- EOP: Improving Rural Health and Telehealth Access
- HHS Awards Over $101 Million to Combat the Opioid Crisis
- Research Brief: Rural Areas Have Higher Individual Health Insurance Premiums and Fewer Plan Choices
- 'Like a Horror Movie': A Small Border Hospital Battles the Coronavirus
- Trump Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and Advances Access to Care in Rural Areas
- President Trump Signs Executive Order on Improving Rural Health and Telehealth Access
- Using Pharmacists to Provide Care in Rural Areas
- Rural Counties Playing Catch-up with 2020 Census Response
- FCC Extends 2.5 GHz Rural Tribal Priority Window
- HHS Extends Application Deadline for Medicaid Providers and Plans to Reopen Portal to Certain Medicare Providers
- Rural and Community Hospitals – Disappearing Before Our Eyes
- Helping America's "Forgotten Places" Amid a Pandemic
- Study Examines Telehealth, Rural Disparities in Pandemic
- Research Brief: Rural Nurse Practitioners Work with More Autonomy than Urban Nurse Practitioners
- Native Americans Feel Devastated by the Virus Yet Overlooked in the Data
HRSA’s #WellChildWednesdays social media campaign, encouraging families to visit their pediatric provider for well-child visits and immunizations, kicked off in June, and due to its success is now extending into mid-August. The focus of an additional 3 posts will be to remind families to “catch up” on any missed appointments and vaccines.
The campaign has generated more than 400 new posts using the #WellChildWednesdays hashtag. More than 600 health centers in nearly every state, as well as federal agencies, the U.S. Surgeon General, and maternal and child health organizations nationwide have amplified the posts on social media. The posts offer families the information and support they need to make well-child visits a priority. Please continue to RETWEET and SHARE the messages on @HRSAgov Twitter and Facebook.
August 18, 1 p.m. – 2 p.m. EDT
On August 18, the U.S. Department of Health and Human Services (HHS) will unveil the latest edition of Healthy People.
Healthy People 2030 is a set of science-based, 10-year national objectives for improving health and well-being in the United States. During the webcast, we’ll highlight the new Healthy People 2030 goals and objectives and provide an overview of the development process. We’ll also feature guest speakers from HHS who will discuss Healthy People 2030 data, social determinants of health, health equity, and more.
No registration is necessary. Just visit hhs.gov/live on August 18 at 1 p.m. EDT. We hope to see you at the virtual launch event.
We know rural health care faces unique challenges in the fight against the COVID-19 pandemic. The Federal Healthcare Resilience Working Group (HRWG) has developed the Rural Health Surge Readiness web portal, a collection of essential rural health care resources, tools, and training that health care workers and organizations – including EMS & 911, inpatient & hospital care, ambulatory care, and long-term care – can utilize to prepare for and respond to COVID-19.
This one-stop shop for rural health care lets users quickly find the information they need to prepare for or respond to surge events, navigate financial challenges related to the pandemic, and can enhance their capacity and capability to provide lifesaving care to Americans who live in rural areas across the country.
The U.S. Department of Health and Human Services (HHS), through the Health and Resources and Services Administration (HRSA), awarded over $101 million to combat substance use disorders (SUD) and opioid use disorders (OUD). The awards support 116 organizations in 42 states and the District of Columbia, with many targeting high-risk rural communities.
“President Trump has focused on expanding access to treatment for Americans with substance use disorders, including opioid use disorder, and that commitment continues during the COVID-19 pandemic,” said HHS Secretary Alex Azar. “The pandemic has created particular stresses for many Americans struggling with substance use disorders, and these HRSA awards will help strengthen prevention, treatment, and recovery services, especially in rural America, at this difficult time.”
HRSA’s Federal Office of Rural Health Policy awarded $89 million to 89 rural organizations across 38 states as part of the Rural Communities Opioid Response Program-Implementation (RCORP-Implementation). Each RCORP-Implementation grant recipient will use the funding to enhance and expand service delivery for SUD and OUD in rural communities. Awardees will work with rural communities to implement a set of core SUD and OUD prevention, treatment and recovery activities grounded in evidence-based or promising practice models which can be tailored to communities’ unique needs. These awards are part of HHS’ broader focus on rural health and human service issues through the Secretary’s Rural Health Task Force and build on the Administration’s commitment to support rural communities under an Executive Order released August 3, 2020.
In addition to the RCORP-Implementation investments, HRSA’s Bureau of Health Workforce awarded nearly $12.5 million to 28 organizations to expand access to behavioral health services for families affected by opioids and other substance use disorders. The Opioid-Impacted Family Support Program (OIFSP) aims to increase the number of training opportunities for behavioral health paraprofessionals working with families, and provides tuition assistance for trainees. Today’s awardees will recruit and train paraprofessionals to work with youth, including in high-need rural areas across the United States.
“These RCORP-Implementation grants are an essential part of HRSA’s overall efforts in helping to combat the opioid epidemic in the rural areas of our country,” said HRSA Administrator Tom Engels. “In addition, behavioral health paraprofessionals play a critical role in taking care of youth and families struggling with substance use disorder and opioid use disorder. This HRSA funding gives trainees the chance to learn in the communities and with the families that most urgently need their services.”
For a list of today’s RCORP-Implementation award recipients, visit: https://www.hrsa.gov/rural-health/rcorp/implementation/fy20-awards
For a list of today’s OIFSP award recipients, visit: https://bhw.hrsa.gov/grants/behavioral-health/opioid-impacted-family-support-fy20-awards
To learn about HRSA-supported resources, visit HRSA’s Opioid Crisis page.
For more information about the national opioid crisis, visit: https://www.hhs.gov/opioids/.
NIOSH Science Blogs
- Skin Irritation From Prolonged Use of Tight-Fitting Respirators
- How Collecting and Analyzing COVID-19 Case Job Information Can Make a Difference in Public Health
Case Investigation and Contact Tracing
CDC has published Case Investigation and Contact Tracing in Nonhealthcare Workplaces. This information will help employers understand how to collaborate with health departments during COVID-19 case investigation and contact tracing.
CDC has developed an infographic with suggestions for how to prevent the spread of COVID-19 when carpooling to and from work.
How and What to Communicate to Employees About COVID-19
CDC has published the COVID-19 Communication Plan for Select Non-healthcare Critical Infrastructure Employers. This document suggests how and what to communicate to employees, including communication channels and messages
According to the Center on Budget and Policy Priorities and the Campaign for Working Families (CWF), an estimated 350,000-450,000 Pennsylvanians may have missed their Economic Impact Payment (EIP), also known as the $1,200 stimulus payment. If people did not file taxes, they can still complete the non-filer form for the EIP until October 15, 2020. In addition, CWF is able to assist people with completing the non-filer form if needed. More information can be found in the press release below.
The Department of Human Services is asking for your help in getting this message out to people who may really need this financial support if they have not already received it.
You can find more information at the DHS website.
Pennsylvania Governor Tom Wolf and Pennsylvania Department of Health Secretary Dr. Rachel Levine today highlighted ongoing efforts to expand testing across Pennsylvania to ensure that every Pennsylvanian who wants a test can get one.
“If we want to mitigate the spread of this very contagious virus, we must continue to understand how it’s impacting Pennsylvania. Most importantly, improving access to testing helps Pennsylvanians who want and need to test for COVID-19,” Gov. Wolf said. “Testing also provides us with critical data to understand where the disease is in our communities so that we can take the necessary proactive measures to stop the spread and continue to protect the public.”
The Wolf Administration continues to work to further increase testing in Pennsylvania. This includes partnerships in place with Walmart and Quest Diagnostics, which provide direct access in many communities, including rural areas.
The administration also continues to work with laboratories across the state in order to enhance testing capacity in Pennsylvania, particularly as we see significant national delays in receiving test results due to other states experiencing major case increases.
“In Pennsylvania, we are committed to ensuring that testing is accessible, available and adaptable,” Secretary of Health Dr. Rachel Levine said. “Through working with our partners, including Walmart and Quest Diagnostics, we are helping to ensure that anyone who needs to get tested for COVID-19 in Pennsylvania can get tested. Testing, along with wearing a mask, washing your hands, maintaining social distancing and contact tracing are essential tools to reduce the spread of COVID-19 in Pennsylvania.”
Nine drive-thru Walmart testing sites launched on Aug. 5. These nine new sites are in addition to existing Walmart drive-thru sites in Clarion, State College, New Castle and Edinboro.
“Walmart is happy to assist Governor Wolf with reliable timely COVID-19 tests via a convenient drive thru,” said Jamie Reilly, Walmart regional health and wellness director.
Pennsylvania has conducted the ninth highest total number of tests for COVID-19 in the country, according to the Centers for Disease Control and Prevention. Since the beginning of the pandemic, more than 1.6 million tests have been completed, which equates to 13 percent of the Pennsylvania population.
At the height of the first wave in April, statewide testing capacity was limited to under 8,000 tests per day. Pennsylvania is now averaging more than 22,000 test results per day, as of Saturday, Aug. 1, and is testing about 4 percent of the population each month.
The most updated testing sites and information is available at the Department of Health. Testing sites continue to be added.
For the updated commonwealth map of testing sites, visit Pennsylvania COVID-19 Viral Testing Sites.
Pennsylvania First Lady Frances Wolf and Agriculture Secretary Russell Redding were joined by Congressman Dwight Evans and food industry leaders to discuss how Pennsylvania’s $10 million Fresh Food Financing Initiative aims to address hunger, food insecurity and food apartheid in the commonwealth while simultaneously increasing market opportunities for Pennsylvania’s agriculture producers. The discussion will be livestreamed on Facebook at 2:00 PM.
“The Wolf administration continues to work to ensure that all Pennsylvanians have equal access to fresh, healthy food, because your zip code should not predetermine the quality of food on your dinner table,” said First Lady Frances Wolf. “The Fresh Food Financing Initiative COVID-19 Relief Fund is one of the many tools we have to combat food insecurity, and it is an exciting step in our fight for food equity across the state.”
In Pennsylvania, approximately 2.04 million Pennsylvanians experience chronic hunger and food insecurity every day during the COVID-19 pandemic. Food insecurity means not having access to reliable and nutritious meals. Since hunger and health are deeply connected, the effects of inadequate food are profound, including increased risks for chronic diseases, higher chances of hospitalization, poorer overall health and increased health care costs. Chronic hunger also affects cognitive function and our ability to learn and retain information.
The Fresh Food Financing Initiative COVID-19 Relief Fund — championed by Congressman Evans and funded through the CARES Act — is available to for-profit, nonprofit or cooperative entities impacted by COVID-19, including grocery stores, corner stores, convenience stores, neighborhood markets, bodegas, food hubs, mobile markets, farmers markets, on-farm markets, urban farms and food aggregation centers with a direct connection to direct-to-consumer retail outlets.
“Is food available? Is it safe, affordable, nutritious? This is food security. Food insecurity, a food apartheid, is what systemic racism has tragically created for many Pennsylvanians,” said Secretary Redding. “Corner stores in inner cities have candy bars, not fresh produce. I’m pleased that we are able to work to address this apartheid through the Fresh Food Financing Initiative by prioritizing Black, Indigenous, and People of Color communities and incentivizing retailers to provide fresh, local food. The program is stimulating economies, increasing market opportunities for farmers and improving local health.”
The goal of the FFFI COVID-19 Relief Fund is to provide grant support to food retailing businesses impacted by COVID-19 to ensure that amidst the pandemic, communities can maintain healthy food access. In recognition of the disproportionate impacts of both COVID-19 and food apartheid on communities made up of Black, Indigenous, and People of Color (BIPOC), and especially Black and African American communities, prioritization will be given to those businesses that are owned by and serve low-income BIPOC communities. Additional prioritization will be given to applicants with supplier diversity and increase business opportunities for Minority Business Enterprises, Women Business Enterprises, Service-Disabled Veteran Business Enterprises, Veteran Business Enterprises, Lesbian, Gay, Bisexual, and Transgender Business Enterprises; and Disability-Owned Business Enterprises.
“I appreciate the Wolf Administration’s continued strong support for the Fresh Food Financing Initiative, including this opportunity to bring stakeholders together to discuss how we can sustain and build on the program’s success,” said Congressman Dwight Evans (D-PA).
The live, virtual panel is an opportunity to highlight the Fresh Food Financing Initiative, build on the work of Governor Wolf’s Food Security Partnership, and discuss the interconnectedness of Pennsylvania’s robust agriculture industry and its ability to break down walls of inequity in Pennsylvania.
For more information on food security in Pennsylvania including information about resources and actions taken by the Wolf Administration and guidelines for the Fresh Food Financing Initiative COVID-19 Relief Fund, visit agriculture.pa.gov/foodsecurity.
Physician Fee Schedule Proposed Rule would make permanent certain telehealth and workforce flexibilities provided during the COVID-19 Public Health Emergency and improve healthcare for Americans in Rural Areas
The Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access that President Trump signed today. The Executive Order and proposed rule advance our efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas. Additionally, the proposed rule implements a multi-year effort to reduce clinician burden under our Patients Over Paperwork initiative and to ensure appropriate reimbursement for time spent with patients. This proposed rule also takes steps to implement President Trump’s Executive Order on Protecting and Improving Medicare for our Nation’s Seniors and continues our commitment to ensure that the Medicare program is sustainable for future generations.
Expanding Beneficiary Access to Care through Telehealth
Over the last three years, as part of the Fostering Innovation and Rethinking Rural Health strategic initiatives CMS has been working to modernize Medicare by unleashing private sector innovations and improve beneficiary access to services furnished via telecommunications technology. Starting in 2019, Medicare began paying for virtual check-ins, meaning patients across the country can briefly connect with doctors by phone or video chat to see whether they need to come in for a visit. In response to the COVID-19 pandemic, CMS moved swiftly to significantly expand payment for telehealth services and implement other flexibilities so that Medicare beneficiaries living in all areas of the country can get convenient and high-quality care from the comfort of their home while avoiding unnecessary exposure to the virus. Before the public health emergency (PHE), only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July. For more information on Medicare’s unprecedented increases in telemedicine and its impact on the health care delivery system, visit the CMS Health Affairs blog here.
As directed by President Trump’s Executive Order on Improving Rural and Telehealth Access, through this rule, CMS is taking steps to extend the availability of certain telemedicine services after the PHE ends, giving Medicare beneficiaries more convenient ways to access healthcare particularly in rural areas where access to healthcare providers may otherwise be limited Improving Rural and Telehealth Access.
“Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for Americas seniors,” said CMS Administrator Seema Verma. “The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. Never one merely to tinker around the edges when it comes to patient-centered care, President Trump will not let this opportunity slip through our fingers.”
During the public health emergency, CMS added 135 services such as emergency department
visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. CMS is proposing to permanently allow some of those services to be done by telehealth including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments. CMS is seeking public input on other services to permanently add to the telehealth list beyond the PHE in order to give clinicians and patients time as they get ready to provide in-person care again. CMS is also proposing to temporarily extend payment for other telehealth services such as emergency department visits, for a specific time period, through the calendar year in which the PHE ends. This will also give the community time to consider whether these services should be delivered permanently through telehealth outside of the PHE.
Prioritizing Investment in Preventive Care and Chronic Disease Management
Under our Patients Over Paperwork initiative, the Trump Administration has taken steps to eliminate burdensome billing and coding requirements for Evaluation and Management (E/M) (or office/outpatient visits) that make up 20 percent of the spending under the Physician Fee Schedule. These billing and documentation requirements for E/M codes were established 20 years ago and have been subject to longstanding criticism from clinicians that they do not reflect current care practices and needs. After extensive stakeholder collaboration with the American Medical Association and others, simplified coding and billing requirements for E/M visits will go into effect January 1, 2021, saving clinicians 2.3 million hours per year in burden reduction. As a result of this change, clinicians will be able to make better use of their time and restore the doctor-patient relationship by spending less time on documenting visits and more time on treating their patients.
Additionally, last year, the Trump Administration finalized historic changes to increase payment rates for office/outpatient E/M visits beginning in 2021. The higher payment for E/M visits takes into account the changes in the practice of medicine, recognizing that additional resources are required of clinicians to take care of the Medicare patients, of which two-thirds have multiple chronic conditions. The prevalence of certain chronic conditions in the Medicare population is growing. For example, as of 2018, 68.9% of beneficiaries have 2 or more chronic conditions. In addition, between 2014 and 2018, the percent of beneficiaries with 6 or more chronic conditions has grown from 14.3% to 17.7%.
In this rule, CMS is proposing to similarly increase the value of many services that are comparable to or include office/outpatient E/M visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, physical and occupational therapy evaluation services and others. The proposed adjustments, which implement recommendations from the American Medical Association, help to ensure that CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients, like primary care and complex or chronic disease management.
Bolstering the Healthcare Workforce/Patients Over Paperwork
CMS is also taking steps to ensure that healthcare professionals can practice at the top of their professional training. During the COVID-19 public health emergency, CMS announced several temporary changes to expand workforce capacity and reduce clinician burden so that staffing levels remain high in response to the pandemic. As part of its Patients over Paperwork initiative to reduce regulatory burden for providers, CMS is proposing to make some of these temporary changes permanent following the PHE. Such proposed changes include nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives (instead of only physicians) to supervise others performing diagnostic tests consistent with state law and licensure, providing that they maintain the required relationships with supervising/collaborating physicians as required by state law; clarifying that pharmacists can provide services as part of the professional services of a practitioner who bills Medicare; allowing physical and occupational therapy assistants (instead of only physical and occupational therapists) to provide maintenance therapy in outpatient settings; and allowing physical or occupational therapists, speech-language pathologists and other clinicians who directly bill Medicare to review and verify (sign and date), rather than re-document, information already entered by other members of the clinical team into a patient’s medical record.
Public comments on the proposed rules are due by October 5, 2020.
For a fact sheet on the CY 2021 Physician Fee Schedule (PFS) proposed rule, please visit: https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4
For a fact sheet on the CY 2021 Quality Payment Program proposed rule, please visit: https://protect2.fireeye.com/url?k=2cb50d33-70e12418-2cb53c0c-0cc47a6d17cc-48198a1001590137&u=https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1100/2021%20QPP%20Proposed%20Rule%20Fact%20Sheet.pdf
For a fact sheet Medicare Diabetes Prevention Program- https://www.cms.gov/newsroom/fact-sheets/proposed-policies-medicare-diabetes-prevention-program-expanded-model-mdpp-calendar-year-2021
To view the CY 2021 Physician Fee Schedule and Quality Payment Program proposed rule, please visit: https://www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other
The current COVID-19 Public Health Emergency (PHE) does not waive any requirements related to Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, CMS added CPT codes 99441, 99442, and 99443, to the list of telehealth codes coverable under the waiver during the COVID-19 PHE. These codes designate three different time increments of telephone evaluation and management service provided by a physician. You can bill for these physician services separately under Part B when furnished to a SNF’s Part A resident.
Medicare Administrative Contractors (MACs) will reprocess claims for CPT codes 99441, 99442 and 99443 with dates of service on or after March 1, 2020, that were denied due to SNF CB edits. You do not have to do anything. If you already received payment from the SNF for these physician services, return that payment to the SNF once the MAC reprocesses your claim.