- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- Public Inspection: CMS: Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- 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
HRSA Opens 2020 Nurse Corps Loan Repayment Program
The Nurse Corps Loan Repayment Program is now accepting applications through Thursday, March 12, 2020. Nurse Corps supports registered nurses (RNs), advanced practice registered nurses (APRNs) and nurse faculty by paying up to 85% of their unpaid nursing education debt. In exchange, participants serve for at least two years at a health care facility with a critical shortage of nurses or an eligible school of nursing in the case of nurse faculty. Before you apply, learn about application details including eligibility and service requirements in the 2020 Application and Program Guidance. Program highlights for 2020 include:
- To combat the nation’s opioid crisis, special funding has been provided for psychiatric nurse practitioners. Learn more by listening to a previously recorded webinar
- To increase the field strength of nurses that provide maternity care to women living in rural and underserved communities, there is a percentage of Nurse Corps funds dedicated to nurses specializing in women’s health
Before you apply, read the annually updated Application and Program Guidance. Make sure you understand the terms and conditions of the Nurse Corps contract, which outlines the requirement for fulfilling your minimum two years of service at an eligible critical shortage facility.
Physician Burnout: Definition(s), Cause(s), Impact(s), Solution(s)
National research has revealed it and rural research suggests it: over 40% of today’s physicians are burned out. This in-depth story reviews information about burnout in healthcare professions and for physicians in particular. Along with reviewing causes and impact, a medical school wellness-advocate, a researcher, and a large healthcare organization with a rural footprint shared interventions and solutions.
ONDCP Releases Guide to Build Healthy Drug-Free Rural Communities
On January 31, 2020, the Trump the Administration released a new tool to assist rural community leaders in building an effective local response to the crisis of addiction, the Rural Community Action Guide: Building Stronger, Healthy Drug-Free Rural Communities. The Guide was developed by the Office of the National Drug Control Policy (ONDCP).
The purpose of the Guide is to arm rural leaders with information they can put into immediate action to create change. It provides background information, recommended action steps, and promising practices to help manage the impact of substance use disorder on local communities and help persons with the disease of addiction. The topics are based on lessons learned from Department of Agriculture rural roundtable discussions held in over a dozen states, as well as the experiences of several rural stakeholder partners.
At the launch, ONDCP Director, Jim Carroll was joined by the U.S. Department of Health and Human Services leadership: the Surgeon General, Dr. Jerome Adams; Admiral Brett Giroir, Assistance Secretary for Health; Dr. Elinore McCance-Katz, Assistance Secretary, SAMHSA; and, Brian LeClair, Deputy Administrator, HRSA.
A diversity of partners (rural and urban) contributed to the work and attended the event including: Addiction Policy Forum, American Farm Bureau Federation, Appalachian Regional Commission, Center for Court Innovation, Community Anti-Drug Coalitions of America, Faces & Voices of Recovery, Housing Assistance Council, National Alliance for Recovery Residences, National Association of Counties, National Association of Development Organizations, National Farmers Union, National Rural Health Association, National Sheriff’s Association, NORC Walsh Center for Rural Health Analysis, NTCA- The Rural Broadband Association, National Rural Transit Assistance Program, Pew Charitable Trusts, and the U.S. Department of Agriculture (National Institute of Food and Agriculture and the Center for Faith-Based and Neighborhood Partnerships).
The guide complements both the Community Assessment Tool, which gives county specific data about deaths and factors which may make a community more vulnerable to addiction, and the Federal Rural Resources Guide, which includes comprehensive information about different federal funds for rural communities impacted by addiction. The Guide also has a companion supplement, a listing of promising practices which you can find here: Rural Community Action Guide: Promising Practices.
ONDCP will be holding a series of rural roundtables to discuss the Guide. The first one will be held in Cape Girardeau, Missouri on February 19, 2020.
Wolf Administration Hosts Roundtable Discussing Effects of Federal SNAP Cuts on Food Banks, Economy, and People Across Pennsylvania
On February 3, 2002, Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller today joined representatives from anti-hunger organizations, employment and training program programs, local grocery retailers, as well as state and local officials at Philabundance to discuss the effects from the Trump Administration’s numerous attacks on the Supplemental Nutrition Access Program (SNAP). Cuts and changes to eligibility for the program will negatively affect charitable food networks across the state, thousands of vulnerable Pennsylvanians, and Pennsylvania’s economy.
“SNAP is not just the nation’s most important anti-hunger program – it helps support local farmers and small businesses and grows economies around the country,” Sec. Miller said. “If proposed federal changes to the SNAP program take effect, the negative impacts will be felt well beyond the thousands of SNAP recipients who will be hurt. Without SNAP, charitable food networks will see an increased demand that they may be unable to meet, and retailers and food producers will experience lost profits from a decreased or more constrained customer base.”
SNAP helps more than 1.7 million Pennsylvanians access food, including about 700,000 children, about 690,000 people with disabilities, and about 300,000 older adults. If people receive less SNAP benefits each month or lose eligibility altogether, they may not have flexibility to make up the cut to their food budget without missing bills or giving up other essential needs. People will turn to local food banks, pantries, and soup kitchens to help meet this need, which creates additional strain on charitable food networks that operate on limited resources.
“This new rule could have dire consequences for over 40,000 people in the Delaware Valley,” said Glenn Bergman, Philabundance Executive Director. “With 700,000+ people already facing hunger in our area, food banks like ours will not be able to make up the difference if cuts occur. This is a short-sighted move by the administration that will not help people find jobs, not make our neighbors more stable and will significantly increase the severity of the hunger crisis in our area.”
In addition to SNAP helping 1.7 million Pennsylvanians keep food on the table and avoid chronic hunger, SNAP helps local economies. More than 10,000 authorized retailers participate in SNAP across Pennsylvania, and these retailers redeemed about $2.6 billion in SNAP benefits in 2018 according to the USDA.
In May 2019, the United States Department of Agriculture (USDA) published a study on the influence of SNAP redemptions on the economy and county-level employment in the time leading up to, during, and after the Great Recession. This study found that SNAP redemptions could have a greater economic stimulus impact than many other forms of government spending per dollar spent, especially during a recession, because they are paid directly to low-income individuals. For instance, the grocery subsidies deliver food directly to tables along with a financial return into rural supermarkets and small businesses in those communities.
The Trump Administration has proposed two rules and has finalized a third that will jeopardize access to SNAP:
- Abled-Bodied Adults Without Dependents (ABAWDs) final rule: In December 2019, the Trump Administration published a final rule, that goes into effect April 2020, that restricts states’ ability to determine which counties can be waived from work requirements for able-bodied adults without dependents, which are waived due to local unemployment rates. The ability to waive counties is now based on federally determined Labor Market Areas and on economic factors like excess labor and high unemployment. The new rule lowers the threshold for unemployment rates those areas must meet to qualify for a waiver and removes state flexibility to determine which counties should be waived, despite states being better positioned to determine the economic environment in the local economies. This rule change will jeopardize access to SNAP for more than 92,000 people, many of whom struggle with mental health, substance use disorder, and other long-term conditions that would be worsened by chronic hunger.
- Broad-Based Categorical Eligibility (BBCE) proposed rule: The Trump Administration in July announced a proposal to eliminate BBCE for SNAP. BBCE is a policy that gives states, including Pennsylvania, the flexibility to determine appropriate income thresholds and extend SNAP benefits to low-income families and individuals who would otherwise struggle to afford food. With BBCE, a Pennsylvania family of four is eligible for SNAP if they earn no more than about $40,000 a year. If BBCE is eliminated, that family of four’s SNAP eligibility limit will drop from about $40,000 a year to no more than $32,000 a year. For elderly single-person households, the limit would change from approximately $24,000 a year to about $15,000. Eliminating BBCE also impacts the ability for low-income children to receive free and reduced-price school lunches. Families whose children are eligible for SNAP receive direct certification for eligibility for free and reduced-price lunches. Additionally, in districts where 40 percent or more children receive free and reduced-price lunches, the school qualifies for the Community Eligibility Provision, which allows schools and school districts in low-income areas to provide free school lunches to the entire school. Reduction in the number of children receiving direct certification may mean entire districts lose their ability to provide free meals for all students.
- Heating/Cooling Standard Utility Allowance (SUA) proposed rule: And in October, the Trump Administration announced a proposal to alter the method Pennsylvania uses to determine the Heating/Cooling SUA for SNAP recipients, which could negatively affect approximately 775,000 households in Pennsylvania. When DHS determines that a household is eligible for SNAP, to determine the value of the grant they will receive, the SUA is used as a factor; acknowledging that money needed to pay for shelter and utilities is not available to be used to purchase food. The Trump Administration’s rule would use a standard formula to determine each state’s SUA for the entire country, ignoring costs of living and utility rates that vary from state to state. The proposed rule impacts the Northeast states more significantly than the rest of the country due to the information used in the calculation. In Pennsylvania, each reduction in the SUA of $10 equates to a $2 to $3 reduction in SNAP benefits. If the Heating and Cooling SUA was reduced by $200, for example, most households would see a reduction in SNAP benefits of $40 to $60 per month.
SNAP participants have an opportunity to gain skills through SNAP 50/50 programs that can help them get a job and excel in career paths like culinary arts, hospitality, banking, health care, and skilled labor. The programs also help with job placement and job retention skills. SNAP 50/50 partnerships come at no cost to the commonwealth and create great value by helping participants gain valuable career skills that can help them find a career path and move off public assistance like SNAP and reach self-sufficiency. By helping participants move into the workforce, SNAP 50/50 supports communities that need skilled workers and helps broaden the state’s tax base.
There are currently 19 SNAP 50/50 programs across Pennsylvania including Philabundance Community Kitchen and Project HOME at the roundtable today. DHS has seen more than 300 positive outcomes – graduations or employment placements – since the start of the SNAP 50/50 program. DHS is actively working to expand SNAP 50/50 partnerships around Pennsylvania, but without greater support from the federal government, there will not be enough employment and training programs to meet the need created by the ABAWD rule’s more stringent work requirements.
“Every one of these rule changes hurts vulnerable people and organizations in Pennsylvania and around the country,” said Secretary Miller. “Every one of these rule changes forces people who are already in difficult positions to make the unconscionable choice of paying for food or paying for other necessities like utilities, rent, or medicine. Food assistance is a simple investment in the public good for all of us. We must lift up the stories of the many Pennsylvanians for whom food assistance programs like SNAP and the help from charitable food organizations is invaluable and protect and preserve these life-saving resources.”
For more information on SNAP, visit www.dhs.pa.gov.
MEDIA CONTACT: Erin James – 717-425-7606
Surgeon General Releases Report on Smoking Cessation
The U.S. Surgeon General released a report on smoking cessation that reviews and updates evidence on the importance of quitting smoking. The report discusses the immediate and long-term health and economic benefits of smoking cessation at the individual and societal levels. The report also covers clinical and population-based interventions that have been shown to effectively increase smoking cessation.
New Resources on Fluoride Varnish and Silver Diamine Fluoride
The National Maternal and Child Oral Health Resource Center at Georgetown University recently published “Fluoride Varnish and Silver Diamine Fluoride: A Resource Guide.” The guide provides descriptions of materials on data and surveillance, professional education and training, and public education.
ED Utilization for Non-Traumatic Dental Conditions
The ASTDD Dental Public Health Policy Committee released a new policy statement on “Reducing Emergency Department Utilization for Non-Traumatic Dental Conditions.” Seeking care in emergency departments for non-traumatic dental conditions has increased substantially in recent years. Reported barriers to oral health care include misdistribution of dentists in rural areas and the cost of dental treatment.
FCC Approves $20 Billion Rural Broadband Funding Plan
Published by Route Fifty, January 30, 2020
The Federal Communications Commission voted January 30, 2020 to approve a $20.4 billion plan to subsidize the construction of high-speed broadband networks in rural America. FCC Chairman Ajit Pai called the vote the “biggest step the FCC has ever taken to close the rural digital divide.”
The Rural Digital Opportunity Fund will help internet service providers deploy broadband over 10 years to areas currently lacking service of at least 25 megabits per second download and 3 Mbps upload speeds. The federal agency estimates about six million rural homes and businesses are located in areas that could benefit from the initiative. Internet service providers, including telecoms and government utilities, would bid to provide broadband and voice services to the locations. Read more.
CMS Rolls Out Guidance to Help States Convert Medicaid Funding into Block Grant
Published in FierceHealthcare, January 30, 2020
The Trump administration has rolled out new guidance to enable states to convert Medicaid funding into a block grant, but only for a limited population.
The Centers for Medicare & Medicaid Services (CMS) released Thursday the Healthy Adult Opportunity Initiative that would enable states to voluntarily apply for a waiver to get a fixed amount to pay for services for adults who aren’t disabled, pregnant or elderly. The initiative is already getting severe pushback from patient advocacy groups, signaling a potential new legal fight for the agency.
“We’ve built in strong protections for our most vulnerable beneficiaries, and included opportunities for states to earn savings that have to be reinvested in strengthening the program so that it can remain a lifeline for our most vulnerable,” said CMS Administrator Seema Verma in a statement.
The initiative will only apply to a limited population: adults under 65 not eligible for Medicaid because of a disability or need for long-term care services. Very low-income parents, children, pregnant women, elderly adults and the disabled are not affected.
A state that gets a waiver from CMS under the initiative can adjust benefits for the limited population or “align benefits more closely to what is available through a commercial insurance benefit package,” according to a fact sheet on the proposal. The states would get a “defined budget target” that is adjusted to either a flat amount or on a per-enrollee basis. “The targets will be negotiated based on the state’s own historic costs and other factors like national and regional trends,” CMS said.
A state has to maintain spending on health services at a “level at least 80% of the target amount,” the fact sheet said. “To the extent they achieve savings and demonstrate no declines in access or quality, CMS will share back a portion of the federal savings for reinvestment in Medicaid.” The state could get a share of between 25-50% of the savings similar to value-based care payment models, Verma said during a briefing on Thursday.
States would also get the power to design a formulary under the initiative similar to those used in commercial insurance markets. The goal is to give states more negotiating power over drugs. However, such formularies can implement tools such as prior authorization or step therapy to steer patients into cost-effective treatments but generate complaints about access to products.
A state that gets a waiver can use any combination of fee-for-service or managed care delivery systems and “will have the flexibility to alter these arrangements over the course of the demonstration, as long as certain guidelines are met,” CMS said in its fact sheet of the demonstration.
Verma said that the states must meet minimum benefit requirements and cannot cap benefits.
However, some physician and patient advocacy groups have long complained that block grants will lead to states cutting eligibility and benefits and warned of the administration’s latest approach.
A transition to block grants could transform Medicaid into a “program with funding limits that drive care rationing for the most vulnerable,” said Howard Burris, president of the American Society of Clinical Oncology, in a statement before the guidance’s release.
Burris added that reducing access to care such as recommended cancer screenings could eventually lead to higher costs for states when patients present a “complex, late-stage illness.”
The American Medical Association charged in a statement that any cap on Medicaid funding will “increase the number of uninsured and undermine Medicaid’s role as an indispensable safety net program.”
The Federation of American Hospitals also lambasted the proposal. “Medicaid block grants have rightly been rejected by Congress,” said President and CEO Chip Kahn. “Rebranding them under the thin veil of a demonstration doesn’t change the fact they would lead to arbitrary cuts that will weaken Medicaid for those most in need.”
Tennessee so far is the only state to apply for a waiver to get a block grant, but it may not be the last. The state’s proposal said it would base the block grant on the historical Medicaid spending through state fiscal years 2016 and 2018.
However, some services would still be covered by the federal-state match. Those services include prescription drugs and uncompensated care to hospitals, some of the sources of higher costs for Medicaid.
Tennessee’s proposal stressed that it won’t lower benefits or eligibility to get savings from the block grant. However, the state does want to be exempt from any new federal mandates on eligibility or covered benefits from Congress or the federal government.
It won’t be the only state. Oklahoma Republican Gov. Kevin Stitt said at an event on Thursday announcing the initiative that the state is considering getting a waiver under the initiative in addition to work requirements.
Block grants have been a popular healthcare policy fixture among conservatives. A 2017 Affordable Care Act (ACA) repeal bill sponsored by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would convert all ACA funding into a block grant.
The bill would also have converted Medicaid funding into a per-capita cap system, which would give states a fixed amount per beneficiary for Medicaid.
Graham and Cassidy’s bill was scuttled in the fall of 2017 after insufficient GOP support in the Senate, but the idea of a block grant for Medicaid continues to retain popularity among conservatives eager to cut entitlement spending.
APHA Healthiest Cities & Counties Challenge
The American Public Health Association (APHA) announces a new Healthiest Cities & Counties Challenge. APHA, in partnership with the Aetna Foundation—a private foundation affiliated with CVS Health—and National Association of Counties, will provide $100,000 in funding and nonfinancial support to selected communities to address access to foods that support healthy eating patterns and access to health services through systems-level approaches and resident engagement over a two-year period.
The Challenge invites applications from cities, counties and federally recognized tribes with a population of up to 600,000 in California, Florida, Georgia, Kentucky, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, and West Virginia that are prepared to work across silos in order to advance health equity and prevent chronic diseases. The deadline is end of February!