On April 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update payment rates for the Skilled Nursing Facilities (SNFs) Prospective Payment System (PPS) for Fiscal Year (FY) 2023 and propose changes to SNF Quality Reporting Program (QRP), SNF Value Based Purchasing Program (VBP), and requests information regarding requirements for Long-Term Care (LTC) facilities to establish mandatory minimum staffing levels.

Key proposals include:

• Updated payment rates by 3.9%, reflecting a market basket index percentage change of 2.8%, increased by the forecast error adjustment of 1.5% and reduced by the productivity adjustment of 0.4% required under the Affordable Care Act. However, a 4.6% proposed parity adjustment to ensure budget neutrality results in an approximately $320 million decrease in Medicare Part A payments to SNFs in FY 2023.
• Requesting information on establishing mandatory minimum staffing requirements for LTC facilities. Specifically, feedback on evidence that establishes an appropriate minimum staffing requirement, associated costs, rural considerations including workforce recruiting challenges, and how the minimum staffing requirement should be measured.
• Adopting the Centers for Disease Control (CDC) Influenza Vaccination Coverage among Healthcare Personnel (HCP) measure for the SNF QRP in FY 2025 to report the percentage of HCP that receive the influenza vaccine each season.
• Revising the compliance date to October 1, 2023, for collecting data on Transfer of Health (TOH) Information to Provider-PAC measure, TOH Information to Patient-PAC measure, and certain standardized patient assessment data elements.
• Adopting new SNF VBP quality measures including the SNF Healthcare Associated Infections (HAI) Requiring Hospitalizations measure and the Total Nursing Hours per Resident Day staffing measure in FY 2026 and the Discharge to Community Post-Acute Care (DTC PAC) measure in FY 2027. Currently, hospital readmissions are the only quality measures for VBP.
• Implementing case minimums and measure minimums as eligibility requirements for inclusion in VBP programs and incentive-based payments.

NRHA plans to submit comments on the proposed rule. Please share any questions or concerns with NRHA staff before the June 10, 2022, deadline. CMS’s FY23 SNF PPS Fact Sheet can be found here. President Biden’s remarks on improving nursing home safety and quality can be found here. The proposed rule can be found here.

For further questions, please contact Alexa McKinley, NRHA Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team.

Pregnancy and those first weeks and months with your child are a beautiful, transformative time. Those times can also be physically and mentally difficult and occasionally overwhelming.

Nearly 60 percent of pregnancy-associated deaths happen between 42 days and one year after giving birth. In Pennsylvania, these pregnancy-related deaths are higher among Black women and women whose births were covered by Medicaid. The most common cause of death in the late postpartum period is heart failure or heart attack. Again, this disproportionately affects Black women and women with low incomes who receive their health coverage through Medicaid.

This is unacceptable. Black mothers deserve better.

Black mothers deserve comprehensive care for the physical and emotional trauma of birth that does not disappear at a six-week postpartum visit. Since taking office, Governor Wolf has prioritized expanding access to health care and supportive services that help parents through pregnancy and the postpartum period and gives children a strong, healthy start that can lead to continued good health, well-being and positive outcomes throughout their lives.

Medicaid Extension of Postpartum Coverage Period

Effective April 1, 2022, under the American Rescue Plan Act, Pennsylvania extended the Medicaid postpartum coverage period for mothers and birthing people who are eligible for the program because of their pregnancy to one year following the birth of a baby. Previously, Medicaid — or Medical Assistance in Pennsylvania — provides coverage for people eligible due to their pregnancy ended 60 days after giving birth. Extending postpartum coverage for those covered through Medicaid will provide continuity in health care by allowing birthing parents to maintain relationships with and access to care providers undisrupted through a critical period in their lives and their babies’ lives.

Press Release: Extension Increases Access to Critical Postpartum Care

Statistics & Facts

• About 3 in 10 births nationwide are paid for through Medicaid, but traditionally, coverage for people who qualify because they are pregnant ends 60 days following the birth of a baby unless their income or circumstances change.

Maternal Mortality

• In Pennsylvania, pregnancy-related deaths grew by more than 21 percent between 2013 and 2018.
• Nationally, about 12 percent of pregnancy-related deaths occur between six weeks and one year postpartum, but almost 60 percent of those are preventable.
• Black women are 3 to 5 times more likely than white women to die after giving birth.
• Statistics from 2020 show the pregnancy-related mortality rate of Black mothers was disproportionate to White and Hispanic mothers:
  • Black Mothers: 55.3 deaths per 100,000 births
  • White Mothers: 19.1 deaths per 100,000 births
  • Hispanic Mothers: 18.5 deaths per 100,000 births

Perinatal Mental Health

• Perinatal depression is the most common complication during pregnancy and the postpartum period.
• 1 in 7 women experience depression during or following a pregnancy, but too often it can go undiagnosed.
• A 2018 study published by the National Institute of Health (NIH) reported that just 1 in 5 women report symptoms of depression or anxiety during or after a pregnancy to a health care provider, but follow through for treatment may be even lower, especially for women of color.

Quality of Care

• People from some racial groups are more likely to be uninsured than non-Hispanic Whites.
• Research indicates that 22 percent of Black women receive a lower quality of care than white women and are subject to discrimination in the health care field.
• According to the American College of Obstetricians and Gynecologists (ACOG), in 2008 only 6.4 percent of obstetricians-gynecologists practiced in rural areas.

Additional Maternal Health Resources

• Health Resources & Services Administration (HRSA) Maternal & Child Health
• Black Mamas Matter Alliance
• March of Dimes
• Strong Start for Mothers and Newborns Initiative — Centers for Medicaid & Medicare Services
• World Health Organization (WHO) response
• Proclamation on Black Maternal Health Week, 2022 — The White House
• The U.S. Surgeon General’s Call To Action to Improve Maternal Health

Sections 120 and 402 of the Consolidated Appropriations Act, 2021 (CAA) made two key changes to Medicare enrollment rules.

First, Medicare coverage will become effective the month after enrollment for individuals enrolling in the last three months of their initial enrollment period or in the General Enrollment Period, thereby reducing any potential gaps in coverage. Currently, if individuals enroll in Medicare in the last three months of their Initial Enrollment Period or in the General Enrollment Period, they may have to wait several months for Medicare coverage to begin.

Second, the proposed rule also establishes a new immunosuppressive drug program that would extend Medicare immunosuppressive drug coverage to certain individuals who have had a kidney transplant. If finalized, the proposed rule would promote accessibility to vital life-saving drugs.

This rule, if finalized, would become effective January 1, 2023, and implement changes made by the CAA

Press Release: https://www.cms.gov/newsroom/press-releases/cms-proposes-updates-reduce-barriers-coverage-simplify-medicare-enrollment-and-expand-access

Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/implementing-certain-provisions-consolidated-appropriations-act-2021-and-other-revisions-medicare-1

Federal Register: https://www.cms.gov/files/document/cms-4199-p.pdf

The National Rural Health Association (NRHA) team submitted comments in response to the OSHA COVID-19 notice of limited reopening of comment period.

NRHA recognizes the need to protect healthcare and healthcare support service workers from occupational exposure to COVID-19 in settings where people with COVID-19 are reasonably expected to be present.  As OSHA works towards permanent regulator solutions, we encourage the agency to recognize already established protocols given where healthcare providers are at this point in the pandemic.  NRHA maintains the position that adding burdensome standards, like the prior ETS proposes, will not protect patients or employees.  Rather it will pull limited staff and financial resources in directions that could be better used providing health care to patients, especially in rural areas.  We have heard from members across the country about loss of staff due to the mandatory vaccination requirements, which perpetuates significant workforce shortages in our rural health care facilities. 

Please feel free to reach out to Carrie (ccochran@ruralhealth.us) with any questions. 

The Appalachian Leadership Institute (ALI) is now accepting applications!

ARC is seeking 40 fellows from all 13 Appalachian states, and all walks of community life, for the Class of 2022-2023.

ALI is a FREE leadership and economic development program designed to help anyone who lives or works in Appalachia gain skills to strengthen their community. From October 2022 – July 2023, participants will attend six multi-day seminars across the Region, and end with a capstone graduation event held in Washington, DC.

Apply by June 1 at arc.gov/leadership.

On April 18, CMS issued a proposed rule for inpatient and long-term hospitals that builds on the Biden-Harris Administration’s key priorities to advance health equity and improve maternal health outcomes. In addition to annual policies that promote Medicare payment accuracy and hospital stability, the fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule includes measures that will encourage hospitals to build health equity into their core functions, thereby improving care for people and communities who are disadvantaged and/or underserved by the health care system. The rule includes 3 health equity-focused measures in hospital quality programs, seeks stakeholder input related to documenting social determinants of health in inpatient claims data, and proposes a “Birthing-Friendly” hospital designation.

For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record users, the proposed increase in operating payment rates is projected to be 3.2%. This reflects a FY 2023 projected hospital market basket update of 3.1% reduced by a projected 0.4 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by statute. Under the LTCH PPS, CMS expects payments to increase by approximately 0.8% or $25 million.

Additional items in the proposed rule related to payment stability for hospitals include a policy that smooths out significant year-to-year changes in hospitals’ wage indexes and a solicitation for comments on payment adjustments for purchasing domestically made surgical N95 respirators. Specifically, CMS is proposing to apply a 5% cap on any decrease to a hospital’s wage index from its wage index in the prior FY; and is considering the appropriateness of payment adjustments accounting for additional costs of purchasing surgical N95 respirators made in the U.S.

More Information:

• Complete press release
• Proposed payment rule fact sheet
• Maternal health & health equity measures fact sheet
• White House statement on Reducing Maternal Mortality and Morbidity
• Proposed rule: Comment by June 17

11 Projects Will Help People in Equity Communities Access Clean Energy

In honor of Earth Day 2022, State Director for Rural Development Bob Morgan announced that the U.S. Department of Agriculture (USDA) is investing more than $16 million in 11 projects in rural Pennsylvania. These investments will strengthen the health and livelihoods of people across rural America.

Today’s announcement is part of the Biden-Harris Administration’s Building a Better America Rural Infrastructure Tour, during which Biden Administration officials are traveling to dozens of rural communities to talk about the impact of Bipartisan Infrastructure Law investments, as well as President Biden’s broader commitment to ensure federal resources reach all communities in rural America.

“People in rural America and across the world frequently experience the impacts of climate change in many ways. This includes more severe droughts, more frequent wildfires, and more destructive and life-threatening storms,” Morgan said. “When we invest in infrastructure in rural communities, we invest in our planet. USDA is proud to celebrate Earth Day and the many ways we are addressing climate change and investing in locally-driven solutions to bring safe water and renewable energy to people in rural areas everywhere.”

USDA Rural Development is taking several actions to mitigate the impacts of climate change in rural communities.

Advancing Equity in Rural Communities

USDA Rural Development is prioritizing projects that advance the Biden-Harris Administration’s key priorities of investing in rural communities to ensure people have equitable access to critical resources and to combat the climate crisis. Investments in these communities will make an impact for generations to come.

For example, the projects in today’s announcement will help advance equity in rural communities, especially in those that have been socially vulnerable, distressed and underserved for far too long.

Clean Energy Infrastructure and Energy Efficiency Improvements

USDA is investing nearly $200,000 in renewable energy infrastructure in Pennsylvania to help agricultural producers, rural small business owners and residents lower energy costs and make energy-efficiency improvements. The Department is making the investments under the Electric Loan Program and the Rural Energy for America Program (REAP).

Through REAP, Rural Development is helping 8 rural businesses and agricultural producers get access to clean energy, while reducing their carbon footprint to make their business operations more cost-effective.

• Saint Francis University in Cambria County received a REAP Energy Audits and Renewable Energy Development grant of $100,000 to assist 28 agricultural producers and rural small businesses across the state of Pennsylvania receive low-cost energy assessments aimed at reducing their energy costs over time. Funds will also be used to create marketing materials, which will be distributed to bring awareness to the program. This program strengthens American energy independence by increasing the private sector supply of renewable energy and decreasing the demand for energy through energy efficiency improvements.

A complete list of all the projects can be found on our website.

The Biden-Harris Administration celebrated Earth Day by focusing on its theme, “invest in our planet”, and is committed to addressing climate change, advancing health equity and pursuing environmental justice – which all depends on a healthy, clean planet. The following is a snapshot of various Earth Day activities the U.S. Department of Health and Human Services, its new Office of Climate Change and Health Equity and other divisions are coordinating as part of a commitment to building a healthier, more climate-resilient future.

“There is an urgent need to act now, and HHS is stepping up to deliver. From releasing $385M in Low Income Home Energy Assistance Program (LIHEAP) funds to introducing a pledge initiative that will connect public and private healthcare stakeholders to reduce emissions, we will use every tool in our toolbox to ensure a healthier future for all,” said HHS Secretary Xavier Becerra.

“History will judge us for the actions or inactions that we take today. I am proud to work for an administration that is choosing to take action, and choosing to prioritize climate and health on Earth Day, and every day,” said HHS Assistant Secretary for Health Admiral Rachel Levine.

The following is a short overview of some of the Department’s efforts surrounding Earth Day 2022.

Assistance and Tools to Address Climate Impacts

• Announced the release of $385M in Low Income Home Energy Assistance Program (LIHEAP) funds, which helps keep families safe and healthy through initiatives that assist families with energy costs.  [ACF]
• Launched the LIHEAP Heat Stress Geographic Information System (GIS) Dashboard that provides information on the progression of extreme heat over time, the health impacts of extreme heat, and visualizations on how LIHEAP is able to alleviate extreme heat stress for vulnerable populations, among other information/tools. The dashboard provides high-quality, accessible, and timely information for our grant recipients and partners to help them determine how best to utilize LIHEAP and other resources to help promote health and wellbeing for vulnerable populations. [ACF]
• Published an Office of Community Services Earth Day webpage that has information on the Dashboard, Earth Day one pagers for LIHEAP, the Low-Income Household Water Assistance Program (LIHWAP), and the Rural Community Development program, and videos on LIHEAP and LIHWAP, and a social media toolkit that can be used to promote the programs and underscore their impact. [ACF]
• Issued a new AHRQ Healthcare Cost and Utilization Project data brief, “Emergency Department Visits for Diagnoses Directly Indicating Heat Exposure: Variation Across Counties in the United States, 2016 – 2020” that quantifies wide state variations in heat-related emergency department visits due to extreme heat exposure. The brief also showed rural counties were more likely than urban counties to have higher rates of ED visits related to heat exposure. [AHRQ]
• Issued a new AHRQ Views blog post “Earth Day at AHRQ: Celebrating Hope through Action” by Agency Deputy Director David Meyers, M.D., and Social Science Analyst Brent Sandmeyer, M.P.H. [AHRQ]
• Hosted the HHS Earth Day 2022 Speaker Series with climate change experts from across the federal government to discuss the basics of climate change, climate science, how climate change impacts health, and how the Office of Climate Change and Health Equity (OCCHE) is coordinating climate and health equity efforts across the Department. [OCCHE and ASA]

Healthcare Sector Resilience and Decarbonization

• Issued a new Pledge Initiative, in partnership with the White House, as a call to action for health care stakeholders to address climate change, including pledges by private sector health systems and other organizations to reduce greenhouse gases. [OCCHE]
• Published a New England Journal of Medicine Perspective “After COP26 — Putting Health and Equity at the Center of the Climate Movement.” [OCCHE]
• Released a request for information in the CMS FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals (LTCH PPS) Proposed Rule seeking input on how health care providers can more effectively respond to climate risks and reduce their emissions and how HHS can support their efforts. [CMS]

Mental Health and Climate Change

• Posted information on disaster preparedness in an era of climate change on SAMHSA’s Disaster Behavioral Health Information Series Resource Center (DBHIS) on SAMHSA.gov. [SAMHSA]
• Released an issue of the quarterly Dialogue newsletter entitled Disaster Behavioral Health in an Era of Climate Change – PDF on SAMHSA.gov. [SAMHSA]

Environmental Justice

• Released a draft outline of 2022 HHS Environmental Justice Strategy and Implementation Plan for public comment on the Federal Register, which closes May 19, 2022. [OCCHE]

Environmental Health Initiatives and Research

• Environmental Health Perspectives (EHP), a leading monthly journal of environmental health research and news published with support from the National Institute of Environmental Health Sciences, part of NIH, is celebrating its 50th anniversary on Earth Day, April 22, 2022.  The journal has contributed significantly to public health over the past five decades. We are excited to honor key moments that established EHP’s leadership in environmental health research and scholarly publishing. (NIEHS)
• Aubrey K. Miller, senior medical advisor to the director of the National Institute of Environmental Health Sciences (NIEHS), will present a keynote at 12:00 pm ET: “Applied Science to Address the Health Impacts of Disasters and Climate Change: Challenges and Opportunities” as part of the 2022 John P. Wyatt, M.D. Environment and Health Symposium at the University of Kentucky on Earth Day, April 22, 2022. (NIEHS)
• Promoted the HHS Endocrine-Disrupting Chemicals (EDC) Innovator Award Competition: Innovative Methods to Address the Impact of Endocrine-Disrupting Chemicals on Black or African American Women. The competition aims to identify and fund programs that demonstrate effectiveness, sustainability, and the ability to replicate and/or expand interventions that address gaps in knowledge and provide solutions to reduce EDC exposure risk for Black or African American women. [OWH]

Digital Medicare Resources

• Promoted the “Go Digital” theme on the Medicare.gov homepage – to reduce waste and receive real-time updates -including a blog and video with information and instructions on how to sign up for the digital Medicare handbook. [CMS]

Department Responds in Record Time to Meet the Growing Health Care Needs in Rural America

U.S. Department of Agriculture (USDA) Rural Development State Director Bob Morgan announced that USDA is awarding $3.9 million in Emergency Rural Health Care Grants to 6 rural health care organizations and community groups in Central Pennsylvania.

“No matter where you live, people deserve good health care, and the Biden-Harris Administration is committed to making that a reality throughout rural America,” Morgan said. “Through the Emergency Rural Health Care Grants Program, USDA is improving access to the critical health care services rural people rely on every day here in rural Pennsylvania.”

The Biden-Harris Administration made these funds available through its historic legislative package, the American Rescue Plan Act. Within months after the Act’s passage, USDA responded quickly by making this funding available to ensure the long-term availability of rural health care services.

The grants USDA is awarding will help rural hospitals and health care providers implement telehealth and nutrition assistance programs, increase staffing, build or renovate facilities, and purchase medical supplies.

Morgan made the announcement at Evangelical Community Hospital. The hospital is one of six recipients to receive grant funds in Central Pennsylvania. The hospital will use a $487,800 grant to support the purchase of an Advanced Life Support (ALS) Medic Unit with radio equipment as well as patient monitors and ancillary equipment to be used in the hospital on inpatient and outpatient units.

The COVID-19 pandemic increased the demand for care on both Emergency Medical Services (EMS) and hospital fronts. The new unit and equipment allows the hospital to be ready from an emergency and in-hospital care standpoint to handle any future COVID-19 surges as well as medical treatment for conditions outside of COVID-19.

Additional awardees in the 12th Congressional District include:

• The Clinton County Department of Emergency Services received a $750,000 grant to purchase and install tower communications equipment for towers in Leidy Township and Chapman Township. The funds will also be used to purchase radio communications equipment to better serve the Bucktail Regional Medical Center. This project will help ensure the emergency services call center reaches the area, and it will improve communication between the hospitals, ambulance services and fire companies.
• Broad Acres Nursing Home Association in Tioga County received $1 million grant to reimburse lost health care revenue incurred from March 13, 2020, to August 31, 2021. The funds will be used to promote or administer vaccines to current and future residents and staff, and to increase testing.
• Lock Haven Emergency Medical Services in Clinton County received a $309,700 grant to purchase two ambulances, two cardiac monitors and defibrillators, a power load system, two Motorola mobile units and six Motorola portable radios. The equipment is needed to help the company provide services to the community, which has seen an influx of patients due to the COVID-19 pandemic.
• Centre Care Inc. in Centre County received a $1 million grant to reimburse lost health care revenue from March 15, 2020, through August 31, 2021, due to the COVID-19 pandemic. The funds will be used to promote or administer vaccines to current and future residents and staff, and to increase testing. Centre Care Incorporated provides nursing, assisted living and senior retirement care to qualifying persons.
• Citizens Hose Company of South Renovo in Clinton County received a $443,800 grant for a quick response unit rescue truck. The new vehicle will allow for better and more reliable response times, and equip the fire department with the necessary equipment, tools and diagnostic capabilities to perform the emergency response tasks. It will also be used to serve as a mobile vaccine administration and testing unit as necessary for the COVID-19 pandemic and for future health crises. This equipment will allow emergency services to reach the remote portions of the service area. The equipment will allow the fire response team to setup a mobile medical unit during emergency situations before ambulance services arrive.

On April 13, a total of $10.5 million in Emergency Health Care grant projects were announced in Pennsylvania. This included 18 projects across Pennsylvania. A full list of these projects can be viewed on our website. This funding will help meet the demands of growing health care needs in rural America and expand access to health care services for 2.2 million people across 22 states.

USDA will announce additional recipients of Emergency Rural Health Care Grants in the coming weeks and months.