The Office for Civil Rights (OCR) released two resource documents for providers and for patients to help explain to patients about privacy and security risks to their protected health information (PHI) when using telehealth services and ways to reduce these risks.

On Nov. 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule announcing finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after Jan. 1, 2024. CMS is finalizing conforming regulatory text changes to implement:

• Extending payment for telehealth services furnished in FQHCs/RHCs through Dec. 31, 2024.
• Delaying the in-person requirements under Medicare for mental health visits furnished by FQHCs/RHCs.
• Including marriage and family therapists (MFTs) and mental health counselors (MHCs) as eligible for payment.
• Aligning enrollment policies so that addiction, drug, or alcohol counselors who meet all of the requirements of MHCs to enroll with Medicare as MHCs will also apply for FQHCs/RHCs.
• Medicare coverage and payment for intensive outpatient program (IOP) services furnished by an FQHC/RHC.
• Extension of the definition of direct supervision to permit virtual presence in FQHCs/RHCs through Dec. 31, 2024.
• A change to the required level of supervision for behavioral health services furnished “incident to” a physician or NPP’s services in FQHCs/RHCs to allow general supervision, rather than direct supervision, consistent with the policies finalized under the PFS during last year’s rulemaking for other settings.
• Inclusion of Remote Physiologic Monitoring and Remote Therapeutic Monitoring in the general care management HCPCS code G0511 when these services are furnished by FQHCs/RHCs.
• Inclusion of Community Health Integration (CHI) and Principal Illness Navigation (PIN) services in the general care management HCPCS code G0511 when these services are provided by FQHCs/RHCs. RHCs and FQHCs that furnish CHI and PIN services will be able to bill these services using HCPCS code G0511, either alone or with other payable services on an RHC or FQHC claim, for dates of service on or after Jan. 1, 2024.
• A change in the methodology to calculate the payment rate for the general care management HCPCS code G0511 that takes into account how frequently the various services are utilized.
• A clarification that obtaining beneficiary consent for chronic care management and virtual communications services is required, but the mode of obtaining the consent can vary and direct supervision is not needed.

Review the CMS press release on the PFS, a summary table, Expanded Medicare Reimbursement for FQHCs Starting Jan. 1, 2024, and a one-pager on the new Intensive Outpatient Program benefit.

The Centers for Medicare and Medicaid Services (CMS) was set to implement a deadline requiring Medicare enrollment of home addresses for providers performing telehealth from home. The date for completion of this work was December 31, 2023, but CMS in a November 6 document, Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19, extended the deadline through December 31, 2024, in response to concerns raised by providers, PACHC, NACHC, and others. Earlier, CMS shared that although this information will be collected for CMS records, the home address does NOT go out on the claims. Between now and the deadline, CMS will work on processes to protect home addresses from public disclosure.

The annual Low-Income Home Energy Assistance Program (LIHEAP) application process for the 2023-24 season is now open for consumers. LIHEAP is a federally-funded program administered by the Pennsylvania Department of Human Services that helps with home heating bills to aid families in staying warm and safe during the winter months. Assistance is available for renters and homeowners. The LIHEAP application period for both cash and crisis grants is open from Nov. 1, 2023, to April 5, 2024. Benefits are determined by county, income, household size and fuel type.

Thanks again to all those who attended the National Stakeholder Call with the CMS Administrator on October 17. In case you missed it, here’s the link to the call summary, recording and transcript: CMS National Stakeholder Calls.

The call featured CMS Administrator Chiquita Brooks-LaSure and her leadership team, who provided updates on CMS’ recent accomplishments and how our cross-cutting initiatives are advancing CMS’ Strategic Plan. CMS serves the public as a trusted partner and steward dedicated to advancing health equity, expanding coverage, and improving health outcomes as we engage the communities we serve throughout the policymaking and implementation process.

We hope you can join us for the next National Stakeholder Call early next year.

From Becker’s Healthcare

Only 45% of U.S. rural hospitals currently offer labor and delivery services, and in 10 states, less than 33% do, according to the Center for Healthcare Quality and Payment Reform.

Over the past decade, more than 200 rural hospitals across the country have ceased delivery services, despite such facilities delivering nearly 1 in 10 babies in the U.S., according to the American Hospital Association.

Low Medicaid reimbursements, rising costs and ongoing staff shortages have led many rural hospitals to close labor and delivery units, leading to a higher number of maternity care deserts — counties without a hospital or birth center offering obstetric care and without any obstetric providers.

Areas where there is low or no access affect up to 6.9 million women and almost 500,000 births across the U.S., a year, according to March of Dimes, a nonprofit aiming to improve maternal and child health. In maternity care deserts alone, about 2.2 million women of childbearing age and almost 150,000 babies are affected.

Couple this with the rise in rural hospital closures (37 facilities have closed since 2020) and rural America has a serious problem on its hands.

“Low Medicaid reimbursement is our greatest challenge, especially in Indiana where rates paid to hospitals have not been raised in over 30 years. This is especially detrimental in rural areas where a higher number of births are covered by Medicaid,” Eric Fish, MD, president and CEO of Schneck Medical Center, in Seymour, Ind., told Becker’s. “In Indiana, over half of babies born on an annual basis are covered by Medicaid, which pays 57 cents on the dollar of the cost of providing care. This means hospitals, specifically in rural areas, are experiencing significant financial losses. Increasing Medicaid reimbursement is imperative to keep these services open and to preserve access in the future.”

Many more rural communities are at risk of losing maternity care because of the financial challenges rural hospitals are facing. Rural hospitals typically lose money on obstetric care, so if a hospital can’t make enough money on other services to offset those losses, it may be forced to eliminate maternity care to prevent the hospital from closing entirely.

Another challenge for rural communities is the ability to recruit and retain health care providers — especially obstetricians.

“In Indiana, 87% of rural residents live in areas with a primary care shortage. Across the country, rural hospitals have been creative in forming strategic regional partnerships, including working with larger hospitals and health systems for care coordination, provider training and other resources,” Dr. Fish said. “Such partnerships help rural patients receive care in their communities while a specialist from a larger system can manage high-risk patients as necessary and support the rural provider in planning for delivery in the community. Solutions are needed to increase the pipeline of health care workers, including incentives for providers who choose to serve rural communities, student loan repayment and more.”

The lack of obstetrics workforce and expertise has been a growing issue in rural America, both for providers and obstetric nurses.

“We have spent upwards of $3 million annually for traveling obstetric nurses to keep our unit staffed 24/7/365, but it is the right thing to do for southwest Iowans in order to decrease the excessive mileage required to reach the nearest obstetrics unit,” Brett Altman, DPT, CEO of Atlantic, Iowa-based Cass Health, told Becker’s. “Low volume obstetrics is not profitable and is one of the key drivers for why so many obstetric units have closed in rural areas as these hospitals hit financial headwinds in addition to concerns of competency.”

With 50% of deliveries in rural areas being funded by Medicaid, the most significant impact would be improved Medicaid reimbursement for maternal care services in rural areas, according to Dr. Altman.

“To help cover the losses associated with obstetrics, perhaps rural hospitals offering obstetrics could qualify for a special exception through Medicaid with an add-on payment program or an annual lump-sum payment, similar to [prospective payment system] hospitals that have received disproportionate numbers of low-income patients, based on the hospital’s disproportionate OB patient percentage,” he said.

It’s no secret that rural hospitals are especially feeling the pinch coming out of the pandemic, but federal financial support or an add-on payment program would go a long way toward ensuring the long-term sustainability of many.

The other big issue rural communities have to contend with is population declines and fewer younger people having children in rural areas, but there are strategies some hospital leaders have found effective in combating these trends.

“Our strategy has been to expand our footprint using a hub-and-spoke model to keep our delivery numbers high enough to maintain competency,” Dr. Altman said. “Over the past three years, we’ve been doing outreach with one of our OBGYNs to three smaller rural hospitals in southwest Iowa, which has increased the number of our deliveries by roughly 50%. It is a win for those outreach communities to have maternal health services available making them more viable places for young people to live, a win for Cass Health, and most importantly a win for young moms in underserved rural areas by creating local access to maternal health services.”

The Federal Office of Rural Health Policy wrapped up a week of recognizing and honoring the heartfelt drive, innovation, and care of providers, administrators, caregivers, researchers, community organizers, and policymakers at every level of government – all working to improve the health and well-being of more than 60 million people living in rural America.

If you missed any of the events, you can come back to view – and share – what happened on HRSA’s page for National Rural Health Day 2023. There, you’ll find:

• Recordings of events;
• Federal investments nationally and state-by-state;
• Infographics describing how HRSA’s investments have been used to address the most pressing issues in rural health;
• Videos showcasing the work of grantees of the Rural Communities Opioid Response Program;
• An episode of the Exploring Rural Health podcast with the CEO of the National Organization of State Offices of Rural Health, the org that started National Rural Health Day back in 2011.

Read more about FORHP’s ongoing efforts supported by HRSA, by the U.S. Department of Health & Human Services, and by the White House; continue to follow what we’re doing on our website and in our Rural Health Updates newsletter, and look for @HRSAgov on social media.

Happy National Rural Health Day.  We hope to see you again next year and every day in between.

The White House issued A Proclamation on National Rural Health Day, 2023

America’s rural communities are indispensable to who we are as a Nation, where over 60 million people who live in rural America fuel our economy and help forge our future.  On National Rural Health Day, we recommit to investing in rural communities and delivering affordable, quality health care so that generations of rural Americans can thrive.

President Biden calls upon the people of the United States to reaffirm our dedication to the health and well-being of rural America and proclaims November 16, 2023, as National Rural Health Day.  

https://powerofrural.org/

#PowerofRural #NationalRuralHealthDay #mnhealth #mnruralhealth