Rural Health Information Hub Latest News

The CDC Lacks a Rural Focus. Researchers Hope a Newly Funded Office Will Help.

In 2017, the Centers for Disease Control and Prevention published multiple reports analyzing health disparities between rural and urban populations.

That effort pleased researchers and advocates for improving rural health because the dozen or so examinations of rural health data provided important details about the 46 million Americans who live away from the nation’s population centers. It began to fill a gap in the information used by those who study and address the issues that affect people in rural communities.

But those reports, the Morbidity and Mortality Weekly Report rural health series, began and ended in 2017. And though the CDC has addressed rural health in other weekly reports and data briefs, the agency hasn’t examined it in such depth since.

That’s one reason rural health advocates successfully pushed for the CDC to extend its rural health focus by creating an Office of Rural Health at the agency. The office is operational as of March 2023, and advocates hope the agency will commit to rural health research and provide analyses that lead to good public health policies for rural communities.

“What we’re seeing is rural continually getting left behind,” said Alan Morgan, CEO of the National Rural Health Association, which urged Congress to fund the office. “They’re communities at risk, communities that may not be employing public health safety measures, and we are flying blind,” he said.

“What’s needed is an ongoing look at rural communities, their populations, to better direct both state and federal efforts to address health disparities,” he said.

Read more.

Stratified Report in Health Care in Medicare Advantage by Race, Ethnicity, and Sex

In recognition of National Minority Health Month, CMS OMH released a report outlining the quality of care received by people enrolled in Medicare Advantage to further understand and address health disparities. The Disparities in Health Care by Race, Ethnicity, and Sex report details the racial, ethnic, and sex differences in health care experiences and clinical care received by Medicare Advantage enrollees based on data reported in 2022.

This report explores national-level race, ethnicity, and sex disparities in health care quality received by Medicare Advantage enrollees in 2022. The report found Black, Hispanic, and particularly American Indian and Alaskan Native enrollees experienced lower than average quality for clinical care across many measures examined in the report. In particular, significant disparities in flu vaccination rates, as compared to the national average, with Black, Hispanic, and Multiracial enrollees vaccinated for the flu at lower than average rates.

This report is based on an analysis of two sources of information, the Healthcare Effectiveness Data and Information Set (HEDIS) and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. HEDIS collects information from medical records and administrative data on the quality of care that people enrolled in Medicare receive. The Medicare CAHPS survey is conducted annually by CMS and focuses on the health care experiences of people with Medicare across the nation.

Health care professionals, organizations, researchers, and hospital leaders can utilize this report along with other CMS tools and resources to help raise awareness of health disparities, develop health care interventions for racially and ethnically diverse populations, and implement quality improvement efforts that advance health equity.

CMS OMH welcomes your participation in promoting health observances such as National Minority Health Month, not only in April, but all year long to raise awareness about health issues affecting people across our nation.

Visit https://go.cms.gov/omh to learn more.

HHS Releases New Guidance to Encourage States to Apply for New Medicaid Reentry Section 1115 Demonstration Opportunity to Increase Health Care for People Leaving Carceral Facilities

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is announcing a new opportunity for states to help increase care for individuals who are incarcerated in the period immediately prior to their release to help them succeed and thrive during reentry. The new Medicaid Reentry Section 1115 Demonstration Opportunity would allow state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions.

“The Biden-Harris Administration has made expanding access to high-quality, affordable health care a top priority,” said HHS Secretary Xavier Becerra. “We are committed to ensuring all Americans have the peace of mind they deserve knowing they have access to life-saving health care, whether it is medication-assisted treatment for substance use disorders or prescription medication to treat other chronic health conditions. Through this historic new effort, we are working to ensure that people who were formerly incarcerated can transition successfully back into the community with the health care supports and services they need. This is an essential step for advancing health equity in our nation and we encourage all states to take advantage of this new opportunity.”

“Today, we reach a significant milestone in expanding access to health care in the Medicaid program,” said CMS Administrator Chiquita Brooks-LaSure. “This guidance outlines a pathway to implement historic changes for individuals who are incarcerated and eligible for Medicaid. By improving care and coordination prior to release from the justice system, we can help build a bridge back to the community and enhance individual and collective public health and public safety outcomes.”

The goal of this demonstration opportunity is to help Medicaid enrollees establish connections to community providers to better ensure their health care needs are met during their reentry process. In January, California became the first state to cover certain health care services for individuals transitioning back to the community. CMS’ action today builds on priorities established by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, and supports President Biden’s comprehensive, evidenced-based public safety strategy, the Safer America Plan, as well as the President’s Unity Agenda to address the mental health crisis and the opioid epidemic.

The Medicaid Reentry Section 1115 Demonstration Opportunity will allow states to cover a package of pre-release services for up to 90 days prior to the individual’s expected release date that could not otherwise be covered by Medicaid due to a longstanding statutory exclusion that prohibits Medicaid payment for most services provided to most people in the care of a state or county carceral facility.

According to the U.S. Department of Justice, from 2011 to 2012, approximately 37 percent of people in state/federal prisons and 44 percent of people who were incarcerated overall had a history of mental illness. The National Institute on Drug Abuse (NIDA) estimates that the rate of substance use disorders for people who are incarcerated may be as high as 65 percent. The NIDA report also says that, without treatment, individuals formerly incarcerated are at increased risk of overdose within the first few weeks of reentry.

The Medicaid Reentry Section 1115 Demonstration Opportunity focuses on covering high-quality services for individuals who are incarcerated, eligible for Medicaid, and returning home to their communities – a group of individuals who have been historically underserved and adversely affected by persistent poverty and inequality. Improving health care transitions and addressing social determinants of health – from case management to medication-assisted treatment – for individuals after they have been released from carceral settings increases the likelihood that they may continue to receive crucial substance-use disorder, mental health, and other health care treatment during this vital period. It also holds promise for reducing emergency department visits, inpatient hospital admissions, overdose, and overdose-related issues, including death, and improving health outcomes overall. Moreover, addressing people’s underlying health needs enhances their ability to succeed and thrive during reentry, thereby lowering the risk of recidivism, helping make our communities healthier and safer.

In addition to increased health and well-being and saving lives, the demonstration aims to accomplish several other essential goals, including improving coordination and communication between correctional systems, Medicaid systems, managed care plans, and community-based providers, as well as increasing investments in health care and related services.

To learn more, read the complete State Medicaid Direct Letter on Medicaid.gov.

USDA Offers New Funding to Promote the Expansion of High-Speed Internet in Rural Areas

The U.S. Department of Agriculture (USDA) today announced the availability of $20 million to deliver broadband technical assistance resources for rural communities, and to support the development and expansion of broadband cooperatives.

USDA is offering the funding under the new Broadband Technical Assistance Program. The program supports technical assistance projects such as conducting feasibility studies, completing network designs and developing broadband financial assistance applications. Funding is also available to help organizations access federal resources, and to conduct data collection and reporting.

“USDA is committed to making sure that people, no matter where they live, have access to high-speed internet. That’s how you grow the economy – not just in rural communities, but across the nation,” said USDA Under Secretary for Rural Development Xochitl Torres Small. “USDA is partnering with small towns, local utilities and cooperatives, and private companies to increase access to this critical service which in turn boosts opportunity and helps build bright futures.”

To learn more, read the full news release.

Pennsylvania Governor’s Administration to Improve Broadband Infrastructure through Apprenticeship Grant Funding

The Pennsylvania Department of Labor & Industry (L&I) today announced the availability of $800,000 in funding to support broadband expansion across the Commonwealth through registered apprenticeship programs that can train a workforce with the skills needed to build high-speed internet infrastructure. From day one, a top priority for Governor Josh Shapiro has been extending and expanding access to broadband across the Commonwealth and making connections more reliable and affordable.

L&I is soliciting applications for grants from registered apprenticeship programs with plans to reach underrepresented populations — including women, minorities, individuals with disabilities, and veterans – for training in broadband-related occupations. According to the Pennsylvania Broadband Development Authority’s (PBDA) master plan, at least 2.6 million Pennsylvanians living in 1.3 million households do not have access to internet or the skills to use technology.

“In the 21st Century, individuals, families and businesses without access to reliable internet service are at a serious economic disadvantage. It’s time we close the digital divide for citizens across Pennsylvania,” L&I Acting Secretary Nancy Walker said. “These funds will build a workforce that can tear down barriers to economic opportunity, especially in the rural areas of Pennsylvania. Investment in these workers is an investment in Pennsylvania’s future.”

In his 2023-2024 budget, Governor Shapiro is proposing $23.8 million for workforce training and apprenticeship programs, including ones aimed directly at improving Pennsylvania’s broadband network.

The Biden Administration’s $1.2 trillion Infrastructure Investment and Jobs Act (IIJA) was signed into law in November 2021. L&I designed this grant opportunity in anticipation of increased employment opportunities for infrastructure projects related to broadband expansion. Under the IIJA, Pennsylvania is expected to receive at least $100 million in funding to help provide broadband coverage across the state.

Last week, Sen. Bob Casey announced an allocation of $200 million to Pennsylvania from the American Rescue Plan for high-speed internet expansion to 44,000 homes and businesses.

Applications must be submitted by 5 p.m. on Monday, June 12, 2023. More information on the Supporting Broadband Infrastructure through Registered Apprenticeships and Pre-Apprenticeships Grant Program and related materials are available on L&I’s website.

For more information on the Pennsylvania Department of Labor & Industry, please visit the website or follow L&I on Facebook, Twitter and LinkedIn.

Pennsylvania Broadband Development Authority Approves Guidelines for $200 Million Broadband Infrastructure Grant Program, Will Begin Accepting Applications in May

The federal funding will help Pennsylvania expand broadband in unserved/underserved areas

Pennsylvania Broadband Development Authority (Authority) Executive Director Brandon Carson announced the approval of grant guidelines for the Pennsylvania Broadband Infrastructure Program, which will provide $200 million in funding to businesses, non-profits, local government, and economic development organizations. The guidelines will be posted on the Authority’s website on Monday, April 10, 2023 and the application process for this program will open on May 10, 2023.

Too many communities lack access to high-speed internet, and many more cannot afford it. This creates a divide between those who have internet access and those who do not. From day one, Governor Josh Shapiro has said extending and expanding access to broadband across the commonwealth and making connection more reliable and affordable is a top priority of the Shapiro Administration.

The Pennsylvania Broadband Infrastructure Program, funded through the Capital Projects Fund, will fund line extension and development projects, as well as large-scale regional infrastructure projects. Upon completion, projects must deliver service that meets or exceeds symmetrical download and upload speeds of 100 Megabits per second, with prioritization being given to fiber-optic deployment. Projects must include a viable sustainability strategy to maintain, repair, and upgrade networks to ensure their continued operation.

“The Authority is pleased to provide this funding to achieve last-mile connections and increase speed for underserved and unserved regions in Pennsylvania,” said Executive Director Carson. “This is the first grant program the Authority is offering, and we look forward to seeing the impact it makes as we work to close the Commonwealth’s digital divide.”

Key Program requirements include:

  • 25-percent match: Federal, state, or local funding received by the applicant is eligible towards the match requirement.
  • Grant amounts: The minimum request considered will be $500,000 and the maximum may not exceed $10 million.
  • Universal coverage: Applicants are required to ensure that all projects either achieve or are part of a plan to achieve universal broadband for the locality or region.
  • Affordability: Applicants must participate in the Affordable Connectivity Program and will be asked to describe and document their digital equity efforts to ensure low- to moderate-income households in the proposed project area will have sustained and affordable access.
  • Labor: The Pennsylvania Prevailing Wage Act may apply to projects funded under this program. Prevailing Wage requirements are generally applicable to grants for construction, demolition, reconstruction, alteration, repair work, renovations, build-out and installation of machinery and equipment more than $25,000.

The application period will begin May 10, 2023, and will close July 10, 2023, at 11:59 PM. The Authority expects to award grants prior to the end of 2023. Funded projects must reach substantial completion ― defined as services being delivered to end users ― by December 31, 2026. The program will be administered in accordance with U.S. Treasury guidelines and Act 96 of 2021.

For more information about the Pennsylvania Broadband Development Authority, visit the Authority’s website.

Apply Now for the Appalachian Leadership Institute!

The Appalachian Regional Commission (ARC) is now accepting applications for the fifth class of the Appalachian Leadership Institute (ALI)!

ALI is a free, nine-month leadership and economic development training program that helps prepare the next generation of Appalachia’s public, private, and nonprofit leaders to build a stronger future for the region.

We’re looking for 40 Fellows from all 13 Appalachian states — and all walks of life — for the Class of 2023-2024.

Learn more and apply by June 1 at arc.gov/leadership.

CMS Proposes Policies to Improve Patient Safety and Promote Health Equity

Proposed Rule Would Reward Hospitals that Deliver High-Quality Care to Underserved Populations

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration’s key priorities to advance health equity and support underserved communities. As required by statute, the fiscal year (FY) 2024 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) rule updates Medicare payments and policies for hospitals. The rule would also adopt hospital quality measures to foster safety, equity, and reduce preventable harm in the hospital setting. CMS is proposing to recognize homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting, which may result in higher payment for certain hospital stays. This action aligns with the Administration’s goal of providing support to historically underserved and under-resourced communities.

“CMS is helping to build a resilient health care system that promotes good outcomes, patient safety, equity, and accessibility for everyone,” said CMS Administrator Chiquita Brooks-LaSure. “This proposed rule reflects our person-centric approach to better measure health care quality and safety in hospitals to reduce preventable harm and our commitment to ensure that people with Medicare in rural and underserved areas have improved access to high-quality health care.”

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 for FY 2024 is projected to be 2.8%. This reflects an FY 2024 projected hospital market basket update of 3.0%, reduced by a projected 0.2 percentage point productivity adjustment. For FY 2024, CMS expects the proposed increase in operating and capital IPPS payment rates would generally increase hospital payments by $3.3 billion. For LTCHs, CMS proposes to increase the LTCH PPS standard Federal payment rate by 2.9%.  Overall, CMS expects LTCH payments under the dual-rate payment system to decrease by 0.9%, or $24 million, primarily due to a projected decrease in high-cost outlier payments in FY 2024 compared to FY 2023.

“With this proposed rule, CMS is more accurately paying hospitals and recognizing for the first time that homelessness, as a social determinant of health, also impacts resource utilization,” said CMS Deputy Administrator Dr. Meena Seshamani. “Creating incentives for hospitals to provide excellent care for underserved populations lays the foundation for a health system that delivers higher-quality, more equitable, and safer care for everyone.”

Advancing Health Equity

CMS is proposing to make health equity adjustments in the Hospital Value-Based Purchasing Program by providing incentives to hospitals to perform well on existing measures and to those who care for high proportions of underserved individuals, as defined by dual eligibility status.  This builds on previous efforts to advance health equity through the finalized health equity adjustment in the Medicare Shared Savings Program and finalized policies in Medicare Advantage and Part D Star Ratings Program. CMS also proposes to recognize the higher costs that hospitals incur when treating people experiencing homelessness, when hospitals report social determinants of health codes on claims. In addition, CMS is requesting comment on how to further support safety-net hospitals.

CMS is also proposing that rural emergency hospitals could be designated as graduate medical education training sites. As a result, more medical residents would be able to train in rural settings, which can help address workforce shortages in these communities. This proposal builds on other policies to support access to care in rural and other underserved communities.

Promoting Patient Safety

Consistent with the CMS National Quality Strategy and the HHS National Healthcare System Action Alliance to Advance Patient Safety goals to promote the highest quality outcomes and safest care for all individuals, the proposed set of quality measures aims to foster safety and equity and to reduce preventable harm in hospital settings. Among this set is a proposal to measure the rate of patients and residents in long-term care hospitals who are up to date on their COVID-19 vaccinations and new, additional measures for screenings for cancer and social drivers of health.

For a fact sheet on the proposed payment rule, visit: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective.

The FY 2024 IPPS/LTCH PPS proposed rule has a 60-day comment period. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-07389/medicare-program-proposed-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals

Significant Operational Changes in Pennsylvania to CHIP Overlaps with Medicaid Unwinding

Starting April 17, the Pennsylvania Department of Human Services (DHS) DHS will decide who qualifies for the Children’s Health Insurance Program and process all new applications and renewals. The current 130,000 CHIP families—and all new enrollees—must go through DHS instead of their CHIP health insurance plan to determine eligibility.

The transition of eligibility processing and determinations from the CHIP plans to caseworkers in local DHS County Assistance Offices (CAO) is on the heels of the unwinding process of Medicaid continuous coverage that began on April 1st.

CAOs, which already have full workloads with the unprecedented task of Medicaid unwinding, will now be responsible for processing CHIP applications and renewals.

And while the CHIP eligibility transition had been in the works long before the COVID-19 pandemic, the state ultimately was able to determine its timing.

Check out CHIP changes webpage for more details about how this change will impact CHIP families.