New integrated Rural Investment Dashboards make more than a decade of USDA Rural Development (RD) investment history instantly accessible to the public!

This uncomplicated interface allows users to sift through RD data gleaned from investments in rural housing, health care, broadband, businesses, infrastructure and much more. With its project-level county and congressional district data, the Rural Data Gateway opens a new chapter in RD’s ongoing commitment to investment transparency. To learn more, read the full news release.

After a year-long cooperative process, eight municipalities in Pennsylvania have incorporated a first-of-its-kind regional municipal authority to address the region’s emergency medical services crisis.

The new Municipal Emergency Services Authority of Lancaster County will fund, manage and provide EMS services to member municipalities in northwest Lancaster County. It will be the first rate-setting regional municipal emergency services authority in Pennsylvania. The founding municipalities are Conoy Township, East Donegal Township, Elizabethtown Borough, Elizabeth Township, Marietta Borough, Mount Joy Township, Penn Township and West Donegal Township.

The path to forming the authority began in 2018, when municipalities in the northwest portion of Lancaster County were at a crossroads with the future of emergency medical services at risk.

Many EMS agencies are struggling to maintain services in the face of soaring costs, funding shortfalls and staffing challenges. Northwest EMS in northwest Lancaster County, which was recognized as Pennsylvania EMS Agency of the Year in 2020 by the Pennsylvania Emergency Health Services Council, was facing insolvency due to insufficient revenue and rising costs.

“Although Northwest EMS is widely known for outstanding service, less than half of municipal residents contribute to the organization through subscriptions,” said Marc Hershey, Elizabethtown Borough Council President and chair of the committee of municipal leaders who convened to address the local EMS crisis. “The average gap between gross billings and insurance payments was averaging over $4 million a year. And increasing expenses for equipment, fuel, certifications, trainings and employee benefits were taking a heavy toll. In short, municipalities in our region needed a bold solution to continue to meet their statutory obligation to ensure EMS readiness to answer the call.”

At the start of 2021, the committee began studying and exploring alternatives. Upon conducting a collaborative analysis, the committee arrived at an innovative solution: Creation of a regional municipal emergency services authority under the Pennsylvania Municipality Authorities Act to fund and provide EMS readiness and services on a regional basis.

Over a period of several months, the committee engaged in municipal public meetings, additional public education initiatives and a public hearing on the proposed solution. The process culminated in eight municipalities in the region enacting ordinances to form the Municipal Emergency Services Authority of Lancaster County. The authority was incorporated on February 7.

“This initiative demonstrates how municipal cooperation can solve regional problems,” said Rob Brady, president of ROBB Consulting and a consultant on the project. “Bringing municipalities together for a common regional cause is no small feat but, as a group, this committee of local leaders embraced a regional mindset to drive the process. Looking forward, the authority will enable each of the member municipalities to ensure that EMS services continue to be available with readiness to respond.”

The board of the authority consists of a representative from each of the authority’s founding municipalities. The board will be responsible for determining the authority’s services and fees.

Instead of generating operating revenue through municipal and membership contributions, the authority will set a reasonable and uniform annual fee to property owners, on par with Northwest EMS subscription rates. As a regional municipal entity, the authority will hold public hearings, enabling community members to have a voice regarding any changes to services or rates.

The authority will begin holding board meetings in March. A public hearing is expected to be held in late summer on the authority’s emergency services and fee structure. The authority plans to be operational and begin providing services by early 2024.

“It is our hope that the Municipal Emergency Services Authority of Lancaster County will serve as a model for other municipalities in Pennsylvania facing an EMS crisis,” Hershey said. “Paving a path to this solution took hard work, but there was never a question that a municipal-led solution was needed. EMS is an essential public service. As municipal leaders, we recognized that we not only needed to solve this problem to meet our statutory obligation. We needed to solve this together to potentially save the lives of our neighbors, family members and friends.”

The Centers for Medicare & Medicaid Services (CMS) released a proposed National Coverage Determination (NCD) decision that would, for the first time, expand coverage for power seat elevation equipment on certain power wheelchairs toMedicare individuals. The proposed NCD is open for public comment for 30 days.

“Millions of people with Medicare rely on medically necessary assistive devices to perform daily tasks that directly impact their quality of life. CMS remains committed to ensuring persons with disabilities are receiving available benefits that improve their health,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s proposal promotes a first of its kind benefit expansion providing people with Medicare additional tools to improve their lives.”

If finalized, power seat elevation equipment would be covered by Medicare for individuals with a Group 3 power wheelchair, which are designed to meet the needs of people with Medicare with severe disabilities, in order to improve their health as they transfer from the wheelchair to other surfaces. Transfers often strain shoulder and back muscles and constrain an individual’s daily mobility at home and other customary locations.

CMS follows a long-standing process established by Congress to determine whether a medical item or service can be covered nationally by Medicare, including when an item or service is reasonable and necessary for the diagnosis of and/or treatment of an illness or injury. Today’s proposed NCD follows an evidence-based clinical analysis CMS initiated in August 2022 to examine whether the use of power seat elevation equipment on power wheelchairs: 1) falls within a Medicare benefit category and 2) if yes, whether it is reasonable and necessary.

Today’s NCD proposal incorporates feedback from interested parties, particularly those who are focused on eliminating health disparities for people with disabilities. CMS encourages comments from all interested parties, in particular, people with Medicare and their families, providers, clinicians, consumer advocates, health care professional associations, and from individuals serving populations facing disparities in health and health care. Additionally, CMS is specifically interested in gathering additional scientific literature that provides evidence surrounding the medical necessity for seat elevation systems through studies that include measurable characteristics related to the performance of transfers.

The proposed National Coverage Determination decision memorandum is available to review here. The 30-day comment period will close March 17, 2023.

For more information on the Medicare coverage determination process, please visit: Medicare Coverage Determination Process

U.S. Department of Agriculture (USDA) Rural Development State Director Bob Morgan announced that USDA is investing $460,900 to support five projects in rural Pennsylvania.

“Emergency services and transportation for students with special needs are vital to quality of life in our rural communities,” Morgan said. “These projects directly support those organizations that often find it difficult to raise the capital funds to guarantee these essential services to their communities.”

The projects awarded today are listed below.

• Manor Township in Armstrong County received a Community Facilities grant of $28,900 to purchase a police vehicle with accessories and upfitting. This will replace a 2017 vehicle with high mileage and is costly to maintain.
• Cranesville Volunteer Fire Department in Erie County received a Community Facilities grant of $30,200 to purchase a new boiler system and vinyl siding for their building.
• Jeannette EMS, Inc. in Westmoreland County received a subsequent Community Facilities Direct Loan of $12,300 to provide financing for the purchase of two new ambulances. The initial investment to the organization was a $128,500 loan and $100,000 grant to help purchase these vehicles, but due to higher equipment costs, the subsequent funding will cover the additional project costs.
• The Township of Penn in Clearfield County received a loan of $35,000 and a grant of $50,000 to purchase a freightliner truck chassis with dump box and appurtenances.
• The Shenandoah Valley School District in Schuylkill County received a loan of $23,600 and a grant of $52,400 to purchase two passenger vans to transport special needs students.

In total, these projects are expected to benefit more than 20,000 rural Pennsylvanians.

You can read the complete news release on our website.

Approximately 61 million Americans live in rural, tribal, and geographically isolated communities across the United States. These communities often experience significant health inequities. Compared to urban Americans, rural Americans are more likely to have heart disease, stroke, cancer, unintentional injuries, suicide risk, and chronic lung disease, and have higher death rates from COVID-19. As clinicians, we have seen these rural health disparities first-hand. One example is a patient who lived far from a health care facility, didn’t have a usual source of care, and didn’t tell anyone about his chest pain until he had a heart attack. Another is a patient with opioid use disorder who lacked access to a nearby source of regular care and didn’t find a primary care doctor until after her first overdose. A third is a patient who required surgery on her arteries because her underlying conditions were not addressed in the rural community where she lived.

Addressing rural health inequities is a cornerstone of the Centers for Medicare & Medicaid Services’ (CMS’) effort to improve health equity. CMS defines health equity as the attainment of the highest level of health for all people, whereby every person has a fair and just opportunity to attain their optimal health regardless of their race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, preferred language, and geography— including whether they live in a rural or other underserved community. CMS’ commitment to rural health equity is reflected in the recently published CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities.

With almost $1 trillion in claims annually and more than 63 million covered Americans – including one in three adults who live in rural areas – Medicare has the potential to significantly impact health care delivered in rural settings. In this piece, we highlight some of CMS’ policies to support rural providers, improve access to care in rural areas, and support the transformation of the rural health delivery system.

Supporting rural providers

The shortage of health care providers in rural areas exacerbates rural health disparities. Only 12% of physicians practice in rural communities, and the majority of areas deemed “health professional shortage areas” by the federal government — 61 percent — are located in rural areas. These communities also face shortages of other critical health care professionals, including nurse practitioners, dentists, and social workers. Over the last decade, many rural hospitals have closed. Many currently face potential closure due to lower or inconsistent patient volume and staff shortages compounded by fewer applicants in rural areas.

Rural hospitals and communities may find support under a Medicare regulation implementing a provision of the “Consolidated Appropriations Act, 2021” creating a Rural Emergency Hospital (REH) provider type.  In exchange for providing emergency department services and observation care (and, if elected by the facility, other outpatient[1] medical and health services), Medicare will pay REHs an additional five percent compared to the normal outpatient rates for most services and will provide a monthly payment that will increase every year with inflation. The intent is that these measures will support financial stability and reduce future closures of rural hospitals.

Rural Hospitals and Critical Access Hospitals, can apply to CMS to elect to become an REH starting January 1^st, 2023. To qualify, hospitals must have 50 or fewer beds and agree not to provide inpatient care. CMS broadly defined the type of services that REHs can provide to maintain access to critical care in rural communities while ensuring patients can be transferred to an acute care hospital if more intensive services are needed. REHs can offer all services that can be provided in an outpatient department, such as emergency care, in addition to maternity care and outpatient surgery. REHs must also offer “observation care,” so they can observe a patient who isn’t ready to be released from an emergency department. Hospitals interested in electing this new REH designation are encouraged to review the materials at the bottom of this post.

Expanding access to care in rural areas

Telehealth is an essential tool to reach people living in rural areas, which face provider shortages and transportation challenges. As clinicians, some of us have personally delivered telehealth services and seen first-hand how it has allowed persons in rural areas to access health care from the comfort and privacy of their own homes.

However, broadband and computer access can still be significant obstacles to using telehealth in rural areas. This is why, after Congressional action, Medicare permanently expanded access to behavioral health services furnished via telehealth, including audio-only services that often just require a telephone. To further increase access for people in rural areas, CMS has proposed incentives for Medicare Advantage plans to include behavioral health clinicians who can provide telehealth services in their networks.  Additionally, CMS has proposed requirements that Medicare Advantage plans assess enrolled individuals for digital health literacy. For those found to have low digital health literacy, Medicare Advantage organizations would develop and maintain procedures to offer digital health education to their enrollees to assist them with accessing telehealth.

Beyond telehealth, CMS concentrates on expanding access to behavioral health care in rural areas, including in Medicare Advantage. CMS has proposed a new requirement for evaluating the provider networks of Medicare Advantage plans, to ensure the plans’ provider networks provide sufficient access to clinical psychologists, licensed clinical social workers, and clinicians that can prescribe medication that treats opioid use disorder. This would help ensure that people enrolled in Medicare Advantage, especially in rural areas, have more accessible options for meeting their behavioral health needs. CMS also focuses  on addressing opioid use disorder, particularly as overdose rates have skyrocketed and rural areas have been significantly affected. Medicare has clarified that it will pay for opioid use disorder treatment services delivered by mobile units of opioid treatment programs. These mobile units are equipped with medical supplies and specially trained staff, and studies have shown that these types of mobile services improve access to medication that treats opioid use disorder, particularly in rural areas.

Transforming the rural health delivery system

Finally, expanding access to high-quality, coordinated care through value-based arrangements will also better support the needs of rural Americans. For instance, CMS is improving the Medicare Shared Savings Program which has improved the delivery of high-quality care in rural areas. Shared Savings Program Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers collaborating to give coordinated, high-quality care to people with Medicare. The program’s goal is to ensure that people receive the right care at the right time, prioritizing their health while preventing medical errors and avoiding unnecessary and duplicative tests and treatments. However, we have seen over time that ACOs are less common in rural areas compared to urban ones.

To address this, CMS is incorporating lessons learned from the Center for Medicare and Medicaid Innovation’s ACO Investment Model into the Shared Savings Program to provide up-front investment dollars to newly-forming, smaller ACOs that treat low-income patients or patients who live in rural or other underserved areas. ACOs could use these upfront payments to hire new health care workers, such as community health workers or behavioral health practitioners, helping to address provider shortages in rural areas. ACOs could also use these funds to address the social needs of persons with Medicare, such as assisting with food, housing, or even transportation – needs that are particularly prevalent in rural areas with higher poverty rates.

In addition, the Center for Medicare and Medicaid Innovation is actively examining ways through existing and new models to improve access to high-quality health care in rural areas, including increasing participation by safety net and Medicaid providers in value-based care models.

Summing up

The three-pronged approach of supporting rural providers, expanding access to care in rural areas, and transforming the rural health delivery system can improve access to high-quality, coordinated care for people in rural communities. However, the magnitude of these changes will only be realized in partnership with rural health providers, rural communities, beneficiaries, caregivers, and other payers, especially Medicaid.

We recognize that many rural providers and communities may need time to consider the new policies and programs outlined in this piece and corresponding regulations, and there are teams available to answer any questions and provide support as needed. Only by working together can we improve access to care in rural areas and advance rural health equity.

For more information about the Rural Emergency Hospital designation, which is an option for rural hospitals starting on January 1, 2023, please visit this fact sheet, the 2023 Outpatient Prospective Payment System final rule, and recently released guidance for Rural Emergency Hospital enrollment and conversion. A new REH Technical Assistance Center, funded by the Health Resources and Services Administration, can help rural hospitals exploring the REH designation. If you are interested in receiving support, please visit the Technical Assistance Center’s website here.

For more information about how to form a Medicare Shared Savings Program ACO and how to qualify for advanced investment payments starting in 2024, please review this fact sheet or the CY 2023 Physician Fee Schedule final rule, and if you have a question, please contact SharedSavingsProgram@cms.hhs.gov.

For more information about CMS proposals to strengthen Medicare Advantage, please visit the Calendar Year (CY) 2024 Medicare Advantage and Part D rule here. The comment period for the CY 2024 Medicare Advantage and Part D proposed rule is currently open and will close on February 13, 2023, at 5 PM.

The mailing of the 2022 Economic Census survey started in early February and many may be wondering how this data being collected benefits them.

The economic census measures employment, payroll and revenue by service or product across the nation’s businesses — invaluable information for overall business strategy and everyday decision-making by governments, economic development organizations and business owners.

The 2022 Economic Census now underway is conducted in 2023 and collects and publishes data for the 2022 reference year. The statistics it collects will cover 19 economic sectors that encompass 910 North American Industry Classification System industries. Businesses asked to participate should respond by March 15.

If you’re one of the more than 4 million business locations that has been selected to respond to the economic census and are still wondering: What’s in it for me?

Continue reading to learn more about:

• How data from the economic census can help you
• Additional resources