The National Rural Health Resource Center’s recently updated Population Health Toolkit — which includes the newest population health data from a half-dozen publicly available data sets — is now available online.

Developed and maintained with support from the Federal Office of Rural Health Policy, the Population Health Toolkit is designed to assist State Offices of Rural Health (SORHs), state Flex Programs and individual health care facilities as they seek to better understand, manage and improve population health in their communities and state.

The toolkit, which was first created in 2016 and is updated annually, includes:

• A population health readiness assessment that allows health care facilities to gauge their preparedness for population health
• Tools and resources to support health care facilities as they build their population health management capabilities
• A web-based dashboard that displays county, state, national and, when available, facility-level data on a range of population health measures, organized into more than a dozen scenarios that explore health conditions, health inequities and the leading causes of death in rural America
• Tutorial videos that offer step-by-step guidance on conducting population health analytics

Explore the Population Health Toolkit

The Population Health Toolkit lets SORHs and state Flex Programs:

• gain a better understanding of local and statewide health patterns by exploring the health needs of individual communities in their state
• gather data on state population health needs that can be included in their upcoming Flex Program applications

SORHs and state Flex Programs are also encouraged to share the toolkit with critical access hospitals and other rural health care providers in their state that can use its features and data to assess their readiness for population health, inform their community health needs assessment process and even compare their facilities’ performance with peers across the state and country.

Have any questions about the Population Health Toolkit? Interested in a walk through of the toolkit? Please contact Tracy Morton, Director of Population Health, at tmorton@ruralcenter.org.
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From Becker’s

More than 15 million people have been disenrolled from Medicaid since April 2023, surpassing HHS’ original estimates with several months left in the redeterminations process.

According to KFF, as of Jan. 16, 15,015,000 people have been disenrolled from Medicaid during the continuous coverage unwinding process. HHS estimated around 15 million people would lose coverage during the process.

States began the process of redetermining the eligibility of Medicaid recipients for the first time since 2020 in April, after continuous eligibility requirements in place during the COVID-19 pandemic expired.

Here are five things to know about where the unwinding process stands:

1. Around one-third of people who had their coverage up for renewal were disenrolled from Medicaid, while two-thirds were reenrolled in the program, according to KFF.
2. The majority of those disenrolled had their coverage terminated for procedural reasons, rather than being determined ineligible on the basis of income. According to KFF, as of Jan. 16, 71% of disenrollments were due to procedural reasons.
3. Disenrollment rates vary widely by state. In Texas, 61% of those whose coverage was up for renewal were disenrolled, while in Oregon and Maine, 13% of those up for renewal were disenrolled.
4. Children account for around 4 in 10 of those disenrolled from Medicaid, according to KFF. In December, HHS asked nine states with the highest child disenrollment rates to implement more flexibility to keep eligible kids enrolled.
5. States were given 12 months to complete the unwinding process, though in December, HHS said it would extend flexibilities offered to states through the end of 2024. At least two states, Arkansas and Idaho, have already completed the redetermination process.

From Axios

Sixty percent of kids who have lost Medicaid coverage this year came from just nine states, all of which are Republican-led, according to new data from the Biden administration.

Driving the news: And the 10 states refusing the Affordable Care Act’s expansion of Medicaid to low-income adults have disenrolled more kids than all of the expansion states combined, the administration also reported.

Why it matters: The data hints at a partisan divide in reviews of Medicaid eligibility after those checks — which were put on hold during the pandemic — resumed this spring.

• The administration on Monday sent warnings to the nine states with large losses in kids coverage, but federal health officials said they have limited power to require those states to make changes.

Context: At least 2.2 million kids have been removed from Medicaid and its sister program, the Children’s Health Insurance Program, during the so-called “unwinding” of pandemic-era coverage protections as of September, according to data from the Centers for Medicare and Medicaid Services.

• More recent data tracked by outside sources suggest this number is closer to 3 million.
• Many may have been disenrolled because of a procedural issue and not necessarily because they were no longer eligible. States have been restoring coverage for over 500,000 people, many of them children, who were inappropriately booted from Medicaid because of an error in calculating income.

State of play: Health and Human Services Secretary Xavier Becerra sent letters to Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas on Monday urging them to better protect kids from losing Medicaid.

• The letters note that HHS “will not hesitate to take action to ensure states’ compliance with federal Medicaid requirements,” though they don’t specify what the department might do.
• CMS earlier this month warned it will fine states that don’t properly report data about who’s losing coverage, Modern Healthcare reported.

By the numbers: South Dakota and Idaho recorded the sharpest decreases in Medicaid enrollment among kids between March and September (27%), according to CMS data.

• Kids’ enrollment decreased by more than 10% in most other states receiving warning letters. Enrollment shrank by 9% in Georgia and 6% in Ohio, but those states are among those with the highest number of kids removed from the program.
• Enrollment also decreased by over 10% in New Mexico, Oklahoma and Utah, but those states did not receive warning letters.

States with the smallest decreases in kids’ enrollment were largely blue states. Enrollment actually increased slightly in New York, Oregon, Massachusetts, Rhode Island and Washington, D.C.

• As of June, more than 20% of children who lost coverage had been re-enrolled in Medicaid or CHIP, federal data shows. It’s unclear how many may have found coverage elsewhere, such as through the ACA insurance marketplaces or a parent’s employer.

The other side: States contacted by Axios defended the coverage losses and said they had followed federal requirements for the unwinding process.

Read more.

The U.S. Department of Agriculture (USDA) is accepting applications for grants to help agricultural producers maximize the value of their products and venture into new and better markets.

USDA is making the grants available under the Value-Added Producer Grants program. The grants help farmers and ranchers generate new products, create marketing opportunities, and increase their incomes through value-added activities.

Eligible applicants include independent producers, agricultural producer groups, farmer or rancher cooperatives, and majority-controlled producer-based business ventures.

USDA may award up to $75,000 for planning activities or up to $250,000 for working capital expenses related to producing and marketing a value-added agricultural product.

Planning activities may include conducting feasibility studies and developing business plans. Working capital expenses may include costs associated with processing, marketing, advertising, inventory and salaries.

USDA is particularly interested in applications that will advance Biden-Harris Administration priorities to:

• Reduce climate pollution and increase resilience to the impacts of climate change through economic support to rural communities.
• Ensure all rural residents have equitable access to Rural Development (RD) programs and benefits from RD-funded projects; and
• Help rural communities recover economically through more and better market opportunities and through improved infrastructure.

Paper applications must be postmarked and delivered by mail, email or in person to the state office where the project is proposed by close of business on April 16, 2024. Electronic applications will be accepted via Grants.gov until 11:59 p.m. Eastern Time on April 11, 2024.

Additional information is available on page 2919 of the Jan. 17 Federal Register.

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

Contact information in Pennsylvania: If you are in Pennsylvania and have questions about this program, please contact Karen Kuhns, area specialist for the Rural Business and Cooperative programs, at 724-261-3893 or karen.kuhns@usda.gov.

The Centers for Medicare & Medicaid Services (CMS) will issue a final rule that places new requirements on Medicare Advantage (MA) organizations, Medicaid managed care plans, Children’s Health Insurance Program (CHIP) managed care entities, state Medicaid and CHIP Fee-for-Service (FFS) programs, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs) to improve the electronic exchange of healthcare data and streamline processes related to prior authorization. This final rule will also add a new measure for eligible hospitals and critical access hospitals (CAHs) under the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System (MIPS) eligible clinicians under the Promoting Interoperability performance category of MIPS.

Weblinks

• Press Release: https://www.cms.gov/newsroom/press-releases/cms-finalizes-rule-expand-access-health-information-and-improve-prior-authorization-process
• Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f
• Final Rule: https://www.cms.gov/files/document/cms-0057-f.pdf

The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced a new model to test approaches for addressing the behavioral and physical health, as well as health-related social needs, of people with Medicaid and Medicare. The Innovation in Behavioral Health (IBH) Model’s goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder by connecting them with the physical, behavioral, and social supports needed to manage their care.  The model will also promote health information technology (health IT) capacity building through infrastructure payments and other activities.

The IBH Model will be tested by the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Under IBH, community-based behavioral health practices will form interprofessional care teams consisting of behavioral and physical health providers, as well as community-based supports. This new model supports the President’s mental health strategy and implements an action item in the HHS Roadmap for BH integration.

Read more.

From Becker’s

CMS has finalized a rule to streamline the prior authorization process and improve the electronic exchange of health information that it estimates will save $15 billion over 10 years.

The requirements generally apply to Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program agencies, Medicaid managed care plans, CHIP-managed care entities and qualified health plan insurers on the federally facilitated exchanges, according to a Jan. 17 CMS news release. The agency proposed the rule in December 2022.

Beginning primarily in 2026, certain payers will be required to include a specific reason when denying requests, publicly report certain prior authorization metrics and send decisions within 72 hours for urgent requests and seven calendar days for standard requests.

The rule also requires affected payers to implement a Health Level 7 Fast Healthcare Interoperability Resources standard application programming interface to support electronic prior authorization.

“Together, these new requirements for the prior authorization process will reduce administrative burden on the healthcare workforce, empower clinicians to spend more time providing direct care to their patients and prevent avoidable delays in care for patients,” CMS said in the release.

The rule also finalizes API requirements to “increase health data exchange and foster a more efficient healthcare system for all.” CMS is delaying the dates for compliance from generally Jan. 1, 2026, to Jan. 1, 2027. Beginning in January 2027, affected payers will be required to expand their current patient access API to include information about prior authorizations and to implement a provider access API that providers can use to retrieve their patients’ claims, encounter, clinical and prior authorization data. CMS is requiring affected payers to exchange, with a patient’s permission, most of the same data using a payer-to-payer FHIR API when a patient moves between payers or has multiple concurrent payers.

The rule also adds a new electronic prior authorization measure for eligible hospitals and critical access hospitals under the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System eligible clinicians under the promoting interoperability performance category.

From Becker’s Hospital Review

Pittsburgh-based Duquesne University opened its College of Medicine on January 17.

The college will welcome its inaugural class of 85 students in July with plans to grow enrollment to 170 students per year beginning in 2026, according to a university news release. The college will provide doctor of osteopathic medicine degrees.

Duquesne said it received significant gifts from foundations, corporations and government entities to support building the medical college. The building includes advanced simulation, augmented reality anatomy labs and other technology.

Kevin Stansbury, the CEO of Lincoln Community Hospital in the 800-person town of Hugo, Colorado, is facing a classic Catch-22: He could boost his rural hospital’s revenues by offering hip replacements and shoulder surgeries, but the 64-year-old hospital needs more money to be able to expand its operating room to do those procedures.

“I’ve got a surgeon that’s willing to do it. My facility isn’t big enough,” Stansbury said. “And urgent services like obstetrics I can’t do in my hospital, because my facility won’t meet code.”

Rural hospitals throughout the nation are facing a similar conundrum. An increase in costs amid lower payments from insurance plans makes it harder for small hospitals to fund large capital improvement projects. And high inflation and rising interest rates coming out of the pandemic are making it tougher for aging facilities to qualify for loans or other types of financing to upgrade their facilities to meet the ever-changing standards of medical care.

Read more.