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!

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 10^th 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 11^th 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 12^th 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 19^th at 4:00pm EDT

Registration Link: mitre.zoomgov.com/meeting/register/…

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.

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

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

Press Release: https://www.cms.gov/newsroom/press-releases/cms-proposes-updates-reduce-barriers-coverage-simplify-medicare-enrollment-and-expand-access

Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/implementing-certain-provisions-consolidated-appropriations-act-2021-and-other-revisions-medicare-1

Federal Register: https://www.cms.gov/files/document/cms-4199-p.pdf

The National Rural Health Association (NRHA) team submitted comments in response to the OSHA COVID-19 notice of limited reopening of comment period.

NRHA recognizes the need to protect healthcare and healthcare support service workers from occupational exposure to COVID-19 in settings where people with COVID-19 are reasonably expected to be present.  As OSHA works towards permanent regulator solutions, we encourage the agency to recognize already established protocols given where healthcare providers are at this point in the pandemic.  NRHA maintains the position that adding burdensome standards, like the prior ETS proposes, will not protect patients or employees.  Rather it will pull limited staff and financial resources in directions that could be better used providing health care to patients, especially in rural areas.  We have heard from members across the country about loss of staff due to the mandatory vaccination requirements, which perpetuates significant workforce shortages in our rural health care facilities. 

Please feel free to reach out to Carrie (ccochran@ruralhealth.us) with any questions. 

The Appalachian Leadership Institute (ALI) is now accepting applications!

ARC is seeking 40 fellows from all 13 Appalachian states, and all walks of community life, for the Class of 2022-2023.

ALI is a FREE leadership and economic development program designed to help anyone who lives or works in Appalachia gain skills to strengthen their community. From October 2022 – July 2023, participants will attend six multi-day seminars across the Region, and end with a capstone graduation event held in Washington, DC.

Apply by June 1 at arc.gov/leadership.

On April 18, CMS issued a proposed rule for inpatient and long-term hospitals that builds on the Biden-Harris Administration’s key priorities to advance health equity and improve maternal health outcomes. In addition to annual policies that promote Medicare payment accuracy and hospital stability, the fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule includes measures that will encourage hospitals to build health equity into their core functions, thereby improving care for people and communities who are disadvantaged and/or underserved by the health care system. The rule includes 3 health equity-focused measures in hospital quality programs, seeks stakeholder input related to documenting social determinants of health in inpatient claims data, and proposes a “Birthing-Friendly” hospital designation.

For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record users, the proposed increase in operating payment rates is projected to be 3.2%. This reflects a FY 2023 projected hospital market basket update of 3.1% reduced by a projected 0.4 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by statute. Under the LTCH PPS, CMS expects payments to increase by approximately 0.8% or $25 million.

Additional items in the proposed rule related to payment stability for hospitals include a policy that smooths out significant year-to-year changes in hospitals’ wage indexes and a solicitation for comments on payment adjustments for purchasing domestically made surgical N95 respirators. Specifically, CMS is proposing to apply a 5% cap on any decrease to a hospital’s wage index from its wage index in the prior FY; and is considering the appropriateness of payment adjustments accounting for additional costs of purchasing surgical N95 respirators made in the U.S.

More Information:

• Complete press release
• Proposed payment rule fact sheet
• Maternal health & health equity measures fact sheet
• White House statement on Reducing Maternal Mortality and Morbidity
• Proposed rule: Comment by June 17

11 Projects Will Help People in Equity Communities Access Clean Energy

In honor of Earth Day 2022, State Director for Rural Development Bob Morgan announced that the U.S. Department of Agriculture (USDA) is investing more than $16 million in 11 projects in rural Pennsylvania. These investments will strengthen the health and livelihoods of people across rural America.

Today’s announcement is part of the Biden-Harris Administration’s Building a Better America Rural Infrastructure Tour, during which Biden Administration officials are traveling to dozens of rural communities to talk about the impact of Bipartisan Infrastructure Law investments, as well as President Biden’s broader commitment to ensure federal resources reach all communities in rural America.

“People in rural America and across the world frequently experience the impacts of climate change in many ways. This includes more severe droughts, more frequent wildfires, and more destructive and life-threatening storms,” Morgan said. “When we invest in infrastructure in rural communities, we invest in our planet. USDA is proud to celebrate Earth Day and the many ways we are addressing climate change and investing in locally-driven solutions to bring safe water and renewable energy to people in rural areas everywhere.”

USDA Rural Development is taking several actions to mitigate the impacts of climate change in rural communities.

Advancing Equity in Rural Communities

USDA Rural Development is prioritizing projects that advance the Biden-Harris Administration’s key priorities of investing in rural communities to ensure people have equitable access to critical resources and to combat the climate crisis. Investments in these communities will make an impact for generations to come.

For example, the projects in today’s announcement will help advance equity in rural communities, especially in those that have been socially vulnerable, distressed and underserved for far too long.

Clean Energy Infrastructure and Energy Efficiency Improvements

USDA is investing nearly $200,000 in renewable energy infrastructure in Pennsylvania to help agricultural producers, rural small business owners and residents lower energy costs and make energy-efficiency improvements. The Department is making the investments under the Electric Loan Program and the Rural Energy for America Program (REAP).

Through REAP, Rural Development is helping 8 rural businesses and agricultural producers get access to clean energy, while reducing their carbon footprint to make their business operations more cost-effective.

• Saint Francis University in Cambria County received a REAP Energy Audits and Renewable Energy Development grant of $100,000 to assist 28 agricultural producers and rural small businesses across the state of Pennsylvania receive low-cost energy assessments aimed at reducing their energy costs over time. Funds will also be used to create marketing materials, which will be distributed to bring awareness to the program. This program strengthens American energy independence by increasing the private sector supply of renewable energy and decreasing the demand for energy through energy efficiency improvements.

A complete list of all the projects can be found on our website.