- 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
- 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
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- State: 60-Day Notice of Proposed Information Collection: J-1 Visa Waiver Recommendation Application
Hospitals Forced to Revamp Business Models or Risk Losing Patients
From Axios
Hospitals’ business models are being upended by fundamental changes within the health care system, including one that presents a pretty existential challenge: People have far more options to get their care elsewhere these days.
Why it matters: Health systems’ responses to major demographic, social and technological change have been controversial among policymakers and economists concerned about the impact on costs and competition.
- Communities depend on having at least some emergency services available, making the survival of hospitals’ core services crucial.
- But without adaptation — which is already underway in some cases — hospitals may be facing deep red balance sheets in the not-too-distant future, leading to facility closures and shuttered services.
The big picture: Many hospitals have recovered from the sector’s post-pandemic financial slump, which was driven primarily by staffing costs and inflation. But systemic, long-term trends will continue to challenge their traditional business model.
- Many of the services that are shifting toward outpatient settings — like oncology, diagnostics and orthopedic care — are the ones that typically make hospitals the most money and effectively subsidize less profitable departments.
- When hospitals lose these higher-margin services, “you’re starving the system that needs profits to provide services that we all might need, but particularly uninsured or underinsured people might need,” said UCLA professor Jill Horwitz.
And hospitals have long claimed that much higher commercial insurance rates make up for what they say are inadequate government rates.
- But as the population ages and moves out of employer-sponsored health plans, fewer people will have commercial insurance, forcing hospitals to either cut costs or find new sources of revenue.
By the numbers: Consulting firms are projecting a bleak decade for health systems.
- Oliver Wyman recently predicted that under the status quo, hospitals will need to reduce their expenses by 15-20% by 2030 “to stay viable.”
- Boston Consulting Group last year projected that health systems’ annual financial shortfall will total more than $200 billion by 2027, and their operating margins will have dropped by 10 percentage points.
- To break even in 2027, a “typical” health system would need payment rate increases of between 5-8% annually — twice the rate growth over the last decade, according to BCG. If the load is borne solely by private insurers, hospitals will need a 10-16% year-over-year increase.
Between the lines: This is the lens through which to view health systems’ spree of mergers and acquisitions, which have increasingly drawn criticism from policymakers, regulators and economists as being anticompetitive.
- For better or worse, when hospitals have a larger market share, they are in a better position to negotiate and bring in more patients, and they can dilute some of the financial pain of poorer-performing facilities.
- And when they acquire physician practices or other outpatient clinics, they’re still getting paid for delivering care even when patients aren’t receiving it in a traditional hospital setting.
- “I think the hospitals have sort of said … ‘We can keep doing things the same way and we can just merge and get higher markups,'” said Yale economist Zack Cooper. “That push to consolidate is saying, ‘Let’s not move forward, let’s dig in.'”
Yes, but: A big bonus of outpatient care is that it’s supposed to be cheaper. But when hospitals charge more for care than an independent physician’s office would have, or they tack on facility fees, costs don’t go down.
The other side: Hospitals are typically on the losing end of negotiations with insurers right now, thanks to how large insurers have become, and are “in an extremely difficult competitive position,” said Ken Kaufman, co-founder of consulting agency Kaufman Hall.
- Criticizing their mergers and acquisitions as anticompetitive is a “complete misunderstanding of the situation,” he said, and moving toward a new care model will take “an incredible amount of resources.”
Reality check: Hospitals account for 30% of the country’s massive health spending tab, and they’ll have to be at the forefront of any real efforts to contain costs.
- They’re also anchors in their communities and are powerful lobbyists, which helps explain why Congress has struggled to modestly reduce what Medicare pays hospital outpatient departments.
- And there’s a growing body of research showing that when hospitals consolidate, costs go up.”They’ve protected their portfolio, and that’s added to the cost of health care,” said Johns Hopkins professor Gerard Anderson.
New PRISM Resource! Preparing Behavioral Health Clinicians for Success and Retention in Rural Safety Net Practices
This study assesses how, among behavioral health clinicians working in rural safety net practices, the amount of exposure to care in rural underserved communities received during training relates to confidence in skills important in their work settings, successes in jobs and communities, and anticipated retention. The summary provides a quick overview of the study published in the Journal of Rural Health.
About PRISM
PRISM is a collaborative of State Primary Care Offices, Offices of Rural Health, Area Health Education Centers and other organizations that have partnered to collect data to identify and document outcomes to enhance the retention of clinicians. Through its design, this collaborative approach builds shared interest, cooperation and group wisdom in best practices to promote retention among the states.
PRISM provides a standardized and state-of-the-art way for states to gather real-time data from clinicians as they serve in States’ and the National Health Service Corps’ (NHSC) loan repayment, scholarship and other incentive programs. This retention data gathering system routinely surveys clinicians as they serve in these public programs to provide quality, consistent, real-time, convenient and ongoing data to inform the management and retention of clinicians in service programs.
PRISM is a complex, longitudinal data gathering system that incorporates the data collection, analysis and dissemination expertise of the Cecil G. Sheps Center for Health Services Research. State offices can easily enter, track and manage retention questionnaires.
PRISM training and technical assistance is provided by 3RNET, supported through a contract with the National Rural Health Association with funds from the US Health Resources and Services Administration (HRSA). State collaborative members pay an annual fee to support enhancements to PRISM.
For more information contact Jackie Fannell
Pennsylvania Broadband’s BEAD Initial Proposal Volume II Has Been Approved!
The Pennsylvania Broadband Development Authority (PBDA) is pleased to announce the National Telecommunications and Information Administration (NTIA) has approved Volume II of the BEAD Initial Proposal. Volume II outlines Pennsylvania’s BEAD implementation efforts including local coordination, the subgrantee selection process, labor standards and workforce readiness, low-cost service options and middle-class affordability. With this approval, the PBDA is another step closer to implementing the $1.16 Billion BEAD Program. The next steps include a process to identity partners who will ultimately build the infrastructure and provide access.
To ensure successful implementation of the BEAD Program, PBDA emphasizes the importance of early collaboration and coordination. Local government partners and internet service providers are uniquely positioned to work towards a collective goal of internet for all Pennsylvanians. To bolster that collaboration, the PBDA encourages all levels of local government to work together with interested internet service providers to identify solutions for the areas of need within their communities. The PBDA website includes resources to aid in those conversations. It will take a proactive approach toward coordination to close digital divide.
Lastly, to strengthen preparation for infrastructure expansion the PBDA established the Broadband Ready Communities (BBRC) Program. The BBRC Program will help to reduce procedural, policy, and permitting barriers to broadband deployment at the local level and to encourage broadband infrastructure investment within participating PA communities. Registration for the Program will close December 31, 2024. To take advantage of this resource, ensure you review the BBRC Program page, guidelines, and the process to register. Please direct any questions regarding the BBRC Program to ra-dcbroadbandready@pa.gov.
Breaking Down U.S. Debt Trends to the Neighborhood Level
The updated Consumer Credit Explorer offers an easy way to visualize trends in U.S. consumer debt at the national, state, and even regional level. What’s new? The go-to resource from the Federal Reserve Bank of Philadelphia has been enhanced with data through Q4 2023. You can also now compare trends in up to two U.S. regions, up to two debt or credit characteristics, and up to two borrower or neighborhood demographics at once.
The tool allows you to see overall debt and types of debt, broken down by borrower age or credit score type, neighborhood income level or majority race/ethnicity, and much more, providing a unique view into household financial well-being.
New Data from the CDC Released on Preventable Premature Death
New Data from the CDC on Preventable Premature Death. The new study from the Centers for Disease Control and Prevention (CDC) is an extension of an earlier CDC study, which showed a higher percentage of early death from the five leading causes in rural counties compared with urban counties during 2010-2017. More recent data show that the rural-urban gap in all-cause mortality continues to widen. In 1999, the death rate in rural areas was 7 percent higher than in urban areas; by 2019, it was 20 percent higher. View CDC’s rural health website and Rural Public Health At-a-Glance to find out what CDC is doing to improve the health and well-being of rural communities.
Volunteer Opportunities Open for 2024 Pop-Up Dental Clinics in Pennsylvania
Looking to volunteer at a dental event in 2024? The PA Coalition for Oral Health compiled a list of pop-up clinics happening across the state. Click on the locations/dates for more information on each clinic. Looking to make a difference year-round? Free clinics rely on volunteers to provide quality, accessible healthcare in their communities. The Free Clinic Association of Pennsylvania can connect you with clinics in your region.
Click here for more info on volunteering with free clinics that see patients year-round.
Remote Area Medical (RAM) Clinics
Sharon, PA – June 8 & 9
Scranton, PA – August 3 & 4
Philadelphia, PA – August 24 & 25
Erie, PA – September 7 & 8
Allentown, PA – October 19 & 20
MOM-n-PA
Reading, PA – June 21 & 22
Mission of Mercy Pittsburgh
Pittsburgh, PA – November 1 & 2
PA’s Insurance Marketplace Issues RFP for Enrollment Assister Contract
Pennie, Pennsylvania’s official health insurance marketplace, has issued a Request for Proposal for Assister Services. The awardee will collaboratively drive statewide activities to increase awareness of the financial help and health coverage available through Pennie, and work directly with community organizations to provide local, in-person enrollment assistance.
The primary goals of this project are to:
- Increase awareness of affordable and high-quality coverage available through Pennie
- Expand the availability of direct, in-person enrollment assistance across Pennsylvania
- Diversify Pennie’s local partners across the Commonwealth so that assister services can be provided in a way that meets unique, local needs
- Increase outreach to historically marginalized communities who are disproportionately uninsured or underinsured.
“Pennie hears every day from people looking for more support to find health coverage that works for their medical needs and their household budget. This new contract will provide enrollment assistance and education through local and trusted partners in communities across the Commonwealth,” noted Pennie’s Executive Director Devon Trolley. “Knowing that ‘word of mouth’ is consistently how most Pennsylvanians learn of Pennie, we are excited to be expanding our network and partnerships to ensure Pennie is woven into the community fabric, and that free expert help is never too far from home.”
Contract Details
The initial term of this contract is four years, including two optional two-year renewals. The Lead Contractor on the project will coordinate and subcontract with five to eight regional organizations across the Commonwealth. These regional offices will be responsible with the bulk of the day-to-day outreach, education, and enrollment assistance while consistently broadening their network of community-based organizations.
Submission and Deadline
Organizations interested in becoming the Lead Contractor can visit, https://www.emarketplace.state.pa.us/Solicitations.aspx?SID=PHIEA%2023-21. All proposals must be submitted by 1 pm on June 27.
For inquiries concerning the RFP specifically, please contact Gwen Zeh, Issuing Officer, at RA-PWPENNIEProcuremt@pa.gov.
Other Opportunities
The new assister services approach will rely on partnering with established regional organizations across Pennsylvania. Pennie is actively seeking information about community partners looking to support enrollment assistance and outreach efforts. For organizations that are interested in supporting Pennie’s efforts but are not interested in becoming the Lead Contractor, visit this link to provide Pennie with your information and level of interest: https://pennie.com/partnerships/.
About Pennie
Pennie® is the official health insurance marketplace for the Commonwealth of Pennsylvania, and the only source of financial help to lower the cost of high-quality private health insurance plans. Pennsylvanians without access to other health coverage can find affordable health plans through Pennie that meet different needs and budgets. Eligibility for financial help is based on income, family size, and other factors. Pennie is operated by the Pennsylvania Health Insurance Exchange Authority, established under state law. For more information, visit pennie.com or follow us on social at fb.com/PenniePA and Twitter.com/PennieOfficial.
Reimagine Rural is Back For Season 2!
The Reimagine Rural podcast is back for a new season! Join Brookings Senior Fellow Tony Pipa for a journey into the heart of rural America, where changemakers are propelling their communities toward new opportunities and equitable prosperity.
Through illuminating conversations with local leaders, Pipa explores the transformative shifts, underlying challenges, and intricate nuances shaping rural development today. This season covers the revitalization of manufacturing, innovative approaches to housing, the expansion of broadband connectivity, and more.
🎧 Listen to episodes one and two, and follow the show on your preferred listening platform to stay updated on the latest episodes.
More about the work
Reimagine Rural is more than just a podcast; The Reimagining Rural Policy initiative at Brookings brings engaging narratives and in-depth analyses that provide a comprehensive view of the policies and trends shaping real-world rural development.
About Brookings
The Brookings Institution is a nonprofit organization based in Washington, D.C. Our mission is to conduct in-depth, nonpartisan research to improve policy and governance at local, national, and global levels.
New Rules Will Help Adults and Children Enroll — and Stay Enrolled in — Medicaid and CHIP
On April 2, the Centers for Medicare and Medicaid Services (CMS) published the most significant set of eligibility regulations since the initial rule implementing the Affordable Care Act (ACA). The new rule will help eligible individuals enroll in Medicaid and Children’s Health Insurance Program (CHIP) coverage and stay enrolled as long as they remain eligible. Many of the provisions address issues that contributed to coverage losses during the unwinding of the continuous enrollment provision that has resulted in at least 13.7 million people losing Medicaid coverage, mostly for procedural reasons.
The new rule is effective 60 days after publication, but because most of the new regulatory requirements will necessitate significant policy, operational, and system changes, CMS has set a three-year pathway for states to come into compliance. This approach attempts to balance the competing needs of making the streamlined processes available as soon as possible and responding to states’ capacity issues.
Key changes that address Medicaid unwinding specifically include:
- Updating address information. States took different steps during the unwinding process to update addresses and respond to returned mail. Certain actions, like relying on updated address information from managed care plans and the United States Postal Service (USPS), were permitted only under temporary authority. The final rule codifies many of these best practices and outlines actions states must take to respond to returned mail and use address information from reliable data sources, such as the USPS. States must come into compliance by December 2025.
- Timelines for responding to requests for information. During the unwinding period, some beneficiaries lost their coverage because they did not respond to requests for information in a timely manner. The final rule allows more time for beneficiaries to respond to such requests. For example, individuals will have at least 15 days to respond to requests at the time of application and 30 days to respond to requests when they report a change in circumstances. A 30-day minimum period already exists at renewal. States must come into compliance with these changes by June 2027.
- Transitions between Medicaid and CHIP. Children can lose coverage or have gaps in coverage when transitioning between Medicaid and CHIP programs. For example, if a child is enrolled in Medicaid and family income increases, he or she may be no longer eligible for Medicaid but eligible for CHIP. In this case, the child would still need to go through a CHIP eligibility determination. The new rule requires each agency to accept determinations of eligibility made by the other agency at both application and renewals, ensuring that children no longer “bounce” between state-run programs. States must come into compliance with these changes by June 2024.
Other key changes in the new regulations include:
- Aligning eligibility and enrollment processes across Medicaid eligibility groups. The final rule extends streamlined, modernized processes that are already required for children, pregnant people, parents, and adults eligible under the ACA Medicaid expansion to people who are older and disabled. For example, under the new rules, individuals who seek coverage based on disability status or age (i.e., 65 or older) must be able to submit applications in person, online, by telephone, or by mail and have their eligibility determined without an in-person interview. Renewals cannot be more frequent than every 12 months, states must first attempt to renew coverage by reviewing data sources rather than requesting documentation, and individuals must have a minimum time period to respond to renewal forms. These changes will significantly ease the administrative burden on individuals who are older or disabled. These populations are more likely to live on fixed incomes and be financially eligible for coverage but disproportionately challenged with meeting enrollment and renewal requirements. States must implement these changes by June 2027.
- Removing CHIP coverage barriers. The final rule eliminates the ability of states to lock out children who are behind in premiums for a set time period (e.g., 30 or 60 days). It also eliminates waiting periods before children can enroll and annual and lifetime benefit limits for CHIP-enrolled children. States are also no longer permitted to require payment of past-due premiums as a condition of reenrollment. Fourteen states currently lock CHIP-enrolled children out of coverage for a period for failure to pay premiums. Nine states have waiting periods, a practice dating back to the early days of CHIP to address concerns that CHIP might “crowd out” or “substitute” coverage under group health plans. Thirteen states currently impose annual or lifetime limits on CHIP benefits, most applied to dental and orthodontia services. States must implement these changes to CHIP by June 2025.
While some states have already implemented many of these policies under temporary authority granted by CMS during the unwinding period, all states will need to evaluate the policy, operational, and systems changes needed to comply with the new rule. Given the issues arising during the unwinding period, states will be developing corrective action plans following the unwinding period. The phased timing of the provisions in the new rule will allow states to combine these efforts, bringing their systems into compliance with both the new and the preexisting rules. Notably, the implementation of many of these changes will qualify for enhanced federal administrative matching funds, helping defray the cost of implementation for states. Once implemented, the changes should result in a more streamlined, efficient, and customer-focused process to determine eligibility, enroll, and renew Medicaid and CHIP coverage.
2024 NHSC New Site Application Opens Soon
Do you know that becoming a National Health Service Corps (NHSC) approved site can help your recruitment and retention goals? You can:
- Inform clinicians of your NHSC-approved status, so they can apply for one of the NHSC Loan Repayment Programs.
- Post a position on the Health Workforce Connector and search job seeker profiles.
- Participate in Virtual Job Fairs, online job fairs that connect you with job-seeking primary care trainees and practicing clinicians.
- Hire an NHSC scholar or an NHSC Students to Service participant.
Eligible healthcare facilities provide outpatient, primary health care services to people in Health Professional Shortage Areas. Sites must contact their State Primary Care Office when applying for or inquiring about a HPSA designation.
Interested in learning more? Click here to check eligibility!