teaching Hospitals, Teaching Physicians and Medical Residents
  • Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)
  • Home Health Agencies
  • Hospice
  • Inpatient Rehabilitation Facilities
  • Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals
  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
  • Laboratories
  • Medicare Shared Savings Program
  • Durable Medical Equipment, Prosthetics, Orthotics and Supplies
  • Medicare Advantage and Part D Plans
  • Ambulances
  • End Stage Renal Disease (ESRD) Facilities
  • Participants in the Medicare Diabetes Prevention Program
  • Intermediate Care Facility for Individuals with Intellectual Disabilities

Department of Health & Human Services Fact Sheet:

In the coming weeks, CMS will be hosting stakeholder calls and office hours to provide additional information. Please continue to visit the CMS Emergencies Page for continuous updates regarding PHE sunsetting guidance as information becomes available to the public.