The Biden-Harris Administration celebrated Earth Day by focusing on its theme, “invest in our planet”, and is committed to addressing climate change, advancing health equity and pursuing environmental justice – which all depends on a healthy, clean planet. The following is a snapshot of various Earth Day activities the U.S. Department of Health and Human Services, its new Office of Climate Change and Health Equity and other divisions are coordinating as part of a commitment to building a healthier, more climate-resilient future.

“There is an urgent need to act now, and HHS is stepping up to deliver. From releasing $385M in Low Income Home Energy Assistance Program (LIHEAP) funds to introducing a pledge initiative that will connect public and private healthcare stakeholders to reduce emissions, we will use every tool in our toolbox to ensure a healthier future for all,” said HHS Secretary Xavier Becerra.

“History will judge us for the actions or inactions that we take today. I am proud to work for an administration that is choosing to take action, and choosing to prioritize climate and health on Earth Day, and every day,” said HHS Assistant Secretary for Health Admiral Rachel Levine.

The following is a short overview of some of the Department’s efforts surrounding Earth Day 2022.

Assistance and Tools to Address Climate Impacts

• Announced the release of $385M in Low Income Home Energy Assistance Program (LIHEAP) funds, which helps keep families safe and healthy through initiatives that assist families with energy costs.  [ACF]
• Launched the LIHEAP Heat Stress Geographic Information System (GIS) Dashboard that provides information on the progression of extreme heat over time, the health impacts of extreme heat, and visualizations on how LIHEAP is able to alleviate extreme heat stress for vulnerable populations, among other information/tools. The dashboard provides high-quality, accessible, and timely information for our grant recipients and partners to help them determine how best to utilize LIHEAP and other resources to help promote health and wellbeing for vulnerable populations. [ACF]
• Published an Office of Community Services Earth Day webpage that has information on the Dashboard, Earth Day one pagers for LIHEAP, the Low-Income Household Water Assistance Program (LIHWAP), and the Rural Community Development program, and videos on LIHEAP and LIHWAP, and a social media toolkit that can be used to promote the programs and underscore their impact. [ACF]
• Issued a new AHRQ Healthcare Cost and Utilization Project data brief, “Emergency Department Visits for Diagnoses Directly Indicating Heat Exposure: Variation Across Counties in the United States, 2016 – 2020” that quantifies wide state variations in heat-related emergency department visits due to extreme heat exposure. The brief also showed rural counties were more likely than urban counties to have higher rates of ED visits related to heat exposure. [AHRQ]
• Issued a new AHRQ Views blog post “Earth Day at AHRQ: Celebrating Hope through Action” by Agency Deputy Director David Meyers, M.D., and Social Science Analyst Brent Sandmeyer, M.P.H. [AHRQ]
• Hosted the HHS Earth Day 2022 Speaker Series with climate change experts from across the federal government to discuss the basics of climate change, climate science, how climate change impacts health, and how the Office of Climate Change and Health Equity (OCCHE) is coordinating climate and health equity efforts across the Department. [OCCHE and ASA]

Healthcare Sector Resilience and Decarbonization

• Issued a new Pledge Initiative, in partnership with the White House, as a call to action for health care stakeholders to address climate change, including pledges by private sector health systems and other organizations to reduce greenhouse gases. [OCCHE]
• Published a New England Journal of Medicine Perspective “After COP26 — Putting Health and Equity at the Center of the Climate Movement.” [OCCHE]
• Released a request for information in the CMS FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals (LTCH PPS) Proposed Rule seeking input on how health care providers can more effectively respond to climate risks and reduce their emissions and how HHS can support their efforts. [CMS]

Mental Health and Climate Change

• Posted information on disaster preparedness in an era of climate change on SAMHSA’s Disaster Behavioral Health Information Series Resource Center (DBHIS) on SAMHSA.gov. [SAMHSA]
• Released an issue of the quarterly Dialogue newsletter entitled Disaster Behavioral Health in an Era of Climate Change – PDF on SAMHSA.gov. [SAMHSA]

Environmental Justice

• Released a draft outline of 2022 HHS Environmental Justice Strategy and Implementation Plan for public comment on the Federal Register, which closes May 19, 2022. [OCCHE]

Environmental Health Initiatives and Research

• Environmental Health Perspectives (EHP), a leading monthly journal of environmental health research and news published with support from the National Institute of Environmental Health Sciences, part of NIH, is celebrating its 50th anniversary on Earth Day, April 22, 2022.  The journal has contributed significantly to public health over the past five decades. We are excited to honor key moments that established EHP’s leadership in environmental health research and scholarly publishing. (NIEHS)
• Aubrey K. Miller, senior medical advisor to the director of the National Institute of Environmental Health Sciences (NIEHS), will present a keynote at 12:00 pm ET: “Applied Science to Address the Health Impacts of Disasters and Climate Change: Challenges and Opportunities” as part of the 2022 John P. Wyatt, M.D. Environment and Health Symposium at the University of Kentucky on Earth Day, April 22, 2022. (NIEHS)
• Promoted the HHS Endocrine-Disrupting Chemicals (EDC) Innovator Award Competition: Innovative Methods to Address the Impact of Endocrine-Disrupting Chemicals on Black or African American Women. The competition aims to identify and fund programs that demonstrate effectiveness, sustainability, and the ability to replicate and/or expand interventions that address gaps in knowledge and provide solutions to reduce EDC exposure risk for Black or African American women. [OWH]

Digital Medicare Resources

• Promoted the “Go Digital” theme on the Medicare.gov homepage – to reduce waste and receive real-time updates -including a blog and video with information and instructions on how to sign up for the digital Medicare handbook. [CMS]

Department Responds in Record Time to Meet the Growing Health Care Needs in Rural America

U.S. Department of Agriculture (USDA) Rural Development State Director Bob Morgan announced that USDA is awarding $3.9 million in Emergency Rural Health Care Grants to 6 rural health care organizations and community groups in Central 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,” Morgan 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.”

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.

Morgan made the announcement at Evangelical Community Hospital. The hospital is one of six recipients to receive grant funds in Central Pennsylvania. The hospital will use a $487,800 grant to support the purchase of an Advanced Life Support (ALS) Medic Unit with radio equipment as well as patient monitors and ancillary equipment to be used in the hospital on inpatient and outpatient units.

The COVID-19 pandemic increased the demand for care on both Emergency Medical Services (EMS) and hospital fronts. The new unit and equipment allows the hospital to be ready from an emergency and in-hospital care standpoint to handle any future COVID-19 surges as well as medical treatment for conditions outside of COVID-19.

Additional awardees in the 12th Congressional District include:

• The Clinton County Department of Emergency Services received a $750,000 grant to purchase and install tower communications equipment for towers in Leidy Township and Chapman Township. The funds will also be used to purchase radio communications equipment to better serve the Bucktail Regional Medical Center. This project will help ensure the emergency services call center reaches the area, and it will improve communication between the hospitals, ambulance services and fire companies.
• Broad Acres Nursing Home Association in Tioga County received $1 million grant to reimburse lost health care revenue incurred from March 13, 2020, to August 31, 2021. The funds will be used to promote or administer vaccines to current and future residents and staff, and to increase testing.
• Lock Haven Emergency Medical Services in Clinton County received a $309,700 grant to purchase two ambulances, two cardiac monitors and defibrillators, a power load system, two Motorola mobile units and six Motorola portable radios. The equipment is needed to help the company provide services to the community, which has seen an influx of patients due to the COVID-19 pandemic.
• Centre Care Inc. in Centre County received a $1 million grant to reimburse lost health care revenue from March 15, 2020, through August 31, 2021, due to the COVID-19 pandemic. The funds will be used to promote or administer vaccines to current and future residents and staff, and to increase testing. Centre Care Incorporated provides nursing, assisted living and senior retirement care to qualifying persons.
• Citizens Hose Company of South Renovo in Clinton County received a $443,800 grant for a quick response unit rescue truck. The new vehicle will allow for better and more reliable response times, and equip the fire department with the necessary equipment, tools and diagnostic capabilities to perform the emergency response tasks. It will also be used to serve as a mobile vaccine administration and testing unit as necessary for the COVID-19 pandemic and for future health crises. This equipment will allow emergency services to reach the remote portions of the service area. The equipment will allow the fire response team to setup a mobile medical unit during emergency situations before ambulance services arrive.

On April 13, a total of $10.5 million in Emergency Health Care grant projects were announced in Pennsylvania. This included 18 projects across Pennsylvania. A full list of these projects can be viewed on our website. This funding will help meet the demands of growing health care needs in rural America and expand access to health care services for 2.2 million people across 22 states.

USDA will announce additional recipients of Emergency Rural Health Care Grants in the coming weeks and months.

Sens. Chuck Grassley (R-Iowa) and Bob Casey (D-Pa.) recently introduced the Rural Hospital Support Act, which would permanently extend two key Medicare rural hospital programs and establish a new rebasing year. “As rural America rebounds from the COVID-19 pandemic, now is not the time to let lifeline programs lapse,” says NRHA CEO Alan Morgan. “Reauthorization is critical to ensuring stability for the rural health safety net.” Complementary legislation, the bipartisan Save America’s Rural Hospitals Act, was recently introduced to the 117th Congress with the goal to raise the rural health safety net, which is crucial to the survival of rural communities.

Interested in advocating on behalf of rural health? Sign up to participate in NRHA’s rural health advocacy campaigns and be sure to review NRHA’s updated advocacy 101 guide.

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.

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:

• Fact Sheet: Behavioral Health Strategy Fact Sheet (PDF)
• Webpage: https://www.cms.gov/About-CMS/Story-Page/behaviorial-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. 

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

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.