- Ways and Means Members Put Forth Solutions to Strengthen Telehealth Access and Improve Health Care for Rural Communities
- In Rural Texas, ERs Are Facing a Growing Mental Health Crisis
- 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
- Farmers Don't Do Mental Health
- Biden-Harris Administration Announces Critical More Than $1.5 Billion State and Tribal Opioid Response Funding Opportunities
- Outlining the Intersection between Health Care and Missing and Murdered Indigenous People
- USDA Rural Development Seeks Input to Improve Access to Grants and Help More Communities Thrive
- Rural Telehealth Extension Reintroduced in Congress
- The South Was the Center of Rural Population Growth Last Year
- Students From Across the State Emphasized the Need for Mental Health Resources in Rural Alaska During a Conference
- How HHS SUD Confidentiality Regulations Will Impact Rural Providers
CMS Finalizes Rule for Interoperability and Prior Authorization
Last week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that advances federal efforts toward interoperability. Through this rule, “impacted payers” of health plans designed by CMS – including, but not limited to, state issuers of Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service programs, Medicare Advantage organizations, and Qualified Health Plan issuers on Federally Facilitated Exchanges – are required to implement and maintain application programming interfaces. Also known as APIs, these interfaces are relied on by the federal government to uphold global standards for the electronic exchange of health care information. Beginning in 2026, impacted payers will also be required to streamline their processes for prior authorization (PA), a common practice of insurance organizations that requires providers to get advanced approval before delivering a service to patients. They must send authorization to providers within 72 hours for urgent requests, and within seven calendar days for non-urgent requests. Beginning in 2027, impacted payers must implement an approved application programming interface for prior authorization, where providers can access the list of covered items and services and get support with their requests. Additionally in 2027, hospitals, including Critical Access Hospitals, and Merit-based Incentive Payment System (MIPS) eligible clinicians will have to attest to using this electronic interface to submit PA requests as part of their Medicare Promoting Interoperability Program reporting requirements. While the use of various electronic exchange methods among hospitals and physicians has increased in recent years, the Government Accountability Office (GAO) recently found that use among small and rural hospitals is lower than that of other hospitals. Federal officials and other stakeholders told GAO that these and other federal provisions could be helpful for small and rural providers because it could make the exchange of data less costly.
CMS Innovation in Behavioral Health (IBH) Model Announced
Last week, the Centers for Medicare & Medicaid Services (CMS) announced a new state-based model that focuses on community-based behavioral health practices for Medicaid and Medicare beneficiaries. In Spring 2024, CMS will open the application process for the IBH Model; up to eight states will receive funding for activities and capacity building. The project period is expected to begin in Fall 2024 and run for eight years to implement an approach to community health that integrates mental treatment with primary and specialty care. By the start of year 4, states may be selected to implement a Medicaid payment model that includes a per-beneficiary-per-month payment, and additional performance-based payments for model years 4-8.
New Report Published: Race and Ethnicity May Affect Whether and Where Hospitals Transfer Patients
Black patients in Florida are transferred to public hospitals more often than white patients, even when comparing patients from the same hospital with similar health conditions and the same insurance, according to new research led by Charleen Hsuan, assistant professor of health policy and administration at Penn State. Before 1986, hospitals would sometimes transfer patients who could not afford care to public hospitals or other safety net hospitals. These safety net hospitals often had poorer health outcomes for their patients than their private counterparts. In 1986, a new federal law curtailed transfers of patients solely because they could not pay, but concerns remain about the reasons that patients are transferred from one hospital to another, Hsuan said.
Over three million patients are transferred between hospitals in the U.S. each year, according to the Centers for Disease Control and Prevention. While transfers typically occur because the original hospital cannot provide needed treatment, a variety of factors affect where or if a patient is transferred.
Hsuan and an interdisciplinary team of researchers studied more than 1.2 million emergency department transfers in Florida to understand whether individuals from different ethnic and racial groups were treated equitably. Their results, published recently in Health Services Research, revealed that Black patients were more likely to be transferred to public hospitals than white patients.
USDA Rural Development Invests $211,000 in Public Safety and Health Care Projects in Pennsylvania
U.S. Department of Agriculture (USDA) Rural Development Pennsylvania State Director Bob Morgan announced investments of more than $211,000 in four Community Facilities or CF projects in four counties in Pennsylvania.
“These investments in public safety and healthcare are vital to the quality of life for rural Pennsylvanians in these communities,” Morgan said. “We are glad we can play a small part in providing these facilities and law enforcement organizations the equipment they need to provide the best services possible.”
The healthcare project at the Fulton County Medical Center was awarded a $60,000 CF grant to purchase new exercise and education equipment for the wellness and clinical center.
The public safety projects were awarded in Mercer, Allegheny, and Mifflin counties.
Greenville Borough in Mercer County received a CF loan and grant of $38,500 and $83,600 to purchase three new police interceptor utility vehicles for the borough’s police department.
Munhall Borough in Allegheny County received a CF grant of $19,500 to purchase a new police responder vehicle. The vehicle is needed to replace one of the borough’s current vehicles that has reached the end of its useful life. This equipment will allow the police department to provide better public services and safety to the community.
Armagh Township in Mifflin County received a CF grant of $47,900 to two new police vehicles with necessary accessories.
In 2023, USDA Rural Development in Pennsylvania invested $119 million through its Community Facilities programs.
Rural Development provides loans, grants and loan guarantees 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.
To subscribe to USDA Rural Development updates, visit GovDelivery subscriber page.
New CareQuest Report Highlights Oral-Systemic Interaction
The CareQuest Institute for Oral Health released a new report, Oral-Systemic Interaction and Medical-Integration: A Life Course Approach. The report provides an overview of the bidirectional nature of oral and systemic diseases across phases of life and explores how integrated care delivery improves access and health outcomes.
Report Compares Rural and Urban Hospital Uncompensated Care
A new report, A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership, demonstrates several key factors that contribute to rural hospital uncompensated care. A summary of the key findings is highlighted below.
Uncompensated care are services provided that are never reimbursed, including charity care and unanticipated bad debt. High uncompensated care burden is a concern because it may contribute to smaller operating margins and rural hospital closures.
The purpose of this study is to better understand patterns of uncompensated care. It extends a 2018 study of geographic variation in uncompensated care between rural and urban hospitals. In the current study, researchers use 2017-2019 Medicare Cost Report data to study the association of uncompensated care with net patient revenue, system affiliation, and ownership among Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals.
Key Findings:
- Rural PPS hospitals had the highest uncompensated care median, and urban PPS hospitals had the lowest.
- Furthermore, rural PPS hospitals with less than $20 million in net patient revenue had the highest median uncompensated care, and urban PPS hospitals with less than $20 million had the lowest.
- Hospitals affiliated with a health system had higher median uncompensated care than hospitals not affiliated with a health system.
- Government-owned hospitals had the highest median uncompensated care for rural PPS and urban PPS, while a small number of for-profit CAHs had the highest median uncompensated care across all groups.
Findings suggest that changes to policies and reimbursement that affect uncompensated care could have a differential effect on hospitals, particularly related to Medicare payment designation, size (as measured by net patient revenue), and ownership.
Contact Information:
George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.966.5011
gpink@email.unc.edu
Additional Resources of Interest:
- Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals
- Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
- Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
- More information about the North Carolina Rural Health Research and Policy Analysis Center
SDOH Infographics and Data on People with Medicare Now Available
CMS is pleased to announce the availability of a new public use file on Socio-demographic and Health Characteristics of Medicare Beneficiaries Living in the Community by Dual Eligibility Status in 2021. This public use file uses data from the Medicare Current Beneficiary Survey and contains estimates on socio-demographic characteristics, functional limitations, chronic conditions, mental health, and oral health of people with Medicare living in the community as well as those with both Medicare and Medicaid.
New infographics are available as well:
Pennsylvania Community Facilities Program Now Accepting Applications!
The Pennsylvania Broadband Development Authority (PBDA) has opened the application period for the COVID-19 ARPA Multi-Purpose Community Facilities (Facilities) Program and it will close 4.20.24 at 12:00 PM. We’d like to remind you as well that the PBDA and the Department of Community & Economic Development (DCED) Customer Service team are hosting two Office Hour Sessions to review FAQs for the Facilities Program and the DCED Electronic Single Application (ESA) System, next week.
Details to attend the Office hours as well as the recording of the Facilities Program overview and the DCED Electronic Single Application (ESA) system walkthrough can be viewed at the links below. The presentation is also available on this same page.
CMS Announces New Actions to Help Hospitals Meet Obligations under EMTALA
Today, the Department of Health and Human Services (HHS) announced that, together with the Centers for Medicare & Medicaid Services (CMS), it will launch a series of actions to educate the public about their rights to emergency medical care and to help support efforts of hospitals to meet their obligations under the Emergency Medical Treatment and Labor Act (EMTALA). As part of this comprehensive plan, the Department will:
- Publish new informational resources on CMS’s website to help individuals understand their rights under EMTALA and the process for submitting a complaint if they are denied emergency medical care;
- Partner with hospital and provider associations to disseminate training materials on providers’ obligations under EMTALA;
- Convene hospital and provider associations to discuss best practices and challenges in ensuring compliance with EMTALA; and
- Establish a dedicated team of HHS experts who will increase the Department’s capacity to support hospitals in complying with federal requirements under EMTALA.
The Department developed this comprehensive plan in response to a growing number of inquiries from patients and providers to CMS about how they can ensure that federal obligations were being met. CMS remains committed to helping all individuals—including patients who are experiencing pregnancy loss and other pregnancy-related emergencies—have access to the emergency medical care required under federal law.
The Biden-Harris Administration remains focused on working with doctors, hospitals, and patients to promote patient access to the care that they are entitled to under federal law and has long taken the position that this required emergency care can, in some circumstances, include abortion care. The U.S. Department of Justice is currently defending that understanding before the Supreme Court.
Updated Population Health Toolkit Now Available
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
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.