On November 26^th, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized a rule establishing a new, six-year mandatory model aimed at increasing access to kidney transplants. Starting in July 2025, selected transplant hospitals will receive financial incentives to perform more kidney transplants. The final rule also includes standard provisions for all mandatory CMS innovation center models starting after January 1, 2025.

– Comment by January 27.  The Office of the Inspector General (OIG) at the U.S. Department of Health & Human Services is seeking recommendations for developing new, or modifying existing, safe harbor provisions under the federal anti-kickback statute, as well as developing new OIG Special Fraud Alerts. The federal anti-kickback statute specifies criminal penalties for knowingly and willfully offering, paying, soliciting, or receiving payment to induce or reward referrals for or purchases of items or services reimbursable under any of the federal health care programs. Safe harbor provisions specify payment and business practices that would not be subject to sanctions under the federal anti-kickback statute, even though they could induce referrals of business for which payment may be made under a federal health care program. Safe harbors currently exist for value-based arrangements and local transportation in rural areas. Rural stakeholders should send recommendations to https://www.regulations.gov, follow the “Submit a comment” instructions, and refer to file code OIG-1124-N.

The Centers for Medicare & Medicaid Services (CMS) announced the allocation of 200 new Medicare-funded residency slots to more than 100 teaching hospitals. The slots are the third allocation from 1,000 new Medicare-funded residency positions authorized over five years under Section 126 of the Consolidated Appropriations Act of 2021. The application period for the fourth round will open in January 2025 and will close March 31, 2025.

– Comment by January 27. The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program and Medicare Prescription Drug Benefit Program (Part D).  Proposals include permitting Medicare and Medicaid coverage of anti-obesity medications, further clarifications to the rules on what MA plans must cover, limits on enrollee cost-sharing for behavioral health, expanded topics that agents/brokers must cover when assisting beneficiaries, parameters around the use of debit cards for supplemental MA benefits, codifying requirements for the Medicare Prescription Payment Plan, and integrating member identification cards for individuals dually eligible for Medicare and Medicaid. As of January 2023, about 45 percent of rural Medicare beneficiaries were enrolled in an MA plan.

– Comment by December 30.  The Centers for Medicare & Medicaid Services (CMS) would like public feedback on 41 Measures Under Consideration for quality reporting and value-based programs before the measures are formally proposed through the rulemaking process. Categories of quality measures for hospitals receiving payment through Medicare, including CMS-designated Rural Emergency Hospitals (REHs), are:

• Post-Acute Care/Long-Term Care Measures
• Clinician Measures
• Hospital Measures

For example, CMS would like early feedback on including the measure Median Time to Pain Medication for Patients with a Diagnosis of Sickle Cell Disease with Vaso-Occlusive Episode in the Rural Emergency Hospital Quality Reporting Program, and the measure Proportion of Patients who Died from Cancer Admitted to Hospice for Less than 3 Days in the Hospital Inpatient Quality Reporting Program. CMS will hold three listening sessions, one for each of these categories, December 17-19.  Register to make live comments or ask questions during these sessions.  You may also enter a comment for public viewing on a form halfway down the page in the headline link.

New data from the Centers for Disease Control and Prevention show that, in 2023, the percentage of adults with diagnosed chronic obstructive pulmonary disease (COPD) was 3.8 percent.  The prevalence of COPD among adults increased as urbanization level decreased.

HRSA’s National Center for Health Workforce Analysis collects data, conducts research, and generates information to inform and support public- and private-sector decision making.  This brief examines the supply of physicians, physician assistants (PA), and nurse practitioners (NP) practicing in primary care specialties: family medicine, general pediatric medicine, general internal medicine, and geriatric medicine.  While rural areas generally have lower primary care physician ratios than urban areas, the data show that NPs and Pas are important in providing primary care in rural areas.  Approximately half of PAs were interested in practicing in rural locations (44 percent), Medically Underserved Areas (58 percent), or Health Professional Shortage Areas (54 percent).

In their most recent brief, “Observed Factors Influencing REH Conversion Decisions,” the Rural Emergency Hospital (REH) Technical Assistance Center (TAC) summarizes the key findings from financial modeling activities and discusses common barriers identified by hospitals considering conversion. In 2023, REHs became a new Medicare rural provider type focused on emergency and observation services, not inpatient care.  The TAC found that while the REH conversion is a viable option for some hospitals, barriers exist for others. To date, 31 hospitals have been designated REHs.  If you are interested in receiving updates and key findings from the TAC, subscribe to the newsletter or visit their website, the Rural Health Redesign Center.

The National Advisory Committee on Rural Health and Human Services is a citizens’ panel of rural health experts that convenes twice each year to examine pressing issues and make recommendations to the U.S. Department of Health & Human Services.  The most recently reports come from a meeting in Austin, Texas in April of this year, with an in-depth look at How Technology and Innovation Can Help Address Rural Health Care Challenges and Supporting Quality Measurement for Rural Health Clinics.

– January 9.   The Association of Schools and Programs of Public Health (ASPPH) and the U.S. Department of Agriculture (USDA) offer a one-year fellowship based in Washington, DC beginning in June 2025.  Hybrid/remote candidates will also be considered for work that contributes to USDA programs related to rural health, including collaborations with federal and nonfederal partners.  To be eligible for this program, applicants must have received their Masters or Doctorate degree prior to the beginning of the fellowship (no later than June 2025) or within the last five years (no earlier than May 2020). Graduate degrees must come from an ASPPH member graduate school or program of public health accredited by the Council on Education for Public Health.