The guidance referenced in this document is applicable to all Exchanges. It does not replace or revise previously issued guidance, but extends previous guidance issued for plan years 2021 and 2022 to plan year 2023. The original guidance referenced current federal regulation at 45 CFR 155.305(f)(4), and the statute at section 1412 of the Affordable Care Act. This guidance extends the same flexibilities for consumers and Exchanges regarding Failure to File and Reconcile (FTR) operations for plan year 2023.

In plan years 2021 and 2022, CMS did not act on data from the Internal Revenue Service (IRS) for consumers who have failed to file tax returns and reconcile a previous year’s advance payments of the premium tax credit (APTC) and with the premium tax credit (PTC) allowed for the year. This change was made in response to the impact of the COVID-19 public health emergency (PHE) on the processing of federal income tax returns and changes concerning the reconciliation of APTC with PTC for tax year 2020 announced by IRS in response to the American Rescue Plan. This change allowed APTC to continue for consumers not required to reconcile by attaching Form 8962, Premium Tax Credit, to their 2020 tax return due to IRS’ announcement and consumers who reconciled but whose tax returns have not yet been processed by the IRS.

CMS will continue to not act on data from the IRS for consumers who have failed to file tax returns and reconcile a previous year’s APTC with the PTC allowed for the year, for plan year 2023. The continuation of this operations flexibility is due to the continued impact of the COVID-19 pandemic on the processing of 2021 federal income tax returns. This flexibility also extends to State-Based Exchanges. As with last year’s announcement, today’s announcement does not change the general requirement for taxpayers for whom APTC was paid in 2021 to file their taxes and reconcile the APTC with the PTC allowed for the year.

For more information, please refer to last year’s FTR Operations Flexibility for Plan Years 2021 and 2022 – Frequently Asked Questions.

References

1. https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/FTR-flexibilities-2021-and-2022.pdf
2. As of May 20, 2022, the IRS reports having 9.8 million unprocessed individual federal tax returns, which includes new tax year 2021 returns. For more information on IRS’ operations during COVID-19, please see https://www.irs.gov/newsroom/irsoperations-during-covid-19-mission-critical-functions-continue

From Axios

After weathering the pandemic with federal COVID aid, rural hospitals are facing a convergence of challenges that could leave many facilities deep in the red and at risk of closing as soon as the end of this year.

Why it matters: Hospitals are among the biggest employers in rural communities and the only health providers in large swaths of the country. But they’ve been operating on the edge for years, tending to older, sicker patients who often can’t afford care.

Driving the news: Hospitals couldn’t persuade Congress to delay a scheduled 2% cut in Medicare payments, then were frustrated by a Medicare payment proposal for 2023 they say ignores the effects of inflation, labor and supply cost pressures.

• Many facilities have burned through federal COVID provider relief funds and Paycheck Protection Program loans that helped them cope with staffing and supply shortages and lower demand as patients deferred care.
• “The data would suggest we will see a lot more rural hospital closures at the end of this year and into 2023,” Alan Morgan, chief executive of the National Rural Health Association, told Axios.
• Closures could dramatically reduce access to care, forcing patients to travel longer distances for inpatient services, substance use treatment and other needs, per the Bipartisan Policy Center, which recommends new payment models and incentives to retain health workers to ease the crunch.
• But sympathy may be limited for an industry that recently received large sums of federal dollars to get through the pandemic.

Flashback: Rural hospital closures are not a new story — since 2010, 140 rural hospitals have closed, according to the University of North Carolina’s Rural Health Research Program’s tracker.

• The majority of closures were in the Southeast, where “you’ve got a lower-income, sicker population that is underinsured or uninsured,” Morgan said.
• The pandemic forced facilities to lay off staff and, in some cases, restrict services just to COVID patients. But Congress responded with a bailout, including $175 billion to hospitals and clinicians around the country that was particularly advantageous to rural facilities.
• While revenues might have dropped, margins at most facilities held firm, a May study in JAMA found.
• Since the beginning of 2021, just five rural hospitals have closed, compared to 19 that closed in 2020 and 18 in 2019.

Go deeper: Experts say many of the rural facilities are running on unsustainable business models.

• Some “only had one-third of their beds filled, with a low occupancy rate, and then you have to run a hospital with a lot of fixed costs and that’s a fundamental reason that hospitals are facing financial challenges,” Ge Bai, a Johns Hopkins University professor who studies rural hospital finance, said.
• The situation leaves facilities in peril without federal aid, especially since many rural residents bypass their local facilities for elective surgeries, Bai said.

CMS is proposing actions to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology. Additionally, in line with President Biden’s Executive Order on Promoting Competition in the American Economy, the calendar year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule includes proposed enhanced payments under the OPPS and the Inpatient Prospective Payment System for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators and a comment solicitation on competition and transparency in our nation’s health care system.

More Information:

• Press release
• Proposed rule fact sheet
• REH fact sheet
• Proposed rule

Starting July 16, 2022, Pennsylvanians will have a new, easier way to connect to behavioral or mental health crisis services. Dialing 988 will connect callers directly to the National Suicide Prevention Lifeline.

76,000 calls were received by the the National Suicide Prevention Lifeline  from Pennsylvania residents in 2020.

In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. The Substance Abuse and Mental Health Services Administration (SAMHSA) sees 988 as a first step towards a transformed crisis care system in America.

People who contact 988 via phone, text, or chat will be directly connected to trained counselors located at 13 PA crisis call centers who can immediately provide phone-based support and connections to local resources, if necessary. Between 80-90 percent of calls are resolved through conversations with call center staff, without further intervention. By directing cases to 988 when a mental or behavioral health crisis isn’t life threatening, the response provided by public services, such as law enforcement and EMS, can be reserved for situations when there is a risk to public safety.

If you’re in crisis, reach out now.

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7.

• CALL: Dial 988
• TEXT– By texting 988, individuals will be asked to complete a short survey to let 988 trained crisis counselors know more about their current situation. After finishing the survey, texters will be connected to crisis counselors.
• CHAT – Lifeline Chat connects individuals with trained counselors for emotional support and other services via web chat.

The current Lifeline phone number (1-800-273-8255) will remain available to people in emotional distress or suicidal crisis, even after 988 is launched.

Who Can Use the New Number?

988 can be used by anyone who needs support for a suicidal, mental or behavioral health, and/or substance use crisis — no matter where they are or where they live.

988 can also be called on behalf of someone else. Counselors can offer guidance on helping a friend or loved one navigating a mental health emergency, and experts advise that people reach out particularly if a loved one reveals a plan to hurt themselves.

Lifeline services are available 24 hours a day, seven days a week at no cost to the caller.

What Happens When You Call 988?

• Back to Basics: How Our Calls Are Routed — 988 Suicide & Crisis Lifeline

When calling 988, the caller will hear the following recording:

“You have reached the National Suicide Prevention Lifeline, also serving the Veterans Crisis Line. Para español, oprima numero dos. If you are in emotional distress or suicidal crisis, or are concerned about someone who might be, we are here to help. If you are a U.S. military veteran or current service member, or calling about one, please press 1 now. Otherwise, please hold while we route your call to the nearest crisis center in our network.”

The following steps will follow depending on the callers needs and call center availability:

• The caller will be routed to a local PA 988 crisis call center.
• If the call is not answered within 60 seconds at the local level, the call is routed to one of PA’s three regional 988 crisis call centers.
• If a regional call center is unavailable, the call is routed to the national backup network.
• Note: Veterans and Spanish-speaking callers are given options to connect to resources specific to their needs.

Trained, compassionate counselors located at 13 crisis call centers across Pennsylvania are ready to provide phone-based support and connections to local resources. Counselors may be able to provide referrals for treatment for mental health, substance abuse, or other behavioral health needs if to local service providers are available. Also, if the counselor recognizes the caller is in need of an in-person response, they are able to dispatch emergency personnel from EMS or law enforcement, or a mobile mental health crisis team if one is available in the caller’s area.

Additional 988 Resources

• 988 Fact Sheet — Pennsylvania Department of Human Services
• 988 Frequently Asked Questions — Substance Abuse and Mental Health Services Administration
• The History of 988 — Vibrant Emotional Health
• Suicide Prevention by the Numbers — 988 Suicide & Crisis Lifeline
• Veterans Crisis Line — 988 Suicide & Crisis Lifeline
• Mental Health in PA — Pennsylvania Department of Human Services

Every year, the Appalachian Regional Commission (ARC) compares each of Appalachia’s 423 counties with national averages. By analyzing unemployment rates, per capita market income, and poverty rates, counties are classified within one of five economic status designations:

• Distressed,
• At-risk,
• Transitional,
• Competitive, or
• Attainment

The designations are used to determine the match requirements for ARC grants, as well as research topics and investment strategies targeting resources to the region’s most distressed areas.

We’ve seen an uptick in at-risk (+14) and distressed (+1) counties, especially in the wake of COVID-19, but Appalachians throughout the region are more resolved than ever to address distress and believe in the potential for progress.

Has your county’s status designation changed this year? Check out our interactive map to find out.