Rural Health Information Hub Latest News

New Rural Policy Brief Published on Telepharmacy Rules and Statutes

A new rural policy brief is available from the RUPRI Center for Rural Health Policy Analysis:

Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States

Jason Semprini, MPP; Fred Ullrich, BA; Keith Mueller, PhD

This policy brief analyzed administrative rules and legislative statutes governing each state’s pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably.

Please click here to read the brief.

Senate Bill Aims to Preserve 340B Eligibility for Hospitals Affected by COVID-19 Pandemic

Fierce Healthcare, by Robert King |

A group of bipartisan senators introduced legislation to ensure that a hospital doesn’t fall out of the 340B drug discount program due to a rapid change in patient volume sparked by COVID-19. The bill comes as hospitals continue to grapple with a financial crisis sparked by the pandemic. It also centers on a controversial program that the Trump administration has sought to cut by more than a third.

“As the ongoing pandemic disrupts our health care system, we must ensure that programs like the 340B program can be there to support our hospitals and our communities,” said Sen. Rob Portman, R-Ohio, one of the co-sponsors of the bill, in a statement.

340B hospitals get a discount on drugs if they meet certain requirements, including providing a certain amount of charity care. Pharmaceutical manufacturers agree to provide the discounts in exchange for their products getting reimbursed by Medicaid.  But a critical metric for determining if a hospital is eligible for 340B is the inpatient hospital admissions of low-income Medicare and Medicaid patients.

However, patient volumes have plummeted at hospitals across the country as the pandemic forced facilities to shutter elective surgical procedures and patients have been afraid of entering a facility for fear of contracting the virus.

“Though hospitals have started resuming elective procedures, and patients have begun returning to seek care, there is concern that as a result of this year’s slowdown, some hospitals may not meet the required inpatient admission threshold to remain in the program for the following year,” according to a release on the bill.

The legislation would ensure any previously eligible 340B hospital would still be eligible for any cost reporting period during the COVID-19 public health emergency.

The current public health emergency period expires July 25. However, Department of Health and Human Services spokesman Michael Caputo tweeted last week that the agency is expected to extend the period again, although no final announcement has been made.

The other co-sponsors of the legislation are Sens. John Thune, R-South Dakota; Debbie Stabenow, D-Michigan; Tammy Baldwin, D-Wisconsin; Ben Cardin, D-Maryland; and Shelley Moore Capito, R-West Virginia.

House lawmakers have also written to leadership asking for similar protections for eligibility for hospitals.

The 340B program has been the focal point of intense opposition from the pharmaceutical industry, which charges the program has gotten too large and that hospitals are not using the savings from discounts on improving patient care. Hospitals shoot back that the discount program is needed for safety-net hospitals already struggling to meet ever-increasing drug prices.

The program has been the center of a major legal fight between hospitals and the Trump administration. Hospitals have sued to halt a nearly 30% cut to payments that the administration instituted in 2018 and 2019. A federal judge sided with the hospital industry that the administration doesn’t have the authority to install the cuts.

However, hospital groups have lately started to battle with the Centers for Medicare & Medicaid Services (CMS) over a survey sent by the agency to 340B hospitals on the acquisition costs for certain outpatient covered drugs. The agency said the survey is intended to help determine payment amounts for drugs acquired by 340B hospitals in order to repay such facilities for the payment cuts.

But hospitals have charged that CMS should instead repay hospitals in full for the payment cuts instead of creating a new solution via the survey.

House Lawmakers Want New Flexibility to Ensure Hospitals Don’t Lose 340B Eligibility Due to COVID-19 Response

Fierce Healthcare, by Robert King |

Some House lawmakers want to ensure safety net hospitals wouldn’t lose eligibility to participate in the 340B drug discount program due to their response to COVID-19.  Reps. Doris Matsui, D-California, and Chris Stewart, R-Utah, wrote to House leadership outlining concerns that hospitals will be cut off from the program because they have to expand capacity to fight COVID-19.

“To support our safety net hospitals through this crisis, we write to ask that any future supplemental relief bill include policies to temporarily protect these hospitals from losing 340B eligibility,” the lawmakers wrote.

The 340B program requires drug companies to provide discounts to disproportionate share hospitals (DSHs) as a condition to participate in Medicaid.  But for a DSH hospital to maintain eligibility, there are several requirements, including that they care for a certain number of DSH patients.

Hospitals, however, are boosting their bed capacity and shifting care to outpatient settings to reserve care for the most critical cases, the letter said.

“While such operational changes are essential to build capacity for crisis response at this time, ensuing shifts in payer mix could potentially reduce a hospital’s DSH adjustment percentage and jeopardize their eligibility for the 340B program,” the lawmakers added.

Lawmakers were also worried about requirements that restrict hospitals from using a group purchasing organization for covered outpatient drugs.

While the Health Resources and Services Administration has given guidance to 340B hospitals on this issue, the agency said it cannot waive the prohibition.  The 340B program has been the focal point of a legal battle between the Trump administration and hospitals.  Hospital groups challenged a nearly 30% cut to the 340B program and prevailed in court.

Pharmaceutical companies charge that the program has gotten too unwieldy and large and that the discounts are not helping hospitals that need them. But hospital groups and 340B advocates charge that drug companies are seeking to avoid offering much-needed discounts to high-cost products and that the program helps hospitals operating on thin margins.

National Rural Health COVID-19 TA Center Launched

Individuals in rural communities often face barriers to health stemming from economic factors, environmental differences, and feelings of isolation. The COVID-19 pandemic has presented a generational challenge and exacerbated these concerns, revealing a critical need for rapid response efforts. With the support of a generous grant of $200,000 from CoBank, the National Rural Health Association (NRHA) is helping rural health care providers overcome barriers they face through the creation of the Rural COVID-19 Technical Assistance Center.

HHS Announces COVID-19 Funding to Certain Rural and Other Providers from Small Metropolitan Areas

In May, HHS announced $10 billion in funding to almost 4,000 rural health care providers including hospitals, health clinics, and health centers. HHS is expanding the existing payment formula to include certain special rural Medicare designation hospitals in urban areas as well as others who provide care in smaller non-rural communities. These may include some suburban hospitals that are not considered rural but serve rural populations and operate with smaller profit margins and limited resources than larger hospitals. They too, have suffered in this pandemic, which is why HHS is responding. HHS estimates the funding announced today will provide relief of over $1 billion to 500 of these hospitals with payments ranging from $100,000 to $4,500,000 for rural designated providers and $100,000 to $2,000,000 for the other providers.

State-by-state breakdown – PDF

Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing approximately $3 billion in funding to hospitals serving a large percentage of vulnerable populations on thin margins and approximately $1 billion to specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas. HHS is also opening the provider portal to allow dentists to apply for relief.  HHS recognizes the urgent need these vital funds play in supporting safety net providers and those serving large rural populations facing financial devastation catalyzed by the pandemic.

“We’ve been distributing the Provider Relief Funds as quickly as possible to those providers who have been hardest hit by the pandemic,” said HHS Secretary Alex Azar. “President Trump is supporting hospitals in continuing to provide COVID-19 care and returning to everyday procedures, especially hospitals that serve vulnerable and minority populations. Close work with stakeholders informed how we targeted this new round of funds to hard-hit safety-net and rural providers.”

As COVID-19 continues to disrupt daily lives, HHS is providing support to healthcare providers fighting the pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers, including those disproportionately impacted by this pandemic.

Additional $3 Billion to Safety Net Hospitals

On June 9th, HHS announced plans to distribute $10 billion in Provider Relief Fund payments to safety net hospitals serving our most vulnerable citizens. Throughout this pandemic, HHS has continued to maintain an open line of communication with Members of Congress, state and local officials, providers and stakeholders to inform our response to this public health emergency. Accordingly, we learned some acute care hospitals did not qualify for funding from this initial announcement. HHS is now expanding the criterion for payment qualification so that certain acute care hospitals meeting the revised profitability threshold of less than of 3 percent averaged consecutively over two or more of the last five cost reporting periods, as reported to the Centers for Medicare and Medicaid Services (CMS) in its Cost Report filings, will now be eligible for payment. HHS expects to distribute over $3 billion across 215 acute care facilities, bringing the total payments for safety net hospitals from the Provider Relief Fund to $12.8 billion to 959 facilities.

State-by-state breakdown – PDF

$1 Billion to Certain Rural Providers and Other Providers from Small Metropolitan Areas

In May, HHS announced $10 billion in funding to almost 4,000 rural health care providers including hospitals, health clinics, and health centers. HHS is expanding the existing payment formula to include certain special rural Medicare designation hospitals in urban areas as well as others who provide care in smaller non-rural communities. These may include some suburban hospitals that are not considered rural but serve rural populations and operate with smaller profit margins and limited resources than larger hospitals. They too, have suffered in this pandemic, which is why HHS is responding. HHS estimates the funding announced today will provide relief of over $1 billion to 500 of these hospitals with payments ranging from $100,000 to $4,500,000 for rural designated providers and $100,000 to $2,000,000 for the other providers.

 State-by-state breakdown – PDF

 Enhanced Provider Relief Fund Payment Portal and Dentists

In June, HHS announced the launch of the Enhanced Provider Relief Fund Payment Portal where eligible Medicaid, Medicaid managed care and CHIP providers were the first to begin reporting their annual patient revenue information for funding. Today, HHS is announcing this portal and an application process is now open to dentists who may not have previously been eligible to receive funding through the Provider Relief Fund. Eligible dentists will receive a reimbursement of two percent of their annual reported patient revenue and will have until July 24, 2020 to apply for funding through the Enhanced Provider Relief Fund Payment Portal. This second phase of General Distribution will continue to expand to include other providers submitting applications for future relief funding opportunities or as directed by HHS.

Return to the Workplace Safely Using Total Worker Health® Strategies—Recorded Webinar 

The NIOSH Total Worker Health® Program hosted a webinar about Reopening America on June 25. NIOSH speakers discussed the most up-to-date science, strategies, and recommendations for returning to work safely as organizations meet the challenges of the COVID-19 pandemic. The speakers also discussed how businesses in other sectors can apply NIOSH guidance to safely reopen. The recorded webinar can be accessed through the above link.

Financial Support for Child Care Providers in Pennsylvania During COVID-19

Pennsylvania Governor Tom Wolf visited the child care center at Pennsylvania State Employees Credit Union (PSECU) headquarters in Harrisburg to announce $53 million in additional financial support for child care providers that have suffered during COVID-19.

“This funding will help child care providers bridge the gap until their clientele returns,” Gov. Wolf said. “It will also help them with any increased costs that have been incurred due to the pandemic – things like cleaning and sanitization, which will help keep the 386,000 children who attend our licensed child care facilities safe, as well as the workers who do so much to care for them.”

The governor was joined at the announcement by Teresa Miller, secretary of the Pennsylvania Department of Human Services (DHS); George Rudolph, president and CEO of PSECU; and Tonya Bastinelli, director of the Bright Horizons child care center at PSECU.

In June, the Wolf Administration distributed $51 million in CARES Act Child Care Development Funds to eligible child care providers. The $53 million announced today is also from CARES Act funding and will be distributed this month. Another $116 million from Act 24 will be distributed in the coming months, bringing the total sum of financial support to $220 million.

The funding is distributed through the Department of Human Services’ (DHS) Office of Child Development and Early Learning (OCDEL), which licenses child care providers in the state and is working with Penn State Harrisburg’s Institute of State and Regional Affairs on an impact study to understand challenges for child care providers reopening and resuming operations during COVID-19.

OCDEL has 7,017 licensed child care providers as of June 24 and 65 have permanently closed based on the February 2020 license list. Based on participation in the June CARES Act distribution, slightly more than 100 additional providers have declined funds indicating they intend to remain closed.

The Penn State study highlights the various operational and financial impacts child care providers have endured and will continue to endure throughout the COVID-19 pandemic.

Based on the preliminary findings of the study, distributing stimulus funds in July is critical to ensure adequate capacity is available in the future. Data collected through this study will be used to help determine allocation of the remaining $116 million.

“While we do not know how this pandemic will look in a week, a month, or a year, we know that a healthy, robust child care system will be critical to weather the economic recovery ahead,” DHS Sec. Teresa Miller said. “This study will capture experiences and challenges child care providers have endured since COVID-19 arose in Pennsylvania and will allow us to direct additional funds how and where our child care providers need them most. This industry is vital to both a healthy economy and our children’s futures, and we will not abandon our child care providers who dedicate their lives to our youngest Pennsylvanians, often at low pay and now, a risk to their health. We will be with you through the challenges to come.”

“Stable, affordable, high-quality child care is an important piece of our workforce development,” Gov. Wolf said. “In fact, my Keystone Economic Development and Workforce Command Center identified it as one of the biggest hurdles to getting more Pennsylvanians into the workforce. As we continue to recover economically from this pandemic, we will need child care available so parents can resume working, or so they can attend training programs or job interviews. And, of course, it is crucial to continue providing high-quality care during critical early years when children are rapidly learning.”

Child care providers who would like to receive round 2 of CARES Act funds should go to the DHS website to fill out the attestation form.

CMS Shares Five Things About Nursing Homes During COVID-19

The Centers for Medicare and Medicaid Services (CMS) is sharing “Five Things About Nursing Homes During COVID-19” part of an ongoing series by the U.S. Department of Health and Human Services. Safeguarding the health and well-being of the most vulnerable and fragile Americans is a top priority for the Trump Administration.  Watch to hear from Administrator Seema Verma about 5 things CMS is doing to stop the spread of coronavirus in nursing homes.

HHS Awards More Than $21 Million to Support Health Centers’ COVID-19 Response

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded more than $21 million to support health centers’ COVID-19 response efforts. The majority of this investment—$17 million—supports 78 Health Center Program look-alikes (LALs) with funding to expand capacity for COVID-19 testing.

Due to the urgent need across the country to respond to the COVID-19 crisis, funding to expand capacity for COVID-19 testing is being made available to LALs through the Health Center Program. These LALs operate and provide services consistent with HRSA Health Center Program requirements; however, unlike HRSA-funded health centers, LAL operations are funded through mechanisms outside of the HRSA Health Center Program.

Currently, almost 88 percent of LALs report conducting COVID-19 testing in their communities, and 56 percent offer walk-up or drive-up testing. With this funding, LALs will expand the range of testing and testing-related activities to best address the needs of their communities, which will cover PPE purchases, workforce training, and laboratory diagnostic activities.

HRSA also awarded over $4.5 million to support the COVID-19 response of Health Center Controlled Networks (HCCNs). HCCNs support health centers to improve quality of care and patient safety by using health information technology to reduce costs and improve care coordination.

For funding details and to read the entire press release, please visit the HHS website here.