- 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
USDA Invests $10.5 Million in American Rescue Plan Funds to Expand Access to Rural Health Care for People in Pennsylvania
Department Responds in Record Time to Meet the Growing Health Care Needs in Rural America
U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small today announced that USDA is awarding $10.5 million in Emergency Rural Health Care Grants to 18 rural health care organizations and community groups in Pennsylvania.
“No matter where you live, people deserve good health care, and the Biden-Harris Administration is committed to making that a reality throughout rural America,” Torres Small said. “Through the Emergency Rural Health Care Grants Program, USDA is improving access to the critical health care services rural people rely on every day here in rural Pennsylvania, and we are proud to have such strong partners like Representatives Cartwright and Wild.”
The Biden-Harris Administration made these funds available through its historic legislative package, the American Rescue Plan Act. Within months after the Act’s passage, USDA responded quickly by making this funding available to ensure the long-term availability of rural health care services.
The grants USDA is awarding will help rural hospitals and health care providers implement telehealth and nutrition assistance programs, increase staffing, build or renovate facilities, and purchase medical supplies.
Torres Small made the announcement at the Greater Pittston Ambulance Rescue Service Association. The association is one of 18 recipients to receive grant funds in Pennsylvania. It will use a $226,900 grant to purchase approximately 200 pieces of medical equipment for emergency and ambulatory services. The equipment includes LIFEPAK monitors, therapy cables and reusable blood pressure cuffs.
The complete news release including all 18 projects that were announced can be viewed on our website.
CMS Announced a Series of Cross-Cutting Initiatives
The Centers for Medicare & Medicaid Services (CMS) announced a series of Cross-Cutting Initiatives (CCIs) that will drive the Centers’ and Offices’ strategic vision to advance health equity, expand coverage, and improve health outcomes. In addition to advancing the six strategic pillars that CMS announced last year, the CCI’s aim to improve behavioral and maternal health coverage, drug price affordability, and rural health care delivery along with strengthening quality improvement strategies and ensuring coverage for eligible individuals post-pandemic. The CCIs will also identify opportunities to streamline the consumer experience of CMS’ coverage programs and expand coverage, while leveraging data to drive innovation and person-centered care. CMS is committed to track, monitor, and refine success measures for these initiatives in partnership with stakeholders and to report on progress to the public.
For more information visit the CCI webpage: https://www.cms.gov/cms-strategic-plan
Learn more about the Cross-Cutting Initiatives Fact Sheet: Overview fact sheet (PDF)
Learn more about the CMS Quality Strategy: National Quality Strategy Fact Sheet (PDF)
Learn more about Behavioral Health:
In January, the Senate Health, Education, Labor, and Pensions (HELP) Committee introduced their bipartisan legislation, the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics (PREVENT Pandemics) Act.
This legislation is designed to respond to the current, and prepare for future, public health emergencies (PHE). In February, NRHA provided comments on critical rural needs for Committee consideration before mark-up. NRHA is pleased that many rural provisions were included in the Committee passed version of the bill. That said, more can be done to improve the rural public health infrastructure through this bill.
NRHA needs member support to ensure successful advocacy for: 1) the creation of an Office of Rural Health within the CDC, 2) additional capital funding for rural providers to improve their infrastructure, and 3) rural representation in all new funding and grant opportunities.
It is now time to gain momentum on ensuring that rural friendly provisions are included in the final passage of this legislation, and we need your help! NRHA urges you to use our pre-drafted Advocacy Campaign to communicate the need for rural friendly tweaks to this important legislation. As a reminder, an Advocacy Campaign is a short message you can send to your elected officials on key issues. The Advocacy Campaign for the PREVENT Pandemics Act can be found here. NRHA has provided pre-drafted language urging your elected officials to support rural friendly tweaks to this important legislation. While the pre-drafted language is sufficient, we encourage you to tell your story in the text as well. You can edit the language to explain how the amendments to the PREVENT Pandemics Act will specifically benefit your facility and community. Elected officials rely on feedback from YOU to understand what is needed in their communities.
In the coming weeks, we will also be introducing an Advocacy Campaign on the Fiscal Year 2023 appropriations cycle.
As always, if you have any questions or would like additional information, do not hesitate to reach out. You can email me at lcostello@ruralhealth.us.
HHS Takes Actions to Promote Safety & Quality in Nursing Homes
CMS issued its fiscal year (FY) 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) proposed rule, which includes asking for public feedback on how staffing in nursing homes and health equity improvements could lead to better health outcomes.
The proposed rule builds upon the Biden-Harris Administration’s commitment to advance health equity, drive high-quality person-centered care, and promote sustainability of its programs. The rule is an important step in fulfilling its goal to protect Medicare skilled nursing facility (SNF) residents and staff by improving the safety and quality of care of the nation’s SNFs (commonly referred to as nursing homes). The SNF PPS provides Medicare payments to over 15,000 nursing homes, serving more than 1.5 million people. Medicare spending to nursing homes is projected to be approximately $35 billion in FY 2022. Through the SNF PPS proposed rule, CMS is continuing its work to transform the SNF payment system to a more patient-centered model by making payments based on the needs of the whole patient, rather than focusing on the volume of certain services the patient receives.
“Everyone deserves to receive safe, dignified, and high-quality care, no matter where they live,” said HHS Secretary Xavier Becerra. “Today we are starting the necessary work to ensure our loved ones living in nursing homes receive the best care at the staffing levels they need. We are working hard to deliver on President Biden’s commitment to protecting seniors and improving the quality of our nation’s nursing homes.”
The SNF PPS proposed rule aims to realize the President’s vision for the nation’s nursing homes as outlined in his State of the Union Address, with a focus on providing safe, dignified, and appropriate care for residents. As part of this vision, the Biden-Harris Administration recently set a goal to improve the quality of nursing homes so that seniors, people with disabilities, and others living in nursing homes get the reliable, high-quality care they deserve. A key part of reaching this goal is addressing staffing levels in nursing homes, which have a substantial impact on the quality of care and outcomes residents experience.
“The COVID-19 pandemic has highlighted serious problems at some of the nation’s nursing homes that have persisted for too long. And we have seen the tragic impact that inadequate staff resources can have on residents and staff,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration has promised that we will work with all stakeholders to do better for nursing home residents, and today’s proposed rule includes important steps toward our goal to promote safety and quality of care for all residents and staff.”
In the SNF PPS proposed rule, CMS is soliciting input to help the agency establish minimum staffing requirements that nursing homes will need to meet to ensure all residents are provided safe, high-quality care, and nursing home workers have the support they need. This input will be used in conjunction with a new research study being conducted by CMS to determine the optimal level and type of nursing home staffing needs. The agency intends to issue proposed rules on a minimum staffing level requirement for nursing homes within one year.
CMS is also requesting stakeholder input on a measure that would examine staff turnover levels in nursing homes for possible inclusion in CMS’ SNF Value-Based Purchasing (VBP) Program, which rewards facilities with incentive payments based on the quality of care they provide to people with Medicare. Looking at the relationship between staff turnover and quality of care, preliminary analysis by CMS has shown that as the average staff turnover decreases, a facility’s overall rating on CMS’ Nursing Home Five Star Quality Rating System increases, which suggests that lower turnover is associated with higher overall quality. CMS will use the stakeholder feedback to inform a proposal of this measure to include in the SNF VBP Program in the future.
In January, CMS began posting nursing home staff turnover rates (as well as weekend staff levels) on the Medicare.gov Care Compare website, and CMS will be including this information in the star rating system starting in July 2022. This information helps consumers better understand each nursing home facility’s staffing environment and also helps providers to improve the quality of care and services they deliver to residents.
The proposed rule also proposes the adoption of 3 new measures into the SNF VBP Program:
- The Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (SNF HAI) is an outcome measure that assesses SNF performance on infection prevention and management.
- The Total Nursing Hours per Resident Day is a structural measure that uses auditable electronic data to calculate total nursing hours per resident each day.
- The Adoption of the Discharge to Community – Post Acute Care Measure for SNFs (DTC) is an outcome measure that assesses the rate of successful discharges to community from a SNF setting.
To advance health equity and address the health disparities that underlie the U.S. health care system, CMS is requesting stakeholder feedback on the role health equity plays in improving health outcomes and the quality of care in nursing homes. Specifically, CMS is seeking comment on how to arrange or classify measures in nursing home quality reporting programs by indicators of social risk to better identify and reduce disparities.
CMS is proposing a 3.9%, or $1.4 billion, update to the payment rates for nursing homes, which is based on a 2.8% SNF market basket update plus a 1.5 percentage point market basket forecast error adjustment and less a 0.4 percentage point productivity adjustment. The proposed rule also contains a proposed adjustment to payment rates as the result of the transition to the SNF payment case-mix classification model ̶ the Patient Driven Payment Model (PDPM) that went into effect on October 1, 2019. When finalizing the PDPM, CMS also stated that the transition to PDPM would not result in an increase or decrease in aggregate SNF spending. Since PDPM implementation, CMS’ data analysis has shown an unintended increase in payments. Therefore, CMS is proposing to adjust SNF payment rates downward by 4.6%, or $1.7 billion, in FY 2023 to achieve budget neutrality with the previous payment system. As a result, the estimated aggregate impact of the payment policies in this proposed rule would be a decrease of approximately $320 million in Medicare Part A payments to SNFs in FY 2023 compared to FY 2022.
More Information:
- Proposed rule
- Fact sheet: President Biden’s remarks during the State of the Union Address on improving nursing home safety and quality
- Fact sheet: FY 2023 SNF PPS proposed rule
HRSA Announces Availability of New Funding to Support Community-Based Doulas
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (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. This announcement builds on the Biden-Harris Administration’s commitment to reduce maternal mortality and morbidity and address the nation’s Black maternal health crisis.
This funding, provided through HRSA’s Healthy Start Initiative, will increase the total number of Healthy Start doula programs from 25 to approximately 50 nationwide. HRSA’s Healthy Start Initiative works to improve health before, during, and after pregnancy and reduce racial and ethnic disparities in rates of infant deaths and adverse maternal health outcomes.
Read the press release.
What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access
From the Kaiser Family Foundation
With more than two years having passed since the COVID-19 pandemic began in early 2020, questions are being raised about when to end the public health emergency declarations made by the federal government early on, with some advocating for their extension and others calling for their expiration. There are numerous implications to ending these emergency declarations, each of which gave the federal government flexibilities to waive or modify certain requirements in a range of areas, including in the Medicare, Medicaid, and CHIP programs, and in private health insurance, as well as to allow for the authorization of medical countermeasures and to provide liability immunity to providers who administer services, among other things. In addition, Congress also enacted legislation that provided additional flexibilities tied to one or more of these emergency declarations, and as such they too are scheduled to expire when (or at a specified time after) the emergency period(s) expires.
This brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made, summarizes the flexibilities triggered by each, and identifies the implications for their ending, in the following areas:
- Coverage, costs, and payment for COVID-19 testing, treatments, and vaccines
- Medicaid coverage and federal match rates
- Telehealth
- Other Medicaid and CHIP flexibilities
- Other Medicare payment and coverage flexibilities
- Other private insurance coverage flexibilities
- Access to medical countermeasures (vaccines, tests, and treatments) through FDA emergency use authorization (EUA)
- Liability immunity to administer medical countermeasures
This is not meant to be an exhaustive list of all federal policy and regulatory provisions made in response to COVID-19 emergency declarations. For example, we do not cover the entire range of federal and state emergency authorities exercised under Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 waivers; Section 1135 waivers; and 1915 (c) waiver Appendix K strategies. The Centers for Medicare & Medicaid Services maintains a more complete list of coronavirus waivers and flexibilities that have been exercised since early 2020; some state actions to respond to the emergency may have expiration dates that are not tied to the end of the federal emergency declarations.
Click here to read the full brief.
State Telehealth and Licensure Expansion COVID-19 Dashboard: A State-by-State Comparison
During the public health emergency, all 50 states and the District of Columbia used emergency authority to waive some aspect(s) of state licensure requirements to facilitate patients getting care. This has provided an unprecedented opportunity for patients, providers, and policymakers to explore the impact of cross-state care. This has benefited the delivery of health care in many ways, but perhaps most notably, it has opened up many new avenues for patient choice and access to care.
As states begin to lift their COVID-19 emergency waivers or let them expire, many of the telehealth and licensure flexibilities enacted at the start of the pandemic to ensure continuity and access to care for patients are also expiring. The Alliance has created a chart outlining which states have lifted their COVID-19 emergency waivers, and how this has impacted telehealth and licensing flexibilities in each state. This document will be updated regularly, and can be found below.
As of March 8, 2022:
- 29 states and D.C. have ended their emergency declarations: AL, AK, AR, CO, DC, FL, IA, IN, KS, ME, MA, MD, MI, MN, MS, MO, MT, ND, NE, NH, NJ, OH, OK, PA, SC, SD, TN, UT, VT, WI.
- IN and PA, however, have licensure flexibilities still in place through March.
- IA is giving providers through May 17 to obtain licensure.
- KS, NJ and VT have extended licensure flexibilities through state legislation.
- Out-of-state professionals can provide telemedicine services to MN residents if they are registered with the Medical Board per Minnesota Statute § 147.032.
- OK allows out-of-state providers to obtain a temporary critical needs license through September 14, 2022.
- 21 states continue to have emergency declarations in place:
- States with declarations in place include: AZ, CA, CT, DE, GA, HI, ID, IL, KY, LA, NV, NM, NY, NC, OR, RI, TX, VA, WA, WV, WY.
- Of these 21 states, 18 states still have licensure flexibilities in place. Licensure flexibilities have expired in NM and ID, despite emergency declarations still in place. This is also true in AZ given HB 2454 (see below).
- CA is going through a phased rollback of COVID-era waivers, however waivers on telehealth and licensure are still in place.
- In total, 24 states still have licensure flexibilities in place.
Click here for the full report and map.
USDA Invites Applications to Strengthen Rural Cooperatives and Expand Economic Opportunities for People in Rural America
U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small announced that the department is accepting applications for grants to help start, expand or improve rural cooperatives and other mutually-owned businesses.
USDA is offering priority points to projects that advance key priorities under the Biden-Harris Administration to help communities recover from the COVID-19 pandemic, advance equity and combat climate change. These extra points will increase the likelihood of funding for projects seeking to address these critical challenges in rural America.
USDA is making the grants available under the Rural Cooperative Development Grant (RCDG) program to help improve economic conditions in rural areas through cooperative development. For fiscal year 2022, the maximum award is $200,000. Grants are awarded on a competitive basis through a national competition.
Nonprofit organizations and institutions of higher education are eligible to apply for grants to provide technical and cooperative development assistance to individuals and rural businesses.
Electronic applications must be submitted to grants.gov by 11:59 p.m. Eastern Time on June 6, 2022. Interested applicants are encouraged to contact their local USDA Rural Development State Office well in advance of the application deadline to discuss their project and ask any questions about the RCDG program or the application process. Contact information for state offices can be found at http://www.rd.usda.gov/contactus/state-offices.
Additional information on the required materials and how to apply for the RCDG program are available on page 19842 of the April 6, 2022, Federal Register.
If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.
Request for Comment: Medicare FY23 Hospice Payment Rate Update Proposed Rule
From the National Rural Health Association
On March 30, 2022, Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to provide routine updates to the Medicare Hospice payment system for Fiscal Year (FY) 2023.
Total estimated payments to hospices of a 2.7% ($580 million) increase in their payments for FY 2023. Further, the per patient that is made to a hospice annually. The proposed aggregate cap that limits the overall hospice payments for FY 2023 is $32,142.65.
Other key proposals include:
- Establish a permanent, budget neutral, mitigation policy to smooth the impact of year-to-year changes in hospice payments related to changes in the hospice wage index through a permanent cap on decreases greater than 5%.
- Improve data collection to measure and analyze disparities across programs and policies that apply to the Hospice Quality Reporting Program (HQRP) including development of a new HOPE tool, updates to quality measures, CAHPS hospice survey, and advancing HIE.
At this point, NRHA is not planning to submit comments on the proposed changes. Please share any questions or concerns with NRHA staff before the May 31, 2022 deadline. To submit comments, please do so through the federal register here. CMS’s FY23 Hospice Payment Rate Update NPRM Fact Sheet can be found here.
CMS: Eligible Individuals Can Receive Second COVID-19 Booster Shot at No Cost
The Centers for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine and there is no applicable copayment, coinsurance or deductible. People with Medicaid coverage can also get COVID-19 vaccines, including boosters, at no cost.
The Centers for Disease Control and Prevention (CDC) recently updated its recommendations regarding COVID-19 vaccinations. Certain immunocompromised individuals and people ages 50 years and older who received an initial booster dose at least four months ago are eligible for another booster to increase their protection against severe disease from COVID-19. Additionally, the CDC recommends that adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least four months ago can receive a second booster dose of a Pfizer-BioNTech or Moderna COVID-19 vaccine.
The COVID-19 vaccine, including the booster doses, is the best defense against severe illness, hospitalization and death from the virus. CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations. More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html and through the CMS COVID-19 Provider Toolkit.
People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.