Research published in the Journal of Appalachian Health reports on disasters in eight rural southeast Kentucky counties in 2021-2022, the changing nature of the disasters, and the behavioral health impact on the residents affected.

The Federal Emergency Management Agency (FEMA) indicates that disasters are occurring more frequently, often impacting communities still recovering from a previous disaster.  This timeline lays out the phases of federal response before and after a disaster.  The compendium of housing and shelter programs includes 10 cabinet-level departments, including FEMA, the U.S. Departments of Health & Human Services (HHS), Agriculture (USDA), and Housing and Urban Development (HUD).

Comment by September 1, 2024.  On July 10, The U.S. Department of Health and Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC), released the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule for public comment. The HTI-2 proposed rule has two sets of new certification criteria designed to enable health IT for public health as well as health IT for payers to be certified under the ONC Health IT Certification Program. These new certification criteria, which would improve public health response and advance the delivery of value-based care, focuses heavily on standards-based application programming interfaces to improve end-to-end interoperability between data exchange health care providers and public health organizations or payers. This rule also establishes the standards and implementation of a new, real-time prescription benefit tool certification criterion, which would empower providers and their patients to make more informed decisions with more transparent information comparing the patient-specific cost of drugs and suitable alternatives. In addition, the proposed rule also updates policy within the HTI-1 final rule published January 2024 related to the exchange of conical images and information blocking.

The Physician-Focused Payment Model Technical Advisory Committee (PTAC), an independent federal advisory committee, has transmitted a Report to the Secretary of Health and Human Services on key issues related to encouraging rural participation in population-based total cost of care (PB-TCOC) models, which are a type of alternative payment model where payment is made up of costs and utilization for all covered medical services delivered to an individual or group. This report compiles information from previous payment model proposals PTAC reviewed, literature addressing the topic, and input received during a rural-focused meeting last year.  They conclude that while value-based care often focuses on improving quality while reducing spending, achieving value in rural areas may require increasing spending.  Increasing rural provider participation in PB-TCOC models requires a sustainable glidepath to value-based care that includes a multi-payer approach and a longer glidepath for taking on risk in rural areas.  They recommend a multi-pronged approach that would improve rural infrastructure, increase and enhance sustainable funding, enhance recruitment and training of rural health physicians and providers, increase community health organization capacity, and address health disparities.

During the COVID-19 public health emergency, Congress provided temporary enhanced federal funding to states to keep enrollees continuously enrolled in Medicaid. Beginning in April 2023, states resumed full eligibility redeterminations (unwinding). States had flexibility in the in their pace of unwinding and many states were still in the process as of May 2024. The CARES Act includes a provision for the Government Accountability Office (GAO), the federal agency that examines how taxpayer dollars are spent, to report on the federal response to the COVID-19 pandemic. Among other things, this report examines the Centers for Medicare & Medicaid Services (CMS) oversight of Medicaid unwinding. The unwinding of the continuous Medicaid coverage provision has resulted in over 22 million enrollees being disenrolled as of May 23, 2024, and over 49 million have had their coverage renewed.  GAO reviewed documentation of CMS’s efforts to assess state compliance with federal unwinding requirements and resolve any noncompliance from March 2023 through April 2024 and interviewed CMS officials about plans for future oversight. According to the report, during the unwinding, CMS found compliance issues with federal redetermination requirements in almost all states, including with long-standing requirements. GAO is recommending that CMS document and implement the oversight practices the agency learned during unwinding were needed for preventing and detecting states compliance issues with redetermination.

 On July 16^th, the Centers for Medicare and Medicaid Services (CMS) released final part two guidance regarding the plan outreach and education for the Medicare Prescription Payment Plan. This guidance includes policy directing plan outreach and education to increase awareness of the Medicare Prescription Payment Plan. To access the payment options outlined in the latest guidance, individuals with Medicare must opt into the Medicare Prescription Payment Plan to utilize the new benefit. Starting in 2025, Medicare Prescription Payment Plans will provide the option to people with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year instead of paying a lump sum at the time of purchase. In addition, the policy to cap the annual out-of-pocket prescription drug costs at $2,000 for all individuals enrolled in the Medicare prescription drug program will also begin. Authorized in the Inflation Reduction Act, the new cap on out-of-pocket drug costs is expected to provide needed financial relief for high prescription drug costs. The cap will also significantly impact rural enrollees who have higher rates of certain health conditions that requires costly medications.

– Comment by September 9. This proposed rule from the Centers for Medicare & Medicaid Services (CMS), issued on July 10, 2024, seeks public comment on payment updates and policy changes to Medicare’s physician fee schedule payments and includes other proposals affecting Medicare and Medicaid beneficiaries. Proposals include payment for both in-person and virtual caregiver training services, permitting certain health care providers to provide virtual direct supervision to auxiliary personnel when required, temporary extension of virtual supervision of residents by teaching physicians in certain cases, permitting Opioid Treatment Programs (OTPs) to furnish periodic assessments using audio-only communications technology when video is not available on a permanent basis, and the return of statutory restrictions on geography, site of service, and practitioner type for non-behavioral health telehealth services. The proposed rule also includes proposed updates applicable to Rural Health Clinics (RHCs), including to allow RHCs to bill for administration of part B preventive vaccines at time of service, continue to require provision of primary care services but no longer enforce “primarily engaged in furnishing primary care services,” seeks comment on how to define “mental diseases” as related to the requirement that RHCs cannot be “primarily engaged in the treatment of mental diseases,” and to eliminate productivity standards. The rule also includes updates to the Quality Payment Program, Medicare Shared Savings Program, and several other proposals affecting RHCs including removal of hemoglobin/hematocrit from the six required lab services and permitting RHCS to bill individual HCPCS care management codes instead of G0511. In addition, coverage for necessary dental exams and procedures are being considered for certain treatment services and expansion of colorectal cancer screenings to promote better access for all beneficiaries is being proposed.

This infographic from the University of Minnesota Rural Health Research Center provides a snapshot of rural-urban differences in midwife-attended births, including changes over time as access to rural obstetric care declined and severe maternal morbidity and mortality rose across the United States.

For the expansion of existing approved residency programs and the establishment of newly approved residency programs. This program trains physicians and dentists in community-based settings with a focus on rural and underserved areas, providing the majority of training in community-based outpatient settings where most people receive their health care. The NOFO has two components: one to support residency slots starting in Academic Year (AY) 2024-2025 and another to support residency slots starting in AY 2025-2026. You must apply to the announcement number that corresponds to the specific academic year and NOFO number.

Academic Year 2024-25 (HRSA-25-091)–Application due September 5, 2024 11:59 p.m. ET.

• Eligible applicants: Teaching Health Center Planning and Development grant recipients and other programs that have filled positions in the 2024 residency match process but have not received THCGME funding from HRSA.
• Award: $10 million to up to six grantees over a period of four years.

Academic Year 2025-26 (HRSA-25-077)–Applications due September 20, 2024 at 11:59 p.m. ET.

• Eligible applicants: Current teaching health centers, Teaching Health Center Planning and Development grant recipients who have obtained accreditation, and other programs who are planning to be accredited and train, starting July 1, 2025, are eligible to apply. Funding for these new slots will depend on congressional appropriations.
• Award: $80 million to 41 grantees over a period of four years.

The Association of State and Territorial Health Officials (ASTHO) explains policy and programs from HRSA’s Bureau of Health Workforce that state-level policymakers can use to address shortages in rural areas.