- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- HRSA Announces Action to Lower Out-of-Pocket Costs for Life-Saving Medications at Health Centers Nationwide
- Public Inspection: HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Increased Risk of Cyber Threats Against Healthcare and Public Health Sector
- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- Announcing the 2030 Census Disclosure Avoidance Research Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- 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
Request for Proposals: Evaluation of Migration and Population Trends in Appalachia
ARC is seeking proposals from qualified researchers to examine migration and population change in the Appalachian Region.
The research will incorporate a variety of datasets, tools, and methodologies to provide an overview of migration and population trends in the region, highlighting how current trends differ from those in the past. Analysis should provide a high-level look at trends dating back to at least 1960, as well as an in-depth examination of trends over the past decade.
The contractor will deliver a final report, executive summary, and state-level fact sheets that help answer the following questions:
- What are the migration and population trends throughout the Region? How have these trends changed over time?
- What are the characteristics of the places that are gaining/losing population? What are the characteristics of people who are migrating?
- How has migration changed the demographic profiles of communities throughout Appalachia?
- How have these demographic changes impacted the places gaining/losing population?
Key dates are outlined below. If you have any questions, please reach out to ARC’s economist Logan Thomas.
RFP open date: August 7, 2024
Questions due: September 4, 2024
Answers posted on arc.gov: September 11, 2024
Proposal due date: October 2, 2024
Interviews: October 21 – November 20, 2024
Selection date: December 11, 2024
Contract period: January – September 2025
Small-Town Patients Face Big Hurdles as Rural Hospitals Cut Cancer Care
The night before her chemotherapy, Herlinda Sanchez sets out her clothes and checks that she has everything she needs: a blanket, medications, an iPad and chargers, a small Bible and rosary, fuzzy socks, and snacks for the road.
After the 36-year-old was diagnosed with stage 3 breast cancer in December, she learned that there weren’t any cancer services in her community of Del Rio, a town of 35,000 near the Texas-Mexico border.
To get treatment, she and her husband, Manuel, must drive nearly three hours east to San Antonio. So they set an alarm for 4 a.m., which allows for just enough time to roll out of bed, brush their teeth, and begin the long drive navigating dark roads while watching for deer.
About an hour before they arrive at the cancer clinic, the couple pulls over to quickly eat fast food in the car. The break gives Herlinda time to apply ointment on the port where the needle for her chemotherapy will be inserted.
“It numbs the area, so when I get to the infusion room the needle won’t hurt,” she said.
For rural patients, getting cancer treatment close to home has always been difficult. But in recent years, chemotherapy deserts have expanded across the United States, with 382 rural hospitals halting services from 2014 to 2022, according to a report published this year by Chartis, a health analytics and consulting firm.
After Hitting Record Low, Uninsured Rates Climb: CDC
From Beckers
After hitting record lows in 2023, uninsured rates are beginning to rise again, according to new CDC data.
According to CDC estimates published August 5, 8.2% of Americans were uninsured in the first quarter of 2024, up from 7.7% in the fourth quarter of 2023.
In the second quarter of 2023, the CDC recorded a record-low uninsured rate of 7.2%. Government estimates predict the uninsured rate will rise over the next decade, driven by Medicaid disenrollment and the expiration of ACA subsidies.
The CDC also said 27.1 million people were uninsured in the first quarter of 2024, up from 25.5 million in the fourth quarter of 2023.
The number of people under 65 with public coverage declined from 75.9 million in the fourth quarter of 2023 to 73.5 million in the first quarter of 2024. Federal agencies estimated insured rates would drop as states began disenrolling Medicaid enrollees for the first time since 2020.
Continuous coverage requirements in place during the COVID-19 pandemic helped drive uninsured rates to new lows. At least 24.8 million people have been disenrolled from Medicaid since March 2023, according to KFF.
Though the number of people with public coverage has decreased, the number of adults under 65 with private insurance was the same between the last quarter of 2023 and the first quarter of 2024, at 176.7 million.
ACA exchange enrollment increased to 16.6 million in the first quarter of 2024, up from 13.3 million in the last quarter of 2023. Federal agencies have worked to steer individuals losing Medicaid coverage to exchange plans.
Enhanced subsidies that offset the premiums for marketplace plans are set to expire at the end of 2025, unless Congress chooses to extend them.
Estimates from the Congressional Budget Office in June projected the uninsured rate will hit 8.9% by 2034.
CMS Launches Oral Health Cross Cutting Initiative
The Centers for Medicare and Medicaid Services (CMS) released the inaugural Oral Health Cross Cutting Initiative (CCI) fact sheet. This initiative is committed to ensuring equitable access to oral health care, eliminating disparities, expanding oral health service availability, and effectively engaging stakeholders. It aims to improve the oral health and wellness of individuals who have Medicare, Medicaid, and Marketplace coverage.
Quality Measures of Oral Health Care for Children Released
The Consortium for Oral Health Systems Integration and Improvement released “Selected Quality Measures of Oral Health Care for Children.” The new brief provides a national summary of selected oral health care quality measures for children including oral evaluation, dental services, topical fluoride for children, and sealant receipt on permanent first molars.
Oral Health Resources for Older Adults Available
PCOH has added two new resources on oral health care for older adults to their Request Materials page. “Oral Health Care Tips for Older Adults” is a resource with tips for oral health care for older adults including the importance of regular dental care and dental access. “Oral Care for Long-Term Care Residents” is a tri-fold brochure with tips providers need to know for treating adults in long-term care facilities. Topics include dry mouth, denture care, and gum disease. These resources, and many others, are available to download or ship for free from the Request Materials page.
New Data Show Highest Number of Health Center Patients in Nearly 60 Year History of the Program
HRSA-Funded Health Centers Served 2.7 Million More Patients Over Past Four Years, Reaching High of More than 31 Million Patients
Today, to mark National Health Center Week, the Health Resources and Services Administration (HRSA) released new data showing over 31 million total patients served at HRSA-funded health centers in 2023—an increase of 2.7 million since 2020.
“Community health centers play a pivotal, and growing, role in America’s health care system. They are especially important in our effort to reduce health care disparities in underserved communities,” said HHS Secretary Xavier Becerra. “More than 31 million people across the country – in every U.S. state, territory, and the District of Columbia – depend on health centers, making them a vital resource. The Biden-Harris Administration wants all Americans to have access to high-quality primary health care services, regardless of a patient’s ability to pay, and community health centers help make that possible.”
“HRSA-funded community health centers make it possible for anyone in the community to access high-quality primary health care, regardless of income,” said HRSA Administrator Carole Johnson. “We are proud to serve millions more people and expand the community health workforce in rural and underserved areas all across the country.”
HRSA-funded health centers are required to treat all patients regardless of ability to pay, and in 2023 more than 90 percent of health center patients had incomes less than 200 percent of the 2023 Federal Poverty Guidelines. Health centers are now serving one in eight children across the country, more than 9.7 million patients in rural areas, over 6.4 million patients who live in or near public housing, and over 1.4 million people experiencing homelessness. Health centers have also expanded their preventive services, screening hundreds of thousands more people for cancer and infectious diseases and caring for patients with substance use disorders.
Health centers continue to be leaders in quality of care, increasing access and improving clinical quality across the board. Quality improvements since 2020 include:
- Administering more than 4 million HIV tests;
- Treating 585,000 prenatal care patients; and
- Improving clinical quality measures for chronic conditions, including hypertension control (+8%) and depression screening (+7%).
For more details on these and other Health Center Program outcomes see Four Years of Health Center Outcomes.
HRSA’s Health Center Program is a cornerstone of our nation’s health care system, especially for those who are uninsured; enrolled in Medicaid; living in rural, remote, or underserved areas; struggling to afford their health insurance co-pays; experiencing homelessness; residing in public housing; or otherwise having trouble finding a doctor or paying for the cost of care.
Hospitals at Risk for Closure, State-by-State
From Becker’s Financial Management
More than 700 rural U.S. hospitals are at risk of closure due to financial problems, with more than half of those hospitals at immediate risk of closure.
The latest analysis from the Center for Healthcare Quality and Payment Reform, based on CMS’s July 2024 hospital financial information, reveals the financial vulnerability of rural hospitals in two categories: risk of closure and immediate risk of closure.
In the first category, nearly every state has hospitals at risk of closure, measured by financial reserves that can cover losses on patient services for only six to seven years. In over half the states, 25% or more of rural hospitals face this risk, with nine states having a majority of their rural hospitals in jeopardy.
The report also analyzes hospitals facing immediate threat of closure meaning financial reserves could offset losses on patient services for two to three years at most. Currently, 360 rural hospitals are at immediate risk of shutting down due to severe financial difficulties.
“The primary reason hundreds of rural hospitals are at risk of closing is that private insurance plans are paying them less than what it costs to deliver services to patients,” CHQPR notes in its report, identifying losses on private insurance patients as the biggest cause of overall financial losses.
“Most ‘solutions’ for rural hospitals have focused on increasing Medicare or Medicaid payments or expanding Medicaid eligibility due to a mistaken belief that most rural patients are insured by Medicare and Medicaid or are uninsured,” according to the CHQPR report. “In reality, about half of the services at the average rural hospital are delivered to patients with private insurance (both employer-sponsored insurance and Medicare Advantage plans). In most cases, the amounts these private plans pay, not Medicare or Medicaid payments, determine whether a rural hospital loses money.”
To preserve and enhance essential hospital services in rural areas, CHQPR recommends that small rural hospitals receive Standby Capacity Payments from both private and public payers. These payments would cover the hospital’s fixed costs for maintaining essential services, ensuring that rural communities continue to have access to necessary healthcare.
Below is a state-by-state listing of the number of rural hospitals at risk of closure in the next six to seven years and at immediate risk of closure over the next two to three years.
Alabama
28 hospitals at risk of closing (54%)
24 at immediate risk of closing in next 2-3 years (46%)
Alaska
2 hospitals at risk of closing (12%)
1 at immediate risk of closing in next 2-3 years (6%)
Arizona
2 hospitals at risk of closing (7%)
1 at immediate risk of closing in next 2-3 years (4%)
Arkansas
25 hospitals at risk of closing (54%)
13 at immediate risk of closing in next 2-3 years (28%)
California
23 hospitals at risk of closing (40%)
10 at immediate risk of closing in next 2-3 years (17%)
Colorado
10 hospitals at risk of closing (23%)
6 at immediate risk of closing in next 2-3 years (14%)
Connecticut
2 hospitals at risk of closing (67%)
1 at immediate risk of closing in next 2-3 years (33%)
Delaware
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
Florida
8 hospitals at risk of closing (36%)
5 at immediate risk of closing in next 2-3 years (23%)
Georgia
22 hospitals at risk of closing (32%)
11 at immediate risk of closing in next 2-3 years (16%)
Hawaii
8 hospitals at risk of closing (62%)
0 at immediate risk of closing in next 2-3 years
Idaho
7 hospitals at risk of closing (24%)
0 at immediate risk of closing in next 2-3 years
Illinois
12 hospitals at risk of closing (16%)
7 at immediate risk of closing in next 2-3 years 9%)
Indiana
5 hospitals at risk of closing (9%)
4 at immediate risk of closing in next 2-3 years (7%)
Iowa
29 hospitals at risk of closing (31%)
10 at immediate risk of closing in next 2-3 years (11%)
Kansas
62 hospitals at risk of closing (63%)
31 at immediate risk of closing in next 2-3 years (32%)
Kentucky
13 hospitals at risk of closing (18%)
6 at immediate risk of closing in next 2-3 years (8%)
Louisiana
24 hospitals at risk of closing (44%)
12 at immediate risk of closing in next 2-3 years (22%)
Maine
10 hospitals at risk of closing (40%)
6 at immediate risk of closing in next 2-3 years (24%)
Maryland
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
Massachusetts
2 hospitals at risk of closing (33%)
1 at immediate risk of closing in next 2-3 years (17%)
Michigan
15 hospitals at risk of closing (23%)
7 at immediate risk of closing in next 2-3 years (11%)
Minnesota
19 hospitals at risk of closing (20%)
7 at immediate risk of closing in next 2-3 years (7%)
Mississippi
35 hospitals at risk of closing (52%)
25 at immediate risk of closing in next 2-3 years (37%)
Missouri
20 hospitals at risk of closing (34%)
10 at immediate risk of closing in next 2-3 years (17%)
Montana
14 hospitals at risk of closing (25%)
4 at immediate risk of closing in next 2-3 years (7%)
Nebraska
5 hospitals at risk of closing (7%)
2 at immediate risk of closing in next 2-3 years (3%)
Nevada
5 hospitals at risk of closing (36%)
3 at immediate risk of closing in next 2-3 years (21%)
New Hampshire
2 hospitals at risk of closing (12%)
0 at immediate risk of closing in next 2-3 years
New Jersey
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
New Mexico
7 hospitals at risk of closing (26%)
6 at immediate risk of closing in next 2-3 years (22%)
New York
29 hospitals at risk of closing (56%)
20 at immediate risk of closing in next 2-3 years (38%)
North Carolina
6 hospitals at risk of closing (11%)
5 at immediate risk of closing in next 2-3 years (9%)
North Dakota
13 hospitals at risk of closing (33%)
5 at immediate risk of closing in next 2-3 years (13%)
Ohio
5 hospitals at risk of closing (7%)
2 at immediate risk of closing in next 2-3 years (3%)
Oklahoma
39 hospitals at risk of closing (50%)
26 at immediate risk of closing in next 2-3 years (33%)
Oregon
8 hospitals at risk of closing (24%)
2 at immediate risk of closing in next 2-3 years (6%)
Pennsylvania
13 hospitals at risk of closing (30%)
7 at immediate risk of closing in next 2-3 years (16%)
Rhode Island
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
South Carolina
10 hospitals at risk of closing (40%)
5 at immediate risk of closing in next 2-3 years (20%)
South Dakota
8 hospitals at risk of closing (16%)
4 at immediate risk of closing in next 2-3 years (8%)
Tennessee
19 hospitals at risk of closing (36%)
17 at immediate risk of closing in next 2-3 years (32%)
Texas
80 hospitals at risk of closing (50%)
30 at immediate risk of closing in next 2-3 years (19%)
Utah
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
Vermont
8 hospitals at risk of closing (62%)
4 at immediate risk of closing in next 2-3 years (31%)
Virginia
9 hospitals at risk of closing (30%)
8 at immediate risk of closing in next 2-3 years (27%)
Washington
16 hospitals at risk of closing (36%)
4 at immediate risk of closing in next 2-3 years (9%)
West Virginia
11 hospitals at risk of closing (35%)
5 at immediate risk of closing in next 2-3 years (16%)
Wisconsin
7 hospitals at risk of closing (9%)
1 at immediate risk of closing in next 2-3 years (1%)
Wyoming
6 hospitals at risk of closing (24%)
2 at immediate risk of closing in next 2-3 years (8%)
Dive Into Appalachian Data!
Take a dip in facts and figures about the Appalachian Region!
ARC’s Chartbook has over 300K data points to explore, including statistics on population (see one map above). 📍 Though much of the region has experienced population decline, Appalachian South Carolina and Georgia have grown since 2010. Some counties in Georgia experienced population growth of over 18%.
Whether you’re interested in population data, education and employment, or how rural Appalachia compares to the rest of rural America, you’ll find an endless sea of interesting facts—all presented at regional, subregional, state and county levels.
Pennsylvania Rural Health Program Receives Award for Quality Excellence
The Pennsylvania Medicare Rural Hospital Flexibility Program received the 2024 Medicare Beneficiary Quality Improvement Project (MBQIP) Certificate of Excellence Award in recognition of outstanding critical access hospital state quality reporting and performance. The Pennsylvania program, which was ranked #1 nationally, has 16 critical access hospitals — these small hospitals of 25 beds or less are in rural counties and serve Medicare, low income and uninsured populations.
The award was presented on July 18 at the annual Medicare Rural Hospital Flexibility Program reverse site visit in Washington, D.C., by the Federal Office of Rural Health Policy in the U.S. Department of Health and Human Services’ Health Resources and Services Administration. Lannette Fetzer, quality improvement coordinator, and Sandee Kyler, rural health systems manager and deputy director, of the Pennsylvania Office of Rural Health (PORH), accepted the award on behalf of the state’s critical access hospitals. PORH, a partnership between the federal government, the state government and Penn State, is administratively housed in the Department of Health Policy and Administration in the Penn State College of Health and Human Development.
MBQIP is a quality improvement activity under the Medicare Rural Hospital Flexibility grant program of the Federal Office of Rural Health Policy. The goal of MBQIP is to improve the quality of care provided in critical access hospitals by increasing quality data reporting and driving quality improvement activities based on the data. MBQIP is a voluntary reporting system that includes quality and satisfaction measures from the Centers for Medicare and Medicaid Services Hospital Compare plus a critical access hospital-specific emergency department transfer communication measure set. Pennsylvania was one of the first four states to have 100% critical access hospital participation in MBQIP.
The Medicare Rural Hospital Flexibility Program improves access to preventive and emergency health care services for rural populations. Providing federal grant funding to eligible states, the program requires states to address rural health network development and directs significant effort into designating critical access hospitals.
“Pennsylvania’s 16 critical access hospitals work vigorously to ensure their hospital provides exceptional patient care, serving as a testament to superior quality service. It is a pleasure to work with them,” Fetzer said.
During the meeting, Fetzer was asked, for the second year, to serve as one of three panelists during a session called “Intersections of Flex: Working Across Program Areas for Greatest Impact,” where she discussed how quality affects the hospital’s bottom line and the importance of quality reporting.
“Successful quality improvement is not a one-time occurrence; it is a continuous and ongoing effort to improve outcomes in health care,” Kyler said. “Our critical access hospitals care about the people and communities they serve. This recognition demonstrates their commitment to high-quality health care in these rural communities. They are commended for their continuing efforts and focus on high-quality health care.”
PORH, which provides expertise in the areas of rural health, agricultural health and safety, and community and economic development, was formed in 1991 as a partnership between the federal government, the Commonwealth of Pennsylvania and Penn State. The office is one of 50 state offices of rural health in the nation funded under a program administered by the Federal Office of Rural Health Policy and is charged with being a source of coordination, technical assistance and networking; partnership development; and assisting in the recruitment and retention of health care providers.