Comment by June 4. On April 4, 2024, the Cybersecurity and Infrastructure Security Agency (CISA) will release its proposed rule to implement new reporting requirements outlined in the Cyber Incident Reporting for Critical Infrastructure Act of 2022 (CIRCIA). Through this proposed rule, the CISA is seeking public comment and input on policies requiring Covered Entities to report Covered Cyber Incidents and ransomware payments to CISA within 72 hours of occurrence of cyber-attack incident or 24 hours after the ransom payment has been made. The rule identifies 16 Critical Infrastructure Sectors, which includes the Healthcare and Public Health sector, as being at risk for a Covered Cyber Incident. As part of the Healthcare and Public Health sector, the rule includes a hospital with 100 beds or more, or a Critical Access Hospital as a Covered Entity. Covered Cyber Incidents experienced by a Covered Entity would be reportable regardless of which part of the organization suffered the impact. Other Covered Entities include Class II (moderate risk) and Class III ( high risk) devices as classified by the U.S. Food and Drug Administration and manufactures of drugs listed in Appendix A Essential Medicines Supply Chain and Manufacturing Resilience Assessment developed by the U.S. Department of Health and Human Services and the Administration for Strategic Preparedness and Response. In total, CISA estimates that over 300,000 entities from the 16 sectors would be covered by the Proposed Rule.

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Comment by May 28.  CMS released proposed rules for Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF),  and Hospice Wage Index and Payment Rate updates. Each rule proposes updates to Medicare payment and quality measurement policies for Fiscal Year 2025, which begins October 1. The proposed rules indicate a 4.9 percent increase in payments for rural SNFs, a 4.6 percent increase for rural IRFs, and a 2.8 percent increase in payments for rural hospices.

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Comment by May 28. On March 28, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) for fiscal year (FY) 2025. The proposal increases payment rates by 2.7 percent, and proposes payment increases for stays involving the use of electroconvulsive therapy. CMS has also issued a request for information regarding facility level payment adjustment factors, including rural and teaching status as well as a potential new adjustment for safety net patient populations.

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Last week, the Departments of Health & Human Services, Labor, and the Treasury released a final rule amending the definition of short-term, limited-duration insurance (STDLI), which is a type of health insurance coverage designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another.  STLDI is not considered to be individual health coverage under the law, so it does not need to meet the same requirements as Marketplace plans.  Under this rule, the Departments are shortening the limit on the length of the initial contract term from 12 months to no more than three months.  Additionally, the maximum total coverage period is changing from 36 months to four months including renewals and extensions.  This rule also revises the federal standard for notices that insurers must use to help consumers better distinguish between comprehensive coverage and STLDI and get information on their health coverage options. This document also sets forth final rules that amend the regulations regarding the requirements for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit in the group and individual health insurance markets.

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Last week, the Centers for Medicare & Medicaid Services (CMS) issued guidance extending the special enrollment period for people who are no longer eligible for Medicaid or Children’s Health Insurance Program (CHIP) due to the end of the Medicaid continuous enrollment, also known as “unwinding,” to Marketplace coverage in states using HealthCare.govfrom July 31, 2024, to November 30, 2024.  This extension is optional for state-based Marketplaces. Consumers who are determined eligible for this Unwinding SEP will have 60 days from the date on which they submit a new or updated HealthCare.gov to make a plan.  CMS’ Job Aid entitle, Assisting Rural Consumers provides information for navigators and assisters to educate rural consumers on Marketplace and Medicaid coverage and assist with enrollment.

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Effective January 1, 2024, most children under the age of 19 who meet their state’s Medicaid or Children’s Health Insurance Program (CHIP) eligibility requirements will remain continuously eligible (CE) for coverage for a full 12-month period. This issue brief estimates that the number of children eligible for Medicaid and CHIP will increase by 3.5 percent in states that previously had partial or no CE policies for children as of January 2023. This increase in average monthly eligibility is driven by an estimated 1.3 million children becoming eligible for at least one additional month of Medicaid or CHIP coverage. Ultimately, the impact of any federal 12-month CE policy is dependent on state enrollment of Medicaid- and CHIP-eligible children, as only enrolled children can benefit from CE expansion.  Medicaid and CHIP are important sources of coverage for rural children. As of 2020-2021, Medicaid/CHIP provided coverage for a larger share of both adults and children in small towns and rural areas than in metropolitan counties nationwide.

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The final rule from the Centers for Medicare & Medicaid Services (CMS) makes changes to simplify the eligibility and enrollment processes in Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program. This rule aligns enrollment and renewal requirements for most individuals in Medicaid, creates timeliness requirements for redeterminations of eligibility, removes barriers to children enrolled in CHIP, and updates recordkeeping requirements.  These changes are intended to reduce coverage disruptions and increase retention of eligible individuals.  CMS also released new and updated resources to support the end of the Medicaid continuous enrollment, or ‘unwinding’, including guidance on unwinding processes and requirements for states; guidance to Medicaid managed care plans; and new resources for partners to help families navigate their state Medicaid fair-hearing process, such as if someone was determined no longer eligible for Medicaid.

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Thursday April 4 at 1:00 pm Eastern. Subject matter experts with the Centers for Medicare & Medicaid Services (CMS) will present the latest hospital price transparency policies and enforcement actions effective January 1, 2024, in a webinar produced by the Rural Health Information Hub (RHIhub).  These policies were effective January 1, 2021 and affect all hospitals operating in the United States.  For those who are unable attend, RHIhub keeps an archive of all webinars on its site.

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Named by the Centers for Disease Control and Prevention as one of the five leading causes of death for rural populations in the United States, unintentional injuries can be fatal or nonfatal injuries that are unplanned and often preventable.  This new resource from the Rural Health Information Hub (RHIhub) gives the how and why injuries are so prevalent, and then provides a collection of effective program models with resources for planning, funding, and sustainability.

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