As part of the Biden-Harris Administration’s ongoing effort to strengthen rural health, the Centers for Medicare & Medicaid Services (CMS) is releasing a new proposed rule protecting access to emergency care and additional outpatient services for people in rural communities. CMS is establishing the Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs). The proposed rule will allow small rural hospitals to seek this new health care provider designation and provide continued access to emergency services, observation care, and additional medical and outpatient services. In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after January 1, 2023. This is a significant step in building on the Administration’s efforts to reduce health care disparities and maintain access to services in rural communities.

Rural communities represent a fifth of the U.S. population, and the Department of Health and Human Services (HHS) is committed to improving health outcomes and promoting health equity in rural America. Since 2010, 138 rural hospitals have closed — with a record-breaking 19 hospitals closing in 2020 alone. These closures occur disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates. Rural communities experience shorter life expectancy, higher mortality, and have fewer local health care providers, leading to worse health outcomes than in other communities. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential health care services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is committed to advancing health equity, driving high-quality person-centered care, and promoting the sustainability of our programs. Today’s action to strengthen rural health furthers our goal of ensuring everyone served by our programs the has access to quality, affordable health care.”

To address these concerns, CMS is implementing a new Medicare provider designation called REHs, which will provide an opportunity for small rural hospitals and CAHs to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities. The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals.

Allowing providers to take advantage of the new designation will ensure that people in rural communities will be able to receive critical outpatient services, including emergency, maternal health, behavioral health, and substance use disorder services.

Today’s action takes steps to ensure the health and safety of all patients, while accounting for the access and quality of care needs of rural communities. In addition, the proposed rule includes several updates for CAHs. Specifically, CMS is proposing to add a definition of “primary roads” to the current location and distance requirements, which is used to determine if facilities qualify as CAHs. The proposed rule also contains proposals allowing CAHs that are a part of a larger health system (containing other hospitals and/or CAHs) to unify and integrate their infection control and prevention and antibiotic stewardship programs, medical staff, and quality assessment and performance improvement programs (known as QAPI) to ensure consistent and safe care. Finally, and importantly, CMS is proposing to establish a patient’s rights Condition of Participation for CAHs to provide for clear requirements for the protection and promotion patient’s rights.

The release of this proposed rule, which is a result of multiple engagements with stakeholders and a Request for Information (RFI), is the first step in the implementation of this new provider type. CMS anticipates including further discussion on important aspects for REHs, such as Medicare enrollment, payment, quality reporting, and more in the upcoming Calendar Year 2023 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule. Stakeholders are encouraged to review both proposed rules, as applicable, and submit formal comment by each respective deadline. All feedback will be taken into consideration as CMS develops its final, comprehensive policies for REHs later this year. For today’s rule, the comment period closes on August 29, 2022.

For more information on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.federalregister.gov/public-inspection/current

To read the Fact Sheet on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.cms.gov/newsroom/fact-sheets/conditions-participation-rural-emergency-hospitals-and-critical-access-hospital-cop-updates-cms-3419

To read the Fact Sheet on HHS actions to strengthen rural health, click here: https://www.hhs.gov/sites/default/files/rural-health-fact-sheet.pdf

Grant Awarded Under the Single Family Housing Self-Help Technical Assistance Program

U.S. Department of Agriculture (USDA) State Director Bob Morgan announced that the Department has partnered with Threshold Housing Development Inc. to invest $470,000 to help meet the demands of the growing housing needs in rural Pennsylvania.

“Rural America is a place everyone can call home,” Morgan said. “Expanding opportunities for homeownership strengthens rural communities and helps families and individuals build wealth and achieve financial stability. Well-built, energy efficient, affordable housing is essential to the vitality of communities in rural America.”

This Rural Development investment will be used for the completion of seven new homes and nine acquisition rehabs.

The technical assistance grant will work in conjunction with USDA’s 502 Self-Help Program, which assists low and very low-income families to obtain affordable housing through new construction or acquisition rehab.

Families choosing new construction will receive on-site technical support from Threshold Housing Development, Inc., and work together mutually with other families in the program, providing 65% of the construction labor to build their homes. By participating in the construction process, these families will realize significant cost savings, enabling them to own a brand-new home with an affordable mortgage payment.

With Threshold’s guidance, families opting for acquisition rehab will purchase and rehab their own homes. They’ll learn to evaluate the scope of rehab work that potential houses require, as well as receive training, monitoring, and assistance during the rehab process of the home they choose.

Background:

The Mutual Self-Help Housing Program provides grants to qualified organizations to help them carry out local self-help housing construction projects.

Through this program, USDA has worked with nearly 230 organizations to provide a unique opportunity for families and individuals to lower the overall purchase price of a new home by investing “sweat equity” into the construction.

Since its inception in 1966, the program has helped nearly 56,000 families build their own affordable and safe homes. Through this program, the Biden-Harris Administration has partnered with community organizations to help 261 families and individuals in socially vulnerable communities build their own homes.

The Department Increases Total Funding to Up to $4 Million to Help More Rural and Tribal Communities Access Placemaking Assistance

U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small announced that USDA is accepting applications for cooperative agreements to help eligible entities provide planning, training and technical assistance to foster placemaking activities in rural and Tribal communities.

The funds are being made available through the Rural Placemaking Innovation Challenge (RPIC). USDA is increasing RPIC funding to up to $4 million to assist more rural communities access placemaking assistance. The previous funding level was $3 million.

Today, USDA is inviting eligible entities to apply for up to $250,000 to help rural and Tribal communities create plans to enhance capacity for high-speed internet access; preserve cultural and historic structures; and support development in transportation, housing and recreational spaces.

This technical assistance will help communities convene partners and identify community needs to develop placemaking plans. These plans will help rural areas build back better and stronger. The entities must support participating rural communities for up to two years.

Learn more about this USDA Stakeholder Announcement.

From the Pennsylvania Department of Health, Bureau of Emergency Medical Services

This EMS Information Bulletin (EMS-IB) supersedes all previously published EMS-IBs related to COVID-19 exemptions as a result of the Disaster Declaration or continuance thereof.

Effective at 11:59 pm June 30, 2022, all regulatory exceptions issued as part of the COVID-19 disaster declaration will expire. This means that all crews must meet legal staffing standards as of July 1, 2022. Any agency that is currently using out-of-state providers to fulfill staffing requirements must immediately stop the use of these providers effective 11:59 pm, June 30, 2022.

However, the Bureau of EMS (Bureau) recognizes the need to evaluate staffing models and has reviewed all authorities granted to the Bureau. As such the Bureau is authorizing all Basic Life Support (BLS) ambulances in the Commonwealth to staff utilizing the provisions of Act 17 of 2020 without making application to the Department, utilizing the provisions outlined below.

Act 17 of 2020 amended the EMS Systems Act to permit the Department of Health (Department) to grant exceptions to the ambulance staffing standard for Basic Life Support (BLS) ambulances.

Pursuant to the Act, exceptions were only to be granted in cases where there were extraordinary reasons and in the best interest of the EMS system and patient care.

On July 6, 2020 the Bureau of EMS (Bureau) issued EMSIB 2020-27 Act 17 of 2020 BLS Ambulance Staffing Exceptions. This document established the general criteria and process for staffing waiver applications.

Despite the termination of the declaration of disaster emergency, the Department finds the continued effects of COVID-19 as well as staffing shortages are impacting the overall EMS system and constitute an extraordinary circumstance.

As a result, and in the best interest of the EMS system the Department is issuing the following staffing exception in accordance with its authority outlined in Act 17 of 2020.

Exception 1:
At the time of patient transport, a BLS ambulance must be operated by a certified Emergency Medical Services Vehicle Operator (EMSVO), and the patient must be attended by an EMS provider at or above the level of an Emergency Medical Technician (EMT).  This exception is effective immediately and will remain in effect until this EMS-IB is superseded or voided by the Department.

Please direct any questions regarding this memo to your regional council.

A new online dashboard developed by the analysts at Stroudwater Associates identifies the top 20% highest opioid dispensing counties in the United States. You can view your state-specific dashboard here.

As the opioid epidemic worsens, we understand that improving the management of long-term prescribed opioids is an increasingly urgent imperative for physicians and hospitals. To help healthcare providers develop and implement a process to better manage patients on long-term opioid therapy, we present a new service offering.

Our clinician-led team guides primary care clinics and provider practices to customize and integrate an opioid management program into daily operations. Stroudwater also offers a 4-part webinar series addressing the current opioid epidemic, the role of primary care, and an introduction to the Six Building Blocks Opioid Management Program.