The Rural Health Information Hub posted a recording of the hour-long webinar from April 5 where experts from the Centers for Medicare & Medicaid Services (CMS) reviewed policy updates on the latest hospital price transparency policies and enforcement actions that were made effective January 1, 2024 and affect all hospitals operating in the United States.

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Last week, the Centers for Medicare & Medicaid Services (CMS) updated this guidance to clarify that informed consent from patients is required before medical students or other students perform important surgical tasks, invasive procedures, or examinations. This guidance specifically references hospital enforced consent obligations in response to increasing public attention to the traditional practice of allowing practitioners or supervised medical, advanced practice provider, or other applicable students to perform examinations to training -related examinations outside the medically necessary procedure, particularly on anesthetized patients.

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In finalizing changes to payment policies for these programs, the Centers for Medicare & Medicaid Services (CMS) estimates an increase in Medicare Advantage plan revenues by an average 3.7 percent, or over $16 billion, from 2024 to 2025. The notice implements changes to the Part C risk adjustment model finalized in the CY 2024 final rule. The changes will be phased in over a three-year period. CMS also finalized technical updates to the Part C and D star ratings and will implement changes to the standard Part D drug benefit required by the Inflation Reduction Act of 2022. This includes capping annual out-of-pocket costs for people with Medicare Part D at $2,000 in 2025. Finally, CMS reminds stakeholders the agency seeks public input on Medicare Advantage Data – comment by May 29.

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The changes from the Centers for Medicare & Medicaid Services (CMS) are intended to improve access to behavioral health care; cap and standardize MA plan compensation to brokers which includes prohibiting volume-based bonuses for enrollment into certain plans; streamline enrollment for individuals dually eligible for Medicare and Medicaid; and annually review MA utilization management policies for health equity considerations. Medicare Advantage enrollments continue to become a significant form of insurance coverage for Medicare eligible rural enrollees with 45.1 percent of nonmetropolitan eligible beneficiaries are enrolled in a MA plan (November 2023 RURPI Rural Policy Brief). Additionally, MA enrollment grew by 7.7 percent (2.2 million) from 2022 to 2023; the highest rate of growth was observed in non-metropolitan counties.

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The final rule from the Centers for Medicare & Medicaid Services sets standards for Marketplaces and issuers, as well as requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters that help Marketplace consumers. The rule includes policies that extend the special enrollment period for low-income people to enroll in coverage in any month rather than only during Open Enrollment, provides states the ability to increase access to routine adult dental services such as cleanings, diagnostic X-rays, and restorative services like fillings and root canals, and sets network adequacy standards for the time and distance people travel to appointments with in-network providers. The rule standardizes certain operations across the Marketplaces to increase reliability and consistency for consumers. Lastly, the rule includes several policies impacting the Medicaid program, Children’s Health Insurance Program, and the Basic Health Program.

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Researchers used data from electronic license renewals in 2021 to examine what factors affect the likelihood of providing medication-assisted treatment (MAT) for opioid use disorder.  Physicians and nurse practitioners who were younger, practiced in a public or community health center, and offered a sliding fee scale in their practice had a greater likelihood of providing MAT.  The study builds on previous research showing a lack of mental health services, professional burnout, and stigma associated with lower rates of MAT provision in rural areas, with a further look at organizational and personal barriers to prescribing.

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U.S. Senator Maggie Hassan (D-NH) announced the introduction of her bipartisan Rural Obstetrics Readiness Act with Senators Susan Collins (R-ME), Katie Britt (R-AL), and Tina Smith (D-MN). The bill provides support for rural health care facilities to provide urgent obstetric care by helping to create training programs focused on obstetric emergencies, establish new federal grants to help these facilities buy specialized equipment for both training and patient care, and create a pilot program for rural facilities to get teleconsultations from maternal health experts to improve care.  Please find the press release here. Please find NRHA’s Rural Maternal Health legislative priorities here.

Congresswoman Yadira Caraveo, M.D. (D-CO) announced a bill to expand healthcare accessibility in rural communities. The Rural Residency Planning and Development Act of 2024 (H.R. 7855), introduced by Rep. Caraveo (D-CO), and Rep. Carol Miller (R-WV), would authorize the Rural Residency Planning and Development program to continue building a strong pipeline of rural physicians for years to come. Nearly 20% of Americans live in rural areas, but only 10% of physicians practice in these communities. Among current medical residency programs, only two percent of training occurs in rural areas. To tackle this shortage, the Rural Residency Planning and Development program, housed under the Health Services and Resources Administration (HRSA), awards funding to support start-up costs to establish new rural residency programs. As of November 2023, award recipients have created 39 new accredited rural residency programs or rural track programs and enrolled 306 resident physicians training in rural clinical settings. Please find NRHA’s rural workforce legislative agenda here.