- CMS: Request for Information; Health Technology Ecosystem
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- State: 60-Day Notice of Proposed Information Collection: J-1 Visa Waiver Recommendation Application
- Public Inspection: CMS: Request for Information: Health Technology Ecosystem
- HHS: Request for Information (RFI): Ensuring Lawful Regulation and Unleashing Innovation To Make American Healthy Again
- VA: Solicitation of Nominations for the Appointment to the Advisory Committee on Tribal and Indian Affairs
- GAO Seeks New Members for Tribal and Indigenous Advisory Council
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- Telehealth Study Recruiting Veterans Now
- USDA Delivers Immediate Relief to Farmers, Ranchers and Rural Communities Impacted by Recent Disasters
- Submit Nominations for Partnership for Quality Measurement (PQM) Committees
- Unleashing Prosperity Through Deregulation of the Medicare Program (Executive Order 14192) - Request for Information
- Dr. Mehmet Oz Shares Vision for CMS
- CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid Partnership
- Social Factors Help Explain Worse Cardiovascular Health among Adults in Rural Vs. Urban Communities
CMS to Roll Out ‘Birthing-Friendly’ Hospital Tag on Care Compare Site
From FIERCE Healthcare
The Biden administration wants to add a “birthing-friendly” designation to facilities on the Centers for Medicare & Medicaid Services’ (CMS’) Care Compare website. The designation, announced Tuesday as part of a larger call to action from the White House to address maternal care, would apply to hospitals that provide perinatal care and participate in a maternity care quality improvement collaborative.
CMS is also encouraging states to take advantage of an option in the American Rescue Plan Act to provide a year of postpartum coverage to pregnant women enrolled in Medicaid or the Children’s Health Insurance Program.
“No mother should have to fight for her coverage or care during pregnancy or while caring for a newborn,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “CMS is doing everything we can to support the health of new parents and families and to advance health equity across the country.” CMS’ Care Compare website lets consumers compare doctors, hospitals and other providers that participate in Medicare. The agency also announced Tuesday a new structural quality measure for its Hospital Inpatient Quality Reporting Program starting with all discharges from Oct. 1 of this year.
Hospitals will have to attest whether “they participate in a statewide and/or national maternal safety quality collaborative and whether they have implemented the recommended patient safety practices or bundles to improve maternal outcomes,” CMS said in a release. A hospital that chooses to participate with this measure and others can be considered “birthing-friendly” on Care Compare.
RELATED: Behavioral, maternal health worsening among children, women, report finds
April in Brief: HRSA Works to Strengthen and Expand Health Care Access
In April, HRSA announced investments to: support community-based doulas; strengthen home visiting supports for parents, infants, and children; expand our investments in state responses to the maternal mortality crisis; launch the largest investment we’ve ever made in Community Health Worker training; and build new data tools to reduce health disparities through health centers.
HRSA also distributed $1.75 billion in Provider Relief Fund payments, released a Request for Information on ways to strengthen and improve the Organ Procurement and Transplantation Network, and launched a new Health Equity Fellowship Program.
In April 2022, the Health Resources and Services Administration took action to support underserved communities, improve maternal health, grow the health care workforce, and reduce health disparities, including:
Health Resources and Services Administration Announces Availability of New Funding to Support Community-Based Doulas
HRSA announced the availability of $4.5 million for hiring, training, certifying, and compensating community-based doulas in areas with high rates of adverse maternal and infant health outcomes.
HRSA Awards $16 Million to Strengthen the Maternal, Infant, and Early Childhood Home Visiting Program, Announces $9 Million Available to Expand State Maternal Health Innovation and Implementation Program
HRSA announced approximately $16 million to strengthen Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Programs through seven awards supporting eight states. These awards will advance data and technology innovations to support positive maternal and child health outcomes in states and communities, and focus on addressing health disparities.
HRSA also announced the availability of up to $9 million through the State Maternal Health Innovation and Data Capacity Program to expand the State Maternal Health Innovation and Implementation Program. This program supports state-level development and implementation of proven strategies to improve maternal health and address maternal health disparities.
HRSA Announces $226.5 Million to Launch Community Health Worker Training Program
HRSA announced the availability of $226.5 million in American Rescue Plan funding to launch the Community Health Worker Training Program. This new program will increase the number of community health workers who play a critical role in connecting people to care, including COVID care; mental health and substance use disorder prevention, treatment and recovery services; chronic disease care; and other important health services.
HRSA Announces $90 Million to Support New Data-Driven Approaches for Health Centers to Identify and Reduce Health Disparities
HRSA announced the availability of nearly $90 million in American Rescue Plan funding to support new data-driven efforts for HRSA Health Center Program-supported health centers and look-alikes to identify and reduce health disparities.
HRSA Distributing $1.75 Billion in Provider Relief Fund Payments to Health Care Providers Affected by the COVID-19 Pandemic
HRSA announced more than $1.75 billion in Provider Relief Fund payments to 3,680 providers across the country. Provider Relief Fund payments have played an important role in the national response to COVID-19, helping health care providers respond to the coronavirus, including retaining and supporting the workforce.
HRSA Releases Request for Information on Ways to Strengthen and Improve the Organ Procurement and Transplantation Network
HRSA released a Request for Information (RFI) seeking input on ways to strengthen and improve the Organ Procurement and Transplantation Network (OPTN). The RFI will support HRSA’s efforts to increase accountability in OPTN operations, modernize performance of the OPTN IT system and related tools, and improve engagement with donors and patients. Comments are due by May 9th.
New Opportunities at HRSA for Early-Career Professionals
HRSA also announced the new HRSA Health Equity Fellowship Program to provide early career professionals with an opportunity to contribute directly to the Biden-Harris Administration’s work to advance racial equity and support underserved communities.
See News & Announcements on HRSA.gov.
Biden Harris Administration Proposes Rule to Fix “Family Glitch” and Lower Health Care Costs
President Biden and Vice President Harris believe that health care is a right, not a privilege. They promised to protect and build on the Affordable Care Act (ACA), lowering costs and expanding coverage so that every American has the peace of mind that health insurance brings.
The Biden-Harris Administration continues to deliver on that promise. Thanks to the landmark American Rescue Plan, ACA premiums are at an all-time low, while enrollment is at an all-time high. Four out of five Americans can find quality coverage for under $10 a month, and families are saving an average of $2,400 on their annual premiums—$200 in savings every month back to families. The Administration has lowered costs and increased enrollment to a record high of 14.5 million Americans—including nearly 6 million who newly gained coverage. With the addition of Missouri and Oklahoma, two states that expanded Medicaid last year, nearly 19 million low-income Americans are enrolled in the ACA’s Medicaid expansion coverage, adding up to a record nearly 80 million children, pregnant women, seniors, people with disabilities, and other low-income Americans covered by Medicaid.
The ‘Massive’ Task Awaiting State Medicaid Agencies
From Route Fifty, March 23, 2022
The end of a public health emergency would mean states losing hundreds of billions in funding for the health care program, and verifying whether millions of enrollees are still eligible.
State Medicaid officials around the country are growing increasingly worried about the mammoth and high stakes task of reevaluating who among roughly 80 million people will still be eligible for Medicaid when the Biden administration declares the national Covid-19 public health emergency to be over—a move expected in July.
With health advocates and state officials acknowledging a lot could go wrong, they are worried people will be mistakenly thrown off of the program, which provides health coverage to low-income Americans.
“It’s a pretty massive undertaking for us,” Nicole Comeaux, New Mexico’s Medicaid director said in an interview. “Really our goal is that everybody stays in the coverage who are eligible for it.”
On top of that challenge, state officials face added pressure because the end of the public health emergency, which began in January 2020, would mean roughly $90 billion a year in increased federal Medicaid funding states have been receiving would suddenly screech to a halt. That could happen as soon as the end of September.
Earlier in the pandemic, Congress and the Trump administration increased the federal government’s share of paying for Medicaid, known as the Federal Medical Assistance Percentage, or FMAP, by 6.2%. The move was a response to people losing health care coverage from their jobs in the early days of the pandemic.
In return for getting the extra money, approved in the March 2020 pandemic relief law known as the Families First Coronavirus Response Act, states were barred from removing anyone from their Medicaid rolls.
Meanwhile, the number of people enrolled in Medicaid and the related Children’s Health Insurance Program grew from 70.7 million in February 2020 to 84.8 million last September, according to federal figures.
When the public health emergency ends, Medicaid offices will have to return to determining whether everyone on the rolls is eligible—except with a lot more people to check compared to before the pandemic.
Recognizing the size of the task, the Centers for Medicare & Medicaid Services in March gave states up to 14 months after the end of the emergency declaration to reevaluate enrollees. But the rub for state budgets is that the increased federal help will have disappeared long before the end of those 14 months.That means it could make sense for them to get their Medicaid rolls in order ahead of the deadline.
Nearly Half of Rural Hospitals Lose Money on Childbirth Services
A large number of rural hospitals that cease obstetrics programs wind up closing later, researcher says.
About 40% of rural hospitals are losing money on their obstetrics programs, but many continue to provide the service because of its importance for community health, a new study shows.
Losing child-birth services can also be a harbinger of hard times for a rural hospital, oftentimes serving as a precursor to closure.
A study conducted by the University of Minnesota Rural Health Research Center found that some rural hospitals keep their obstetrics programs open even after they have stopped being financially viable.
In large part, researcher Julia Interrante said, rural hospitals that close their obstetrics units are more likely to close their doors for good.
“Usually the obstetrics unit will close, and then other services will start to close before the entire hospital closes,” she said. “It’s not always the case – sometimes we see things where hospitals will enter into mergers or move those services to another hospital location… But often when they end up closing OB services, then it usually kind of leads toward the hospital closing.”
A survey of obstetric unit managers or administrators at nearly 300 rural hospitals found that whether the program was in the black wasn’t as important to these leaders as how much the community needed it.
Hospitals reported they needed 200 births per year to maintain safety standards and to remain financially viable. More than 40% said they had fewer births than needed to sustain operations financially.
“I think that’s really striking,” Interrante said. “But so many of them also reported understanding the need and importance of having those services in rural communities, because people are still giving birth, and they have to have somewhere to go.”
The survey respondents said it was important to keep the obstetrics units open because of the complications patients could encounter if they had to drive long distances to give birth.
About two-thirds of survey respondents said meeting their community’s needs was the most important factor in keeping their obstetrics units open, even if there weren’t enough births in the area to warrant it financially. Only 16.5% said their top priority in making that decision was the financial aspect. Nearly 13% said their top priority was staffing.
Nationally, birth rates have been falling since 2008, according to the U.S. Census Bureau. Birth rates tend to be higher in rural areas, around 1,900 births per every 1,000 women, compared to 1,600 births for 1,000 women in urban areas. However, because there are fewer women of child-bearing age in rural areas, hospitals tend to see fewer births per year.
“Many hospital administrators in rural communities care deeply about the health of pregnant rural residents,” Katy Backes Kozhimannil, director of the Rural Health Research Center and lead author of the study, said. “Rural hospital administrators prioritized local community needs over finances and staffing, keeping obstetric units open because local pregnant patients need care. Policy investments are needed to help rural hospitals and communities support safe, healthy pregnancies and births.”
Interrante said insurance reimbursement is one issue rural hospitals face in keeping the obstetrics units open. Rural areas tend to have more patients on Medicaid, she said, which only reimburses a percentage of what it costs hospitals to provide those services. According to the CDC, half of the women who give birth in rural areas are on Medicaid, compared to 41.9% in urban areas.
More than a quarter of those responding to the survey said they were not sure if they would continue providing obstetrics. Or they said they expected to stop offering the service, indicating a continued downward trend in health care access, researchers said.
“The responses from the rural hospital administrators strongly highlight the fact that they provide obstetric services because they are so necessary and important for the health of rural communities they serve,” Bridget Basile Ibrahim, a co-author of the study, said. “For many of the patients who give birth at these hospitals, it would be a huge burden for them to travel to the next nearest hospital to give birth.”
Researchers concluded that any policies to improve rural obstetrics care should take into account community needs, clinical safety, and rural hospital finances. How low-volume, rural hospitals are reimbursed should be investigated to ensure those hospitals’ financial viability, they said.
HHS Region 3 Director Named
Dr. Ala Stanford has been named Regional Director for HHS Region 3.
Dr. Stanford gained national recognition during the COVID-19 pandemic using the infrastructure of her pediatric surgery practice to create a grassroots organization to focus on testing, contact tracing and vaccination in communities devoid of access to care and resources. Her focus on the most vulnerable populations disproportionately impacted by COVID-19 saved lives.
Dr. Stanford is a practicing physician for over 24 years. She is board certified by the American Board of Surgery in both pediatric and adult general surgery. She is former director of the Center for Minority Health and Health Disparities of Temple University School of Medicine in Philadelphia, PA, a member of the Philadelphia Board of Health COVID-19 advisory board and trusted national leader and public health advocate. In addition to opening a Center for Health Equity to improve health outcomes in communities with the lowest life expectancy, her organization was responsible for providing nearly 100,000 COVID-19 tests and vaccinations. She was recognized by Admiral Rachel Levine and Surgeon General Vivek Murthy as demonstrating best health practices and a national model during a public health crisis.
Dr. Stanford has received many accolades, notably a: 2021 Top 10 CNN Hero, and 2021 George H.W. Bush Points of Light Award Recipient. Most recently she led a FEMA mission, Region 3 Team to vaccinate students in Philadelphia School District and a mobile vaccination unit in hard hit Southeastern Pennsylvania neighborhoods.
Dr. Stanford said, “I am humbled to be named HHS’s new Regional Director, especially at this critical time in our nation’s recovery efforts. Ensuring communities across Region 3 have access to the information and resources they need to stay safe and healthy, with a particular emphasis on advancing equity, will be my top priority, in all aspects of health care.”
Welcome Dr. Stanford!
CMS To Hold Listening Sessions on Rural Health Strategy
The Centers for Medicare & Medicaid Services (CMS) Rural Health Council is hosting public, virtual listening sessions to ensure the CMS Rural Health Strategy reflects the needs and priorities of those living and working in rural and frontier communities, including Tribal Nations and U.S. territories.
CMS invites you to join a listening session to provide your feedback on the current Rural Health Strategy and help improve CMS’s approach to advancing rural health. All listening sessions will be held virtually and dates are specific to your area. These sessions are meant for individuals with lived experience receiving health care or supporting healthcare service delivery in rural communities, including Tribal Nations and U.S. territories.
Prior to the listening session, you are encouraged to review the CMS Rural Health Strategy, and be prepared to speak to the following topic areas during the call:
- Which of the CMS Rural Health Strategy objectives should CMS continue to prioritize?
- What is missing from the current CMS Rural Health Strategy objectives?
- What can CMS do to advance health equity for rural and frontier communities, including Tribal Nations and U.S. territories?
Please plan to attend the session that pertains to your CMS region, see information below. Listening sessions are open to the public to attend. If you have any questions about the CMS Rural Health Strategy listening sessions, please send to: RuralHealth@cms.hhs.gov.
Listening Session #1: CMS Regions 5, 7 and 8
Relevant States & Territories: Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin, Iowa, Kansas, Missouri, Nebraska, Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
Date/Time: Tuesday, May 10th at 4:00pm EDT
Registration Link: mitre.zoomgov.com/meeting/register/…
Listening Session #2: CMS Region 4, Puerto Rico, and U.S. Virgin Islands
Relevant States & Territories: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Puerto Rico, Virgin Islands
Date/Time: Wednesday, May 11th at 12:00pm EDT
Registration Link: mitre.zoomgov.com/meeting/register/…
Listening Session #3: CMS Regions 6, 9, 10
Relevant States & Territories: Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Arizona, California, Hawaii, Nevada, Alaska, Idaho, Oregon, Washington, Guam, American Samoa, Commonwealth of the Northern Mariana Islands
Date/Time: Thursday, May 12th at 6:00PM EDT
Registration Link: mitre.zoomgov.com/meeting/register/…
Listening Session #4: CMS Regions: 1,2,3 (excluding Puerto Rico & U.S. Virgin Islands, which will be included in Listening Session #2)
Relevant States & Territories: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Delaware, Maryland, Pennsylvania, Virginia, West Virginia, District of Columbia
Date/Time: Thursday, May 19th at 4:00pm EDT
Registration Link: mitre.zoomgov.com/meeting/register/…
FY 2023 Skilled Nursing Facilities (SNF) Prospective Payment System (PPS) Proposed Rule
On April 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update payment rates for the Skilled Nursing Facilities (SNFs) Prospective Payment System (PPS) for Fiscal Year (FY) 2023 and propose changes to SNF Quality Reporting Program (QRP), SNF Value Based Purchasing Program (VBP), and requests information regarding requirements for Long-Term Care (LTC) facilities to establish mandatory minimum staffing levels.
Key proposals include:
- Updated payment rates by 3.9%, reflecting a market basket index percentage change of 2.8%, increased by the forecast error adjustment of 1.5% and reduced by the productivity adjustment of 0.4% required under the Affordable Care Act. However, a 4.6% proposed parity adjustment to ensure budget neutrality results in an approximately $320 million decrease in Medicare Part A payments to SNFs in FY 2023.
- Requesting information on establishing mandatory minimum staffing requirements for LTC facilities. Specifically, feedback on evidence that establishes an appropriate minimum staffing requirement, associated costs, rural considerations including workforce recruiting challenges, and how the minimum staffing requirement should be measured.
- Adopting the Centers for Disease Control (CDC) Influenza Vaccination Coverage among Healthcare Personnel (HCP) measure for the SNF QRP in FY 2025 to report the percentage of HCP that receive the influenza vaccine each season.
- Revising the compliance date to October 1, 2023, for collecting data on Transfer of Health (TOH) Information to Provider-PAC measure, TOH Information to Patient-PAC measure, and certain standardized patient assessment data elements.
- Adopting new SNF VBP quality measures including the SNF Healthcare Associated Infections (HAI) Requiring Hospitalizations measure and the Total Nursing Hours per Resident Day staffing measure in FY 2026 and the Discharge to Community Post-Acute Care (DTC PAC) measure in FY 2027. Currently, hospital readmissions are the only quality measures for VBP.
- Implementing case minimums and measure minimums as eligibility requirements for inclusion in VBP programs and incentive-based payments.
NRHA plans to submit comments on the proposed rule. Please share any questions or concerns with NRHA staff before the June 10, 2022, deadline. CMS’s FY23 SNF PPS Fact Sheet can be found here. President Biden’s remarks on improving nursing home safety and quality can be found here. The proposed rule can be found here.
For further questions, please contact Alexa McKinley, NRHA Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team.
Promoting Good Health for Black Mothers & Their Families in Pennsylvania
Pregnancy and those first weeks and months with your child are a beautiful, transformative time. Those times can also be physically and mentally difficult and occasionally overwhelming.
Nearly 60 percent of pregnancy-associated deaths happen between 42 days and one year after giving birth. In Pennsylvania, these pregnancy-related deaths are higher among Black women and women whose births were covered by Medicaid. The most common cause of death in the late postpartum period is heart failure or heart attack. Again, this disproportionately affects Black women and women with low incomes who receive their health coverage through Medicaid.
This is unacceptable. Black mothers deserve better.
Black mothers deserve comprehensive care for the physical and emotional trauma of birth that does not disappear at a six-week postpartum visit. Since taking office, Governor Wolf has prioritized expanding access to health care and supportive services that help parents through pregnancy and the postpartum period and gives children a strong, healthy start that can lead to continued good health, well-being and positive outcomes throughout their lives.
Medicaid Extension of Postpartum Coverage Period
Effective April 1, 2022, under the American Rescue Plan Act, Pennsylvania extended the Medicaid postpartum coverage period for mothers and birthing people who are eligible for the program because of their pregnancy to one year following the birth of a baby. Previously, Medicaid — or Medical Assistance in Pennsylvania — provides coverage for people eligible due to their pregnancy ended 60 days after giving birth. Extending postpartum coverage for those covered through Medicaid will provide continuity in health care by allowing birthing parents to maintain relationships with and access to care providers undisrupted through a critical period in their lives and their babies’ lives.
Press Release: Extension Increases Access to Critical Postpartum Care
Statistics & Facts
- About 3 in 10 births nationwide are paid for through Medicaid, but traditionally, coverage for people who qualify because they are pregnant ends 60 days following the birth of a baby unless their income or circumstances change.
Maternal Mortality
- In Pennsylvania, pregnancy-related deaths grew by more than 21 percent between 2013 and 2018.
- Nationally, about 12 percent of pregnancy-related deaths occur between six weeks and one year postpartum, but almost 60 percent of those are preventable.
- Black women are 3 to 5 times more likely than white women to die after giving birth.
- Statistics from 2020 show the pregnancy-related mortality rate of Black mothers was disproportionate to White and Hispanic mothers:
- Black Mothers: 55.3 deaths per 100,000 births
- White Mothers: 19.1 deaths per 100,000 births
- Hispanic Mothers: 18.5 deaths per 100,000 births
Perinatal Mental Health
- Perinatal depression is the most common complication during pregnancy and the postpartum period.
- 1 in 7 women experience depression during or following a pregnancy, but too often it can go undiagnosed.
- A 2018 study published by the National Institute of Health (NIH) reported that just 1 in 5 women report symptoms of depression or anxiety during or after a pregnancy to a health care provider, but follow through for treatment may be even lower, especially for women of color.
Quality of Care
- People from some racial groups are more likely to be uninsured than non-Hispanic Whites.
- Research indicates that 22 percent of Black women receive a lower quality of care than white women and are subject to discrimination in the health care field.
- According to the American College of Obstetricians and Gynecologists (ACOG), in 2008 only 6.4 percent of obstetricians-gynecologists practiced in rural areas.
Additional Maternal Health Resources
- Health Resources & Services Administration (HRSA) Maternal & Child Health
- Black Mamas Matter Alliance
- March of Dimes
- Strong Start for Mothers and Newborns Initiative — Centers for Medicaid & Medicare Services
- World Health Organization (WHO) response
- Proclamation on Black Maternal Health Week, 2022 — The White House
- The U.S. Surgeon General’s Call To Action to Improve Maternal Health
CMS Proposes Revised Medicare Enrollment Rules
Sections 120 and 402 of the Consolidated Appropriations Act, 2021 (CAA) made two key changes to Medicare enrollment rules.
First, Medicare coverage will become effective the month after enrollment for individuals enrolling in the last three months of their initial enrollment period or in the General Enrollment Period, thereby reducing any potential gaps in coverage. Currently, if individuals enroll in Medicare in the last three months of their Initial Enrollment Period or in the General Enrollment Period, they may have to wait several months for Medicare coverage to begin.
Second, the proposed rule also establishes a new immunosuppressive drug program that would extend Medicare immunosuppressive drug coverage to certain individuals who have had a kidney transplant. If finalized, the proposed rule would promote accessibility to vital life-saving drugs.
This rule, if finalized, would become effective January 1, 2023, and implement changes made by the CAA
Federal Register: https://www.cms.gov/files/document/cms-4199-p.pdf