The U.S. Department of Agriculture (USDA) announced a new online tool showing its rural investments, overall and for each state, going back to 2012.  USDA’s Rural Development division offers a wide range of loans, grants, and loan guarantees (many in our Ongoing Opportunities section, below) that provide essential services, help create jobs and support economic development.  With the Rural Data Gateway, USDA shows where and how Rural Development has supported local and regional economies in the last 11 years through 69 programs.

Approximately 61 million Americans live in rural, tribal, and geographically isolated communities across the United States. These communities often experience significant health inequities. Compared to urban Americans, rural Americans are more likely to have heart disease, stroke, cancer, unintentional injuries, suicide risk, and chronic lung disease, and have higher death rates from COVID-19. As clinicians, we have seen these rural health disparities first-hand. One example is a patient who lived far from a health care facility, didn’t have a usual source of care, and didn’t tell anyone about his chest pain until he had a heart attack. Another is a patient with opioid use disorder who lacked access to a nearby source of regular care and didn’t find a primary care doctor until after her first overdose. A third is a patient who required surgery on her arteries because her underlying conditions were not addressed in the rural community where she lived.

Addressing rural health inequities is a cornerstone of the Centers for Medicare & Medicaid Services’ (CMS’) effort to improve health equity. CMS defines health equity as the attainment of the highest level of health for all people, whereby every person has a fair and just opportunity to attain their optimal health regardless of their race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, preferred language, and geography— including whether they live in a rural or other underserved community. CMS’ commitment to rural health equity is reflected in the recently published CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities.

With almost $1 trillion in claims annually and more than 63 million covered Americans – including one in three adults who live in rural areas – Medicare has the potential to significantly impact health care delivered in rural settings. In this piece, we highlight some of CMS’ policies to support rural providers, improve access to care in rural areas, and support the transformation of the rural health delivery system.

Supporting rural providers

The shortage of health care providers in rural areas exacerbates rural health disparities. Only 12% of physicians practice in rural communities, and the majority of areas deemed “health professional shortage areas” by the federal government — 61 percent — are located in rural areas. These communities also face shortages of other critical health care professionals, including nurse practitioners, dentists, and social workers. Over the last decade, many rural hospitals have closed. Many currently face potential closure due to lower or inconsistent patient volume and staff shortages compounded by fewer applicants in rural areas.

Rural hospitals and communities may find support under a Medicare regulation implementing a provision of the “Consolidated Appropriations Act, 2021” creating a Rural Emergency Hospital (REH) provider type.  In exchange for providing emergency department services and observation care (and, if elected by the facility, other outpatient[1] medical and health services), Medicare will pay REHs an additional five percent compared to the normal outpatient rates for most services and will provide a monthly payment that will increase every year with inflation. The intent is that these measures will support financial stability and reduce future closures of rural hospitals.

Rural Hospitals and Critical Access Hospitals, can apply to CMS to elect to become an REH starting January 1^st, 2023. To qualify, hospitals must have 50 or fewer beds and agree not to provide inpatient care. CMS broadly defined the type of services that REHs can provide to maintain access to critical care in rural communities while ensuring patients can be transferred to an acute care hospital if more intensive services are needed. REHs can offer all services that can be provided in an outpatient department, such as emergency care, in addition to maternity care and outpatient surgery. REHs must also offer “observation care,” so they can observe a patient who isn’t ready to be released from an emergency department. Hospitals interested in electing this new REH designation are encouraged to review the materials at the bottom of this post.

Expanding access to care in rural areas

Telehealth is an essential tool to reach people living in rural areas, which face provider shortages and transportation challenges. As clinicians, some of us have personally delivered telehealth services and seen first-hand how it has allowed persons in rural areas to access health care from the comfort and privacy of their own homes.

However, broadband and computer access can still be significant obstacles to using telehealth in rural areas. This is why, after Congressional action, Medicare permanently expanded access to behavioral health services furnished via telehealth, including audio-only services that often just require a telephone. To further increase access for people in rural areas, CMS has proposed incentives for Medicare Advantage plans to include behavioral health clinicians who can provide telehealth services in their networks.  Additionally, CMS has proposed requirements that Medicare Advantage plans assess enrolled individuals for digital health literacy. For those found to have low digital health literacy, Medicare Advantage organizations would develop and maintain procedures to offer digital health education to their enrollees to assist them with accessing telehealth.

Beyond telehealth, CMS concentrates on expanding access to behavioral health care in rural areas, including in Medicare Advantage. CMS has proposed a new requirement for evaluating the provider networks of Medicare Advantage plans, to ensure the plans’ provider networks provide sufficient access to clinical psychologists, licensed clinical social workers, and clinicians that can prescribe medication that treats opioid use disorder. This would help ensure that people enrolled in Medicare Advantage, especially in rural areas, have more accessible options for meeting their behavioral health needs. CMS also focuses  on addressing opioid use disorder, particularly as overdose rates have skyrocketed and rural areas have been significantly affected. Medicare has clarified that it will pay for opioid use disorder treatment services delivered by mobile units of opioid treatment programs. These mobile units are equipped with medical supplies and specially trained staff, and studies have shown that these types of mobile services improve access to medication that treats opioid use disorder, particularly in rural areas.

Transforming the rural health delivery system

Finally, expanding access to high-quality, coordinated care through value-based arrangements will also better support the needs of rural Americans. For instance, CMS is improving the Medicare Shared Savings Program which has improved the delivery of high-quality care in rural areas. Shared Savings Program Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers collaborating to give coordinated, high-quality care to people with Medicare. The program’s goal is to ensure that people receive the right care at the right time, prioritizing their health while preventing medical errors and avoiding unnecessary and duplicative tests and treatments. However, we have seen over time that ACOs are less common in rural areas compared to urban ones.

To address this, CMS is incorporating lessons learned from the Center for Medicare and Medicaid Innovation’s ACO Investment Model into the Shared Savings Program to provide up-front investment dollars to newly-forming, smaller ACOs that treat low-income patients or patients who live in rural or other underserved areas. ACOs could use these upfront payments to hire new health care workers, such as community health workers or behavioral health practitioners, helping to address provider shortages in rural areas. ACOs could also use these funds to address the social needs of persons with Medicare, such as assisting with food, housing, or even transportation – needs that are particularly prevalent in rural areas with higher poverty rates.

In addition, the Center for Medicare and Medicaid Innovation is actively examining ways through existing and new models to improve access to high-quality health care in rural areas, including increasing participation by safety net and Medicaid providers in value-based care models.

Summing up

The three-pronged approach of supporting rural providers, expanding access to care in rural areas, and transforming the rural health delivery system can improve access to high-quality, coordinated care for people in rural communities. However, the magnitude of these changes will only be realized in partnership with rural health providers, rural communities, beneficiaries, caregivers, and other payers, especially Medicaid.

We recognize that many rural providers and communities may need time to consider the new policies and programs outlined in this piece and corresponding regulations, and there are teams available to answer any questions and provide support as needed. Only by working together can we improve access to care in rural areas and advance rural health equity.

For more information about the Rural Emergency Hospital designation, which is an option for rural hospitals starting on January 1, 2023, please visit this fact sheet, the 2023 Outpatient Prospective Payment System final rule, and recently released guidance for Rural Emergency Hospital enrollment and conversion. A new REH Technical Assistance Center, funded by the Health Resources and Services Administration, can help rural hospitals exploring the REH designation. If you are interested in receiving support, please visit the Technical Assistance Center’s website here.

For more information about how to form a Medicare Shared Savings Program ACO and how to qualify for advanced investment payments starting in 2024, please review this fact sheet or the CY 2023 Physician Fee Schedule final rule, and if you have a question, please contact SharedSavingsProgram@cms.hhs.gov.

For more information about CMS proposals to strengthen Medicare Advantage, please visit the Calendar Year (CY) 2024 Medicare Advantage and Part D rule here. The comment period for the CY 2024 Medicare Advantage and Part D proposed rule is currently open and will close on February 13, 2023, at 5 PM.

The mailing of the 2022 Economic Census survey started in early February and many may be wondering how this data being collected benefits them.

The economic census measures employment, payroll and revenue by service or product across the nation’s businesses — invaluable information for overall business strategy and everyday decision-making by governments, economic development organizations and business owners.

The 2022 Economic Census now underway is conducted in 2023 and collects and publishes data for the 2022 reference year. The statistics it collects will cover 19 economic sectors that encompass 910 North American Industry Classification System industries. Businesses asked to participate should respond by March 15.

If you’re one of the more than 4 million business locations that has been selected to respond to the economic census and are still wondering: What’s in it for me?

Continue reading to learn more about:

• How data from the economic census can help you
• Additional resources

The U.S. Department of Agriculture (USDA) Rural Development State Director Bob Morgan highlighted the ways the Biden-Harris Administration is delivering on its promises to build a better America and rebuild the backbone of the country, the middle class in rural Pennsylvania.

“Today, we are highlighting USDA Rural Development’s actions in 2022 to rebuild our economy and rural communities, minimize the impacts of climate change, create good-paying jobs for American workers, and invest in our families,” Morgan said.

In fiscal year 2022, USDA Rural Development invested more than $789 million in rural Pennsylvania. You can view the national level news release on the USDS Rural Development website.

Here is a look at USDA Rural Development’s actions in 2022 to rebuild our economy and rural communities, minimize impacts of climate change, create good-paying jobs for American workers, and invest in our families.

• Single Family Housing Program: $412 million
• Multi-Family Housing Program: $55 million
• Water & Environmental Programs: $27 million
• Community Facility Program: $74 million
• Business Programs: $182 million
• Electric Program: $37 million

For detailed information you can view the newly launched Rural Data Gateway website.

ARC issued a Request for Proposals for our POWER (Partnerships for Opportunity and Workforce and Economic Revitalization) Initiative.

POWER investments help create economic growth and diversification in Appalachian communities affected by job losses in coal mining, coal power plant operations, and coal-related supply chain industries. Since 2015, ARC has invested more than $396 million in 449 projects across 360 coal-impacted communities through POWER.

In 2023, ARC is investing up to $65 million in partners and projects boosting broadband, entrepreneurship, tourism, agriculture, and other budding sectors.

POWER Pre-Application Workshops

ARC is hosting several upcoming workshops to answer questions and share best practices so prospective grantees can submit strong applications.

• 2/21 – POWER Pre-Application Workshop (Virtual)
• 2/23 – POWER / ARISE / INSPIRE Workshop (Belden, MS)
• 2/28 – POWER / ARISE / INSPIRE Workshop (Knoxville, TN)
• 3/2 – POWER / ARISE Workshop (Pittsburgh, PA)

Questions?

If your organization could use assistance in project development and/or grant writing, please contact your Local Development District (LDD) or email Jennifer Lench at DCED at jlench@pa.gov.

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) would like to share this message from the Chief Statistician of the United States (CSOTUS) within the U.S. Office of Management and Budget (OMB) about an important step in advancing the collection of race and ethnicity data across Federal agencies.

The Office of the CSOUTUS took a key step forward in its formal process to revise OMB’s statistical standards for collecting and reporting race and ethnicity data across Federal agencies by releasing a set of initial proposals in a Federal Register Notice. Comments are open now until April 12, 2023.

In 2022, the Chief Statistician of the United States (CSOTUS) within the U.S. Office of Management and Budget (OMB) convened the Federal Interagency Technical Working Group on Race and Ethnicity Standards (Working Group) to review and develop recommendations for revising OMB’s 1997 Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (SPD 15).  Input from stakeholders and the public will be critical in guiding the Working Group as it continues to refine and finalize its recommendations.

The proposals are open for anyone to provide thoughts and reactions, including how they may affect different communities, by April 12, 2023 at Regulations.gov, where you can submit comments by searching for “OMB-2023-0001.” If you would like more information, the Working Group also has a new public website at: spd15revision.gov where you can learn more about the initial revision proposals and how the public can get involved, or read a recent blog post from the White House announcing the news.

Increasing the collection of standardized demographic data across health care systems is an important step towards health equity. To learn more about the CMS efforts on data collection, review The Path Forward: Improving Data to Advance Health Equity Solutions.

Looking for more information about the CMS Office of Minority Health? Visit our website at https://go.cms.gov/omh and subscribe to our listserv for the latest information.