Senate Republican leaders have asked the Trump administration to rescind an 1115 Medicaid waiver that would expand social services for vulnerable populations, including low-income families, chronically homeless individuals, and people being released from incarceration. Republicans believe the added services in the waivers — approved last year under the Biden administration, but not yet implemented — will balloon Pennsylvania’s Medicaid costs. In response, Gov. Josh Shapiro’s administration has scaled back implementation plans.

US Senators worked down to the wire to avoid a midnight funding lapse in Washington DC last week. Despite widespread Democratic criticism of the House’s six month “Continuing Resolution” (CR), a number of Democrats joined their Republican colleagues and voted to pass the legislation. The CR provides both mandatory and discretionary funding at the FY24 levels for Section 330, the National Health Service Corps, and Teaching Health Centers, through Sept. 30, 2025.

Last week, the Centers for Medicare & Medicaid Services (CMS) announced that Accountable Care Organizations (ACOs) that want to begin participating in the Medicare Shared Saving Program starting January 1, 2026, must apply between May 29 and June 12 at noon Eastern.  The Shared Savings Program is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an ACO to give coordinated, high-quality care to Medicare beneficiaries. After submitting an application, new ACOs that serve rural areas may be eligible for Advanced Investment Payments, upfront funds to build infrastructure and address beneficiary needs.

Last week, the Innovation Center at the Centers for Medicare & Medicaid Services (also known as CMMI) announced they are terminating four models early to align with its statutory obligation and strategic goals. Innovation Center Models are intended to be time-limited experiments to determine what approaches should be expanded nationwide, what components need further testing, and what approaches are not viable for expansion. The models ending early are Primary Care First, Making Care Primary, ESRD Treatment Choices (ETC), and Maryland Total Cost of Care. Termination of the ETC model will be proposed through rulemaking.  Subject to discussions with State authorities, Maryland will transition to the AHEAD model and begin its implementation period in January 2026.

– Comment by April 11.  Last week, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the Marketplace Integrity and Affordability Proposed Rule, which proposes additional safeguards meant to protect consumers from improper enrollments and changes to their health care coverage, as well as to establish standards that aim to ensure the integrity of the Affordable Care Act (ACA) Marketplaces.  It was formally published on Wednesday, March 19, with comments due April 11.

Last week, the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC) released the new NCHS Urban-Rural Classification Scheme for Counties. For this update, the NCHS used delineations of metropolitan and micropolitan statistical areas from the Office of Management and Budget as well as estimates from the U.S. Census Bureau to classify counties and county equivalents into six categories – four metropolitan and two nonmetropolitan. This scheme allows researchers, policy makers, and others to study the health of U.S. residents according to how urban or rural their county is. Read more about how FORHP uses several federal data sources to define rural for programs.

Yesterday, the Economic Research Service (ERS) at the U.S. Department of Agriculture released a report indicating worsening health for working-age adults in rural areas in the U.S.  Using data from the Centers for Disease Control and Prevention, researchers found that the gap in mortality rates between rural and urban areas grew from a rural lead over urban areas of 6 percent in 1999 to a rural lead of 43 percent in 2019.

The team at Rural Health Value released a new resource, Introduction to Rural Clinically Integrated Networks (CINs), that defines CINs, describes common CIN characteristics, and explores the unique value-based care advantages a rural CIN may bring to its members.  The conclusion of the brief is that a collaboration of independent rural health care organizations, incorporated as a CIN, can achieve the scale and develop the infrastructure necessary to successfully participate in value-based care and payment opportunities. The Rural Health Value team is funded by the Federal Office of Rural Health Policy.

– Expect comments to be due early April. The Centers for Medicare & Medicaid Services (CMS) released the “Marketplace Integrity and Affordability Proposed Rule,” which proposes additional safeguards to protect consumers from improper enrollments and changes to their health care coverage, as well as establish standards to ensure the integrity of the Affordable Care Act (ACA) Marketplaces.  Key proposals include revising standards for income verification processes; modifying eligibility redetermination procedures; revising actuarial value standards for health plans; requiring Marketplaces to deny eligibility for advance payments of the premium tax credit (APTC) upon a tax filer’s failure to reconcile APTC for one year; shortening the annual Open Enrollment Period to November 1 through December 15; and eliminating the special enrollment period for persons with annual household incomes below 150% of the federal poverty level (FPL). Since 2018, the number of Marketplace plans in rural areas has grown, although the number of issuers in rural areas still lags behind the number in urban areas. Once CMS displays the proposed rule in the public Inspection section of the Federal Register, the public will have 30 days to submit comments.

Last week, the Centers for Medicare & Medicaid Services (CMS) announced rescission of previous guidance for Center Information Bulletins (CIBs) related to services and supports addressing health-related social needs (HRSN) for Medicaid and state Children Health Insurance Programs (CHIPs).  The rescinded guidance includes the 2023 CIB, Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program, and the 2024 CIB, Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program.  Rescinding this guidance does not negate programs that are currently approved.  Rather, it informs States and the public that CMS will review applications to cover HRSN services on a case-by-case basis.