- 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
Pennsylvania Broadband Authority Receives 2025 Governor’s Award
The Pennsylvania Broadband Development Authority (PBDA) team has been selected as recipients of the 2025 Governor’s Awards for Excellence — one of the highest honors in state government.
The PBDA team received the honor for securing a historic $1.16 billion in federal funding and launching multiple competitive grant programs to bridge the digital divide.
Congratulations to the Team!
A ‘Perfect Storm’ Strains Rural Hospitals
From Becker’s Hospital Review
The One Big Beautiful Bill Act signed July 4 will change the rural healthcare landscape, and CEOs are finding innovative ways to prepare for changes phased in over the next few years.
The bill will phase in over the next several years:
- ACA special enrollment was limited for most enrollees
- Restricts state-directed payments and provider taxes for hospitals
- Medicaid cuts
- Medicaid work requirements developed by states as early as January 2027
- Increased oversight of the Medicaid provider taxes
- $50 billion over five years for the Rural Health Transformation program
Tom Vasko, CEO of Shattuck, Okla.-based Newman Memorial Hospital, has spent the last three years expanding services at the independent, 25-bed critical access hospital. Residents pay taxes to support the hospital for access to care in addition to their daily essentials.
“Every day I have to think thoughtfully, methodically yet quickly where I place those last few dollars of my neighbors,” Mr. Vasko said. “It can be agonizing, paralyzing, yet rewarding when we see another day. The bill threatens the day.”
Oklahoma has 97 hospitals with negative operating margins depending on the directed payments cut in the new bill. The hospital also treated a high percentage of government payers, losing money on every Medicare patient treated; the same will be true for Medicaid when all provisions of the bill go into effect. At Newman, 18% of Medicaid and 60% of Medicare patients will cost the hospital money; just 22% of the private payer patient base will have to make up the difference.
“Our PPS and CAH hospitals have been strained heavily by Medicare Advantage already this year,” said Mr. Vasko. “It seems our congressional leaders have created the perfect storm with the bill and the irreversible damage to come with Medicaid intensifying the strain.”
Mark Behl, president and CEO of Fairfield, Calif.-based NorthBay Health, said the legislation will “significantly affect hospitals nationwide.” He is particularly concerned with the nearly $1 trillion in Medicaid cuts over the next 10 years.
“This could result in a significant number of people in our communities losing coverage, which for hospitals like NorthBay means a sharp rise in uncompensated care, increased pressure on emergency departments and further financial strain,” he said. “In addition, reductions in provider tax revenue and nursing home funding could further destabilize the system by shifting more patients into already stressed acute care settings.”
Hospitals currently have a limited financial levers to pull in response to revenue losses, according to Mr. Behl, and those choices often have severe consequences for the community, including layoffs, service cuts and hospital closures.
“When faced with significant financial strain — such as what we’re anticipating from recent federal policy changes — health systems are often forced to scale back or eliminate programs that carry the highest operational costs,” said Mr. Behl. “Ironically, these are often the most complex, resource-intensive, and critically important services — such as trauma care, behavioral health, or specialty programs — designed to support the most vulnerable populations.”
Mr. Behl and his team are analyzing all options and exploring innovative ways to adapt to policy changes. But it might not be enough.
“With the magnitude of these changes, my greatest concern is the potential need to reduce the very care that our patients and community rely on most,” he said.
The new legislation’s cuts to Medicaid, provider taxes elimination and limits on state directed payments will increase the uninsured rate and weaken Medicaid as a payer, according to Nanis Hayek, an analyst at Moody’s Ratings. The move reverses several years of improving Medicaid reimbursement, and places rural and safety net hospitals at a particular risk.
“Though Medicaid is particularly critical for safety net and rural hospitals, it is an important payer for most hospitals, comprising about 15% of revenue sector-wide,” said Ms. Hayek. “While we expect states and hospitals to take mitigating actions, the magnitude of federal reductions and changes will be credit negative for the sector.”
States already taking action to support rural healthcare are a beacon for small hospitals.
“We’ve been watching this closely as some estimates show Wisconsin ranking as the lowest state in the country for use of federal funds to support our state’s Medicaid program, according to the Wisconsin Hospital Association,” said Kelly Macken-Barmble, CEO of Osceola Medical Center. “The governor recently passed as part of the budget, increased reimbursement to Wisconsin hospitals via expansion of the existing hospital assessment or DPP. This means we will likely see an increase in reimbursement for the time being. We need to continue to watch [financial and access to care impacts] closely, and other possible changes to programs like 340B and critical access hospital cost-based reimbursement that threaten the long-term viability of rural healthcare.”
But there is hope. Forward-looking leaders are already partnering with community organizations and technology companies to bring new services and data capabilities into rural hospitals. Newman Memorial is partnering with primary care and specialty physicians, creating a partnership model to grow a stronger referral base and ancillary revenue. Mr. Vasko said the hospital has seen an uptick of 24,000 patient visits annually after developing the program and launching two new primary care clinics and a specialty clinic.
Orthopedics has been a boon for the hospital as well.
“Our orthopedic practice has created a true concierge approach to medicine that has produced results reversing the outmigration of surgical procedures,” he said. “We now draw orthopedic patients from Oklahoma City two-and-a-half hours away. This reversal approach has contributed to community benefit and driven local economic impact for our community businesses.”
The hospital is also focused on revenue cycle optimization, identifying underpayments and payer negotiations to align services and disease states. Mr. Vasko is also keeping a close eye on 340B policy changes and governance so the hospital captures appropriate drug pricing this year.
“Simply sitting flat footed remaining between four walls will result in certain death for any rural facility,” he said. “Over the last three years I’ve applied more private equity and for profit tactics with respect to liquidity and growth than ever seen in a nonprofit environment. I’m grateful these strategies are prevalent in past experiences. It’s been the defining factor in our ability to exist. As the Northwest Oklahoma Chair of the Oklahoma Hospital Association it is my responsibility to drive hospital care across 25% of Oklahoma’s landmass. Therefore, I will continue to spend time at the Capitol with our state and federal legislators to educate, lobby and author legislation to improve Oklahoma’s healthcare and address its healthcare rankings to acceptable terms.”
Pennsylvania BEAD Round Two Resources Available
The Pennsylvania Broadband Development Authority (PBDA) has released several resources to assist with the development of applications for BEAD Round Two. These resources can be found on the PBDA BEAD Program Page, under “Additional Information”.
These resources include a revised list of BEAD Eligible Locations, updated Frequently Asked Questions (FAQs), an overview of BEAD Program changes, and an update to Round Two scoring criteria to align with federal requirements.
If you have additional questions regarding Round Two of the BEAD Program, please reach out to ra-dcpbda_bead@pa.gov.
Veterans! Tell Your Oral Health Story
The American Institute of Dental Public Health (AIDPH) is collecting stories from veterans about their experiences with dental health. AIDPH is asking the oral health community to share the “Veteran Oral Health Storytelling Form” with any veterans you know. Stories will be used to amplify veteran voices to existing data.
Pennsylvania Governor’s Shapiro Administration Implements Multistate Health Care Compacts
Pennsylvania Governor Josh Shapiro and Secretary of the Commonwealth Al Schmidt announced that starting July 7, Pennsylvania will become a full participant in three health care compacts that provide additional flexibility for qualified medical professionals to provide care to patients in dozens of states. Nurses, physicians, and physical therapists will now be able to streamline the application process to prove they meet all licensing requirements to provide care to patients in other compact member states.
New Report: The Impact of High Hospital Fixed-Cost Ratios on Rural Populations
This new brief, The Impact of High Hospital Fixed-Cost Ratios on Rural Populations, describes the regional variation in Critical Access Hospital (CAH) and Low-Volume Hospital (LVH) status with respect to average fixed-to-total-cost ratios, finding that CAHs tend to have the highest ratios, followed by LVHs. However, the average ratio for each status differs regionally across the United States.
Key Findings:
- Fixed-to-total-cost ratios vary along the rural continuum. Recent RUPRI research found that hospitals in noncore counties without towns of at least 2,500 people have the highest ratios, with a median estimate of 0.933 (where 1 means 100 percent of costs are fixed). Moreover, groups of distinct fixed-to-total-cost profiles emerged based on Urban Influence Codes (UICs).
- As UIC groups become more rural, hospitals’ estimated fixed-to-total-cost ratios increase. Populations in those UIC groups tend to be older, more likely to be on Medicare or Medicaid, less likely to have a college education, and less likely to have employer-sponsored insurance.
- CAHs and LVHs have higher fixed-to-total-cost ratios. CAHs are concentrated in the upper Great Plains states, with 80.5 percent and 77.6 percent of all nonmetropolitan hospitals in North Dakota and Montana, respectively, having the CAH designation. LVHs tend to be in the South—46.6 percent of Alabama’s nonmetropolitan hospitals have the LVH designation—and are also common in some Mountain states.
- Because the level of rurality itself matters, policymakers could identify ways that this insight could be used to refine payment policies to better support all Americans’ access to hospital services.
Authors: Abigail Barker, PhD; Eliot Jost, MBA, MPH; Timothy McBride, PhD; and Keith Mueller, PhD
Growing Impact: Climate Change, Extreme Heat, and Infant Health
Protecting pregnant women and infants from the health risks of a warming climate
Extreme heat, defined as a period of time when temperatures stay above 90 degrees Fahrenheit for several days, now contributes to nearly half a million deaths each year. One at-risk group is pregnant women because pregnancy increases the risk of heat-related illness. This is due to the body working harder to cool both the mother and baby, making it easier to overheat and harder to stay hydrated, factors that may contribute to pregnancy complications. Another at-risk group is infants whose bodies are not yet equipped to regulate heat. On the latest episode of “Growing Impact,” a team of researchers discussed their project that looks to inform lawmakers with actionable insights to protect these at-risk groups.
Ruohao Zhang is an assistant professor of agricultural economics, sociology and education at Penn State and principal investigator on the project. He said California, which is known for its warm climate and abundant sunshine, experiences more frequent heat waves than many other parts of the U.S. According to a report from the California Department of Insurance, the state saw seven major extreme heat events between 2013 and 2022, resulting in nearly 460 deaths and an estimated $7.7 billion in economic losses.
“Climate change makes extreme weather events more frequent, including these extreme temperature events,” he said. “The vulnerability of individuals such as low-income minorities, seniors, children and pregnant women are usually more affected by the extreme weather events. In this project, we are investigating the health impact of extreme temperature events. We are also exploring the socio-economic disparities in relation to these extreme temperatures.”
For example, low-income households often don’t have or can’t afford to use air conditioning.
“Households can certainly use air conditioning systems to overcome extreme temperatures, but it comes with less affordable energy bills,” Zhang said. “This makes the impact of the extreme temperature disproportionately greater on low-income households. We hope our study will inform government policies related to affordable energy that may help address social inequity concerns regarding the resilience against these climate change and extreme weather events.”
Kristin Sznajder, a collaborator on the project, is an assistant professor of public health sciences in the Department of Public Health Sciences and the Penn State College of Medicine. She said because of socio-economic disparities, pregnant women from low-income communities may suffer more from extreme temperatures.
“Think about the potential long-term impact on newborns, despite the immediate social inequity concerns we have here. This may also worsen future social justice challenges by amplifying the intergenerational transmission of health inequity,” she said. “Maternal health in the U.S. is of real national importance. Our outcomes in this country are worse than in other developed countries.”
According to a 2024 report from The Commonwealth Fund, the U.S. has the highest rate of maternal deaths among wealthy countries, especially for Black women, and more than 80% of these deaths could be prevented.
“Growing Impact” is a podcast by the Institute of Energy and the Environment. It features Penn State researchers who have been awarded IEE seed grants and discusses their foundational work as they further their projects. The podcast is available on multiple platforms, including YouTube, Apple, Amazon and Spotify.
New Report Sheds Light on Worker Displacement in Appalachia
“Worker displacement” is the separation of long-tenured workers from their employer in a way that is involuntary, permanent and independent of on-the-job performance. This issue affects all Appalachians, regardless of age, education level or industry.
In our new research report, Worker Displacement in Appalachia, we examine how displacement rates vary throughout the region, based on a number of factors, and the outcomes workers face after job loss. 📅
Using data from the most recent Displaced Worker Supplements, along with other sources, the report sheds light on the experiences of displaced workers in Appalachia and provides insights to target resources to the group.
Worker Displacement in Appalachia is online now!
300K+ New Data Points on the Appalachian Region Released
New data recently released show that Appalachia’s labor force participation continues to improve, although population growth is slower than in the nation as a whole.
This new data comes as part of our 15th annual update of The Appalachian Region: A Data Overview from the 2019-2023 American Community Survey, also known as “The Chartbook.”
The Chartbook offers a world of data on the Appalachian Region; dive in now!
More Key Takeaways From The Chartbook:
⚙️ Decrease in Unemployment
Appalachia’s unemployment rate decreased by 0.8 percentage points between 2014-2018 to 2019-2023, compared to a 0.4 percentage point decrease in the rest of the U.S.
🏠 Homeownership ️
Among occupied housing units, homeownership in the region was 6.7 percentage points higher than in the U.S. overall.
💵 Household Income
At $64,588, the median household income in Appalachia is nearly $14,000 below the U.S. average of $78,538.
💸 Cost Burdens
The share of households in Appalachia that are cost burdened — where housing costs are 30% or more of monthly income — is 6.7 percentage points lower than the U.S. average.
New CMS Innovation Center Model WISeR Launched
On June 27, CMS announced a new Innovation model called Wasteful and Inappropriate Service Reduction (WISeR). The model aims to support Original Medicare beneficiaries in receiving safe and appropriate care and protect taxpayers by testing enhanced technologies to expedite the process of reviewing medical necessity. NACHC is reviewing the model to see how it will impact CHC patients.
For more information, see the CMS WISeR Model Webpage.