Rural Health Information Hub Latest News

HIV/AIDS Clinics Sue HHS Over Drug Manufacturers’ Denials of 340B Pricing

The national association of HIV/AIDS clinics and two of its members sued U.S. Health and Human Services (HHS) Secretary Alex Azar in federal court to compel him to protect their rights to buy covered outpatient drugs from four manufacturers that refuse to sell them when ordered through 340B contract pharmacy arrangements. The Oct. 9 suit brought by Ryan White Clinics for 340B Access (RWC-340B), its Kentucky member Matthew 25 AIDS Services and its Tennessee member Cempa Community Care, is a major turning point in the months-long struggle over 340B contract pharmacy involving the drug industry, 340B covered entities and their trade associations, HHS, the U.S. Health Resources and Services Administration (HRSA) and Congress. It brings the federal judiciary into the equation. A second similar lawsuit against HHS and HRSA is expected soon. Click here for more information on the lawsuit.

Dept. of Health Announces Rapid Antigen Test Card Distributions 

The Wolf Administration has begun distributing the state’s first allotment of 250,000 COVID-19 antigen test kits provided by the federal government to Clinical Laboratory Improvement Amendments (CLIA)-certified institutions across Pennsylvania. Distribution is starting with Bradford, Centre, Lebanon, Montour, Northumberland, Schuylkill and Snyder counties because of the recent high disease incidence rate in these areas. The Secretary of Health also issued an order to laboratories, healthcare practitioners, healthcare providers and facilities reinforcing that all antigen test results, both positive and negative, are required to be reported to the Department of Health via its reporting system, PA-NEDSS. Click here to learn more.

NHSC and Nurse Corps Build Healthy Communities 

2020 Health Workforce Field Strength Numbers Increase Access to Primary and Substance Use Disorder Care

Read the full press release

 

There are now more than 16,000 National Health Service Corps (NHSC) members providing care to more than 17 million Americans. An additional 1.8 million patients are cared for by over 1,700 Nurse Corps clinicians. Nurse Corps also added 135 faculty to its rolls.

NHSC and Nurse Corps programs support the recruitment and retention of dedicated primary care, dental, and behavioral health providers who care for underserved patients daily in high-need areas of the U.S. and its territories.

As part of our commitment to recruiting clinicians interested in serving in underserved areas, we take an active role in connecting clinicians with employment opportunities at approved sites. After a pause this spring and summer, we recently resumed hosting Virtual Job Fairs -a live interactive platform that provides students and clinicians the opportunity to meet with hundreds of recruiters hiring in underserved communities across the country.

Share how we’re making strides to impact health equity and increase access to care for those who need it most. Forward this email and use the graphics below to share with your audiences. Follow and tag us on our NHSC and Nurse Corps Facebook, NHSC and Nurse Corps LinkedIn, and NHSC Twitter accounts.

Thank you all for the hard work you do. Your dedication and support throughout 2020 has helped communities all over the nation get through a very difficult year.

Learn about HRSA’s Coronavirus response at hrsa.gov/coronavirus

 

CMS: Enforcement Discretion Relating to Certain Pharmacy Billing

The Centers for Medicare & Medicaid Services (“CMS”) appreciates its long-standing partnership with immunizers, including pharmacies, to facilitate the efficient administration of vaccinations, particularly for vulnerable populations in long-term care facilities and other congregate care settings across America. Leveraging immunizers’ capabilities and expertise will play an important role in the Department’s ability to broadly distribute and administer COVID-19 vaccinations, including Medicare beneficiaries.

America is facing an unprecedented challenge. Quickly, safely, and effectively vaccinating our most vulnerable citizens in settings that have accounted for about 30 percent of U.S. COVID-19 deaths is a top-priority mission for the Trump Administration. Unfortunately, many long-term care facilities may not have sufficient capacity to receive, store, and administer vaccines. And some long-term care facility residents cannot safely leave the facility to receive vaccinations.

Outside immunizers can help fill that urgent need and provide onsite vaccinations at skilled nursing facilities (“SNFs”). But to do so during this global emergency, Medicare-enrolled vaccinators must be able to bill directly and receive direct reimbursement from the Medicare program. However, the Social Security Act requires SNFs to bill for certain services, including vaccine administration, even when SNFs rely on an outside vendor to perform the service. See Social Security Act §§ 1862(a)(18), 1842(b)(6)(E).

Therefore, in order to facilitate the efficient administration of COVID-19 vaccines to SNF residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance (collectively, “SNF Consolidated Billing Provisions”). Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.

CMS will exercise such discretion (1) during the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. § 1320b-5(g)) and ending on the last day of the calendar quarter in which the last day of such emergency period occurs; or (2) so long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings—whichever is later. While CMS exercises this enforcement discretion, compliance with SNF Consolidated Billing Provisions is not material to CMS’ decision to reimburse for COVID-19 vaccine administration. If CMS decides in the future to cease exercising this enforcement discretion, CMS will provide public notice in advance and allow at least 60 days for affected outside immunizers to modify their business practices.

More Than $15 Million in Funding Awarded to Continue Economic Growth in Coal-Impacted Communities in the Commonwealth’s Appalachian Region

Pennsylvania Governor Tom Wolf announced that more than $15 million has been awarded to 15 projects in Pennsylvania’s Appalachian Region through the Appalachian Regional Commission’s (ARC) Partnerships for Opportunity and Workforce and Economic Revitalization (POWER) Initiative.

“Our coal-impacted communities in Pennsylvania have felt the changing economy of the country’s energy production in a major way and cannot be left behind,” Gov. Wolf said. “These 15 project awardees are focused on improving the way of life for individuals in the Appalachian Region—bringing new economic opportunities, preparing a skilled workforce, investing in broadband and other critical infrastructure, and advancing community and economic development.”

Pennsylvania received the most awards, with 11 implementation awards, two broadband awards, and two technical assistance awards. The projects range from focus on energy innovation, broadband investments, tourism, substance use disorder, behavioral health, and workforce academies.

“We are so proud to congratulate the commonwealth’s 15 POWER awardees, whose submitted projects will position our Appalachian Region communities for economic growth and new investments for years to come,” said Department of Community and Economic Development Secretary Dennis Davin. “Across coal-impacted counties, this funding will support major economic and community-focused efforts to further grow vibrant, strong local economies, which is more important now than ever before.”

Each year through the POWER Initiative, the ARC offers competitive funding to 13 Appalachian states (Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and West Virginia) for numerous projects in a wide range of program areas. The ARC’s focus for the 2020 POWER Initiative is investments that are regional, strategic, transformational, and that maximize economic revitalization.

The POWER Initiative targets federal resources to help communities and regions affected by job losses in coal mining, coal power plant operations, and coal-related supply chain industries. By encouraging economic diversity, enhancing job training and re-employment opportunities, creating jobs in existing and new industries, and attracting new investments, it supports efforts to create a more vibrant economic future for coal-impacted communities.

A list of all awardee projects is available online.

Learn more about the ARC’s POWER Initiative.

Trump Administration Drives Telehealth Services in Medicaid and Medicare

On October 14, CMS expanded the list of telehealth services that Medicare Fee-for-Service will pay for during the COVID-19 Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care.

“Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. “Medicaid patients should not be forgotten, and today’s announcement promotes telehealth for them as well. This revolutionary method of improving access to care is transforming health care delivery in America. President Trump will not let the genie go back into the bottle.”

Expanding Medicare Telehealth Services:

For the first time using a new expedited process, CMS added 11 new services to the Medicare telehealth services list since the publication of the May 1 COVID-19 Interim Final Rule with comment period (IFC). Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately and for the duration of the PHE. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available on the List of Telehealth Services webpage.

In the May 1 COVID-19 IFC, CMS modified the process for adding or deleting services from the Medicare telehealth services list to allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare telehealth services list builds on the efforts CMS has already taken to increase Medicare beneficiaries’ access to telehealth services during the COVID-19 PHE.

Since the beginning of the PHE, CMS added over 135 services to the Medicare telehealth services list – such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services. With this action, Medicare will pay for 144 services performed via telehealth. Between mid-March and mid-August, over 12.1 million Medicare beneficiaries – over 36% – of people with Medicare Fee-for-Service received a telemedicine service.

Preliminary Medicaid and CHIP Data Snapshot on Telehealth Utilization and Medicaid & CHIP Telehealth Toolkit Supplement:

In an effort to provide greater transparency on telehealth access in Medicaid and CHIP, CMS released, for the first time, a preliminary Medicaid and CHIP data snapshot on telehealth utilization during the PHE. This snapshot shows, among other things, that there have been more than 34.5 million services delivered via telehealth to Medicaid and CHIP beneficiaries between March and June of this year, representing an increase of more than 2,600% when compared to the same period from the prior year. The data also shows that adults ages 19-64 received the most services delivered via telehealth, although there was substantial variance across both age groups and states.

To further drive telehealth, CMS released a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned from states that implemented telehealth changes. The updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires.

The toolkit includes approaches and tools states can use to communicate with providers on utilizing telehealth for patient care. It updates and consolidates in one place the FAQs and resources for states to consider as they begin planning beyond the temporary flexibilities provided in response to the pandemic.

View the Medicaid and CHIP data snapshot on telehealth utilization during the PHE.

Onerous Price Transparency Regulation Looms as COVID-19 Flares in Rural America

On January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) is slated to implement a price transparency regulation that will require all hospitals, including critical access hospitals (CAHs), to develop a list of shoppable services in an effort to help patients better understand the cost of care for non-emergent services. This regulation must be delayed.

Practically all hospitals, and especially rural hospitals, have not had the time nor the resources they needed to comply with the price transparency requirements during the COVID-19 public health emergency (PHE). Half of all states are reporting increases in new COVID-19 cases, and several are setting new records for new daily cases reported, including rural states such as Montana and South Dakota.

Additionally, the regulation requires hospitals to disclose negotiated rates for their services. Unlike large urban systems, rural hospitals have absolutely no bargaining power when negotiating rates with managed care plans; they simply accept the rates offered. Rural hospitals could lose millions in revenue, and many already face negative operating margins and are on the verge of closure. Put simply, if CMS implements the price transparency regulation, hospitals will risk noncompliance and financial penalties, and many rural hospitals will close.

Rural Areas Seeing Increases in COVID-19

Some of the country’s least populous states are facing major COVID-19 surges in what North Dakota Gov. Doug Burgum called “a regional COVID storm,” according to The New York Times. North Dakota, South Dakota and Montana are among the states with the highest number of cases per capita, while other rural states like Wyoming, Idaho and Nebraska have recently seen their highest seven-day case average of the pandemic.

Changes in Federal and State Telehealth Policy Since COVID-19

In this 47-minute video, experts discuss telehealth policy changes made by the Centers for Medicare and Medicaid Services (CMS).   These address common issues related to provider type and location, billing and reimbursement, and guidance specific to Federally Qualified Health Centers and Rural Health Clinics.  The video is sponsored by the FORHP-supported Center for Connected Health Policy, a nonprofit working to improve health outcomes through telehealth.