- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- Announcing the 2030 Census Disclosure Avoidance Research Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- Public Inspection: CMS: Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- CMS: Request for Information; Health Technology Ecosystem
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- State: 60-Day Notice of Proposed Information Collection: J-1 Visa Waiver Recommendation Application
CMS Releases Guidance on Provider Directories, Services for Incarcerated Young People
In July, Centers for Medicare and Medicaid Services (CMS) released two pieces of guidance on provisions in the Consolidated Appropriations Act (CAA) of 2023. The first piece of guidance addresses new requirements around accurate, regularly updated, and searchable provider directories in Medicaid and CHIP. Medicaid agencies and managed care organizations will need to make these changes by July 1, 2025. The second piece of guidance discusses Section 5121 of the CAA, which creates a new requirement to provide screening, diagnostic, and case management services to “eligible juveniles” who are post-adjudication in correctional facilities. Medicaid agencies will also have the option, under Section 5122 of the CAA, to provide full Medicaid and CHIP benefits to incarcerated young people who are pre-adjudication.
New Data Show Highest Number of Health Center Patients in Nearly 60 Year History of the Program
HRSA-Funded Health Centers Served 2.7 Million More Patients Over Past Four Years, Reaching High of More than 31 Million Patients
Today, to mark National Health Center Week, the Health Resources and Services Administration (HRSA) released new data showing over 31 million total patients served at HRSA-funded health centers in 2023—an increase of 2.7 million since 2020.
“Community health centers play a pivotal, and growing, role in America’s health care system. They are especially important in our effort to reduce health care disparities in underserved communities,” said HHS Secretary Xavier Becerra. “More than 31 million people across the country – in every U.S. state, territory, and the District of Columbia – depend on health centers, making them a vital resource. The Biden-Harris Administration wants all Americans to have access to high-quality primary health care services, regardless of a patient’s ability to pay, and community health centers help make that possible.”
“HRSA-funded community health centers make it possible for anyone in the community to access high-quality primary health care, regardless of income,” said HRSA Administrator Carole Johnson. “We are proud to serve millions more people and expand the community health workforce in rural and underserved areas all across the country.”
HRSA-funded health centers are required to treat all patients regardless of ability to pay, and in 2023 more than 90 percent of health center patients had incomes less than 200 percent of the 2023 Federal Poverty Guidelines. Health centers are now serving one in eight children across the country, more than 9.7 million patients in rural areas, over 6.4 million patients who live in or near public housing, and over 1.4 million people experiencing homelessness. Health centers have also expanded their preventive services, screening hundreds of thousands more people for cancer and infectious diseases and caring for patients with substance use disorders.
Health centers continue to be leaders in quality of care, increasing access and improving clinical quality across the board. Quality improvements since 2020 include:
- Administering more than 4 million HIV tests;
- Treating 585,000 prenatal care patients; and
- Improving clinical quality measures for chronic conditions, including hypertension control (+8%) and depression screening (+7%).
For more details on these and other Health Center Program outcomes see Four Years of Health Center Outcomes.
HRSA’s Health Center Program is a cornerstone of our nation’s health care system, especially for those who are uninsured; enrolled in Medicaid; living in rural, remote, or underserved areas; struggling to afford their health insurance co-pays; experiencing homelessness; residing in public housing; or otherwise having trouble finding a doctor or paying for the cost of care.
Hospitals at Risk for Closure, State-by-State
From Becker’s Financial Management
More than 700 rural U.S. hospitals are at risk of closure due to financial problems, with more than half of those hospitals at immediate risk of closure.
The latest analysis from the Center for Healthcare Quality and Payment Reform, based on CMS’s July 2024 hospital financial information, reveals the financial vulnerability of rural hospitals in two categories: risk of closure and immediate risk of closure.
In the first category, nearly every state has hospitals at risk of closure, measured by financial reserves that can cover losses on patient services for only six to seven years. In over half the states, 25% or more of rural hospitals face this risk, with nine states having a majority of their rural hospitals in jeopardy.
The report also analyzes hospitals facing immediate threat of closure meaning financial reserves could offset losses on patient services for two to three years at most. Currently, 360 rural hospitals are at immediate risk of shutting down due to severe financial difficulties.
“The primary reason hundreds of rural hospitals are at risk of closing is that private insurance plans are paying them less than what it costs to deliver services to patients,” CHQPR notes in its report, identifying losses on private insurance patients as the biggest cause of overall financial losses.
“Most ‘solutions’ for rural hospitals have focused on increasing Medicare or Medicaid payments or expanding Medicaid eligibility due to a mistaken belief that most rural patients are insured by Medicare and Medicaid or are uninsured,” according to the CHQPR report. “In reality, about half of the services at the average rural hospital are delivered to patients with private insurance (both employer-sponsored insurance and Medicare Advantage plans). In most cases, the amounts these private plans pay, not Medicare or Medicaid payments, determine whether a rural hospital loses money.”
To preserve and enhance essential hospital services in rural areas, CHQPR recommends that small rural hospitals receive Standby Capacity Payments from both private and public payers. These payments would cover the hospital’s fixed costs for maintaining essential services, ensuring that rural communities continue to have access to necessary healthcare.
Below is a state-by-state listing of the number of rural hospitals at risk of closure in the next six to seven years and at immediate risk of closure over the next two to three years.
Alabama
28 hospitals at risk of closing (54%)
24 at immediate risk of closing in next 2-3 years (46%)
Alaska
2 hospitals at risk of closing (12%)
1 at immediate risk of closing in next 2-3 years (6%)
Arizona
2 hospitals at risk of closing (7%)
1 at immediate risk of closing in next 2-3 years (4%)
Arkansas
25 hospitals at risk of closing (54%)
13 at immediate risk of closing in next 2-3 years (28%)
California
23 hospitals at risk of closing (40%)
10 at immediate risk of closing in next 2-3 years (17%)
Colorado
10 hospitals at risk of closing (23%)
6 at immediate risk of closing in next 2-3 years (14%)
Connecticut
2 hospitals at risk of closing (67%)
1 at immediate risk of closing in next 2-3 years (33%)
Delaware
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
Florida
8 hospitals at risk of closing (36%)
5 at immediate risk of closing in next 2-3 years (23%)
Georgia
22 hospitals at risk of closing (32%)
11 at immediate risk of closing in next 2-3 years (16%)
Hawaii
8 hospitals at risk of closing (62%)
0 at immediate risk of closing in next 2-3 years
Idaho
7 hospitals at risk of closing (24%)
0 at immediate risk of closing in next 2-3 years
Illinois
12 hospitals at risk of closing (16%)
7 at immediate risk of closing in next 2-3 years 9%)
Indiana
5 hospitals at risk of closing (9%)
4 at immediate risk of closing in next 2-3 years (7%)
Iowa
29 hospitals at risk of closing (31%)
10 at immediate risk of closing in next 2-3 years (11%)
Kansas
62 hospitals at risk of closing (63%)
31 at immediate risk of closing in next 2-3 years (32%)
Kentucky
13 hospitals at risk of closing (18%)
6 at immediate risk of closing in next 2-3 years (8%)
Louisiana
24 hospitals at risk of closing (44%)
12 at immediate risk of closing in next 2-3 years (22%)
Maine
10 hospitals at risk of closing (40%)
6 at immediate risk of closing in next 2-3 years (24%)
Maryland
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
Massachusetts
2 hospitals at risk of closing (33%)
1 at immediate risk of closing in next 2-3 years (17%)
Michigan
15 hospitals at risk of closing (23%)
7 at immediate risk of closing in next 2-3 years (11%)
Minnesota
19 hospitals at risk of closing (20%)
7 at immediate risk of closing in next 2-3 years (7%)
Mississippi
35 hospitals at risk of closing (52%)
25 at immediate risk of closing in next 2-3 years (37%)
Missouri
20 hospitals at risk of closing (34%)
10 at immediate risk of closing in next 2-3 years (17%)
Montana
14 hospitals at risk of closing (25%)
4 at immediate risk of closing in next 2-3 years (7%)
Nebraska
5 hospitals at risk of closing (7%)
2 at immediate risk of closing in next 2-3 years (3%)
Nevada
5 hospitals at risk of closing (36%)
3 at immediate risk of closing in next 2-3 years (21%)
New Hampshire
2 hospitals at risk of closing (12%)
0 at immediate risk of closing in next 2-3 years
New Jersey
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
New Mexico
7 hospitals at risk of closing (26%)
6 at immediate risk of closing in next 2-3 years (22%)
New York
29 hospitals at risk of closing (56%)
20 at immediate risk of closing in next 2-3 years (38%)
North Carolina
6 hospitals at risk of closing (11%)
5 at immediate risk of closing in next 2-3 years (9%)
North Dakota
13 hospitals at risk of closing (33%)
5 at immediate risk of closing in next 2-3 years (13%)
Ohio
5 hospitals at risk of closing (7%)
2 at immediate risk of closing in next 2-3 years (3%)
Oklahoma
39 hospitals at risk of closing (50%)
26 at immediate risk of closing in next 2-3 years (33%)
Oregon
8 hospitals at risk of closing (24%)
2 at immediate risk of closing in next 2-3 years (6%)
Pennsylvania
13 hospitals at risk of closing (30%)
7 at immediate risk of closing in next 2-3 years (16%)
Rhode Island
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
South Carolina
10 hospitals at risk of closing (40%)
5 at immediate risk of closing in next 2-3 years (20%)
South Dakota
8 hospitals at risk of closing (16%)
4 at immediate risk of closing in next 2-3 years (8%)
Tennessee
19 hospitals at risk of closing (36%)
17 at immediate risk of closing in next 2-3 years (32%)
Texas
80 hospitals at risk of closing (50%)
30 at immediate risk of closing in next 2-3 years (19%)
Utah
0 hospitals at risk of closing
0 at immediate risk of closing in next 2-3 years
Vermont
8 hospitals at risk of closing (62%)
4 at immediate risk of closing in next 2-3 years (31%)
Virginia
9 hospitals at risk of closing (30%)
8 at immediate risk of closing in next 2-3 years (27%)
Washington
16 hospitals at risk of closing (36%)
4 at immediate risk of closing in next 2-3 years (9%)
West Virginia
11 hospitals at risk of closing (35%)
5 at immediate risk of closing in next 2-3 years (16%)
Wisconsin
7 hospitals at risk of closing (9%)
1 at immediate risk of closing in next 2-3 years (1%)
Wyoming
6 hospitals at risk of closing (24%)
2 at immediate risk of closing in next 2-3 years (8%)
Rural Community Health Worker Programs: Proving Value and Finding Sustainability
The latest feature article in The Rural Monitor features four rural health care organizations describing the impact of their community health worker programs and strategies for sustaining them.
Rural Center of Excellence on SUD Prevention: Reducing Stigma Rural Care Settings
This campaign from the University of Rochester (UR) Recovery Center of Excellence developed an awareness campaign to address stigmatizing beliefs around substance use disorder (SUD) that can pose a barrier to care in rural communities. The resource features perspectives of people in recovery from SUD as well as providers. UR has one of three FORHP-supported Rural Centers of Excellence on Substance Use Disorder.
2025 Proposed CMS Rules – What’s in the Rules for RHCs & How You Can Get Involved in Regulatory Advocacy
– Thursday, August 15 at 2 pm Eastern. The National Association of Rural Health Clinics (NARHC) will host the free webinar with details on the recently released Centers for Medicare and Medicaid Services (CMS) Calendar Year 2025 Medicare Physician Fee Schedule (MPFS) proposed rule. This annual regulatory update contains Rural Health Clinic (RHC) specific proposals to eliminate productivity standards, remove hemoglobin/hematocrit from the six required lab services, reform care management billing, and allow RHCs to bill for administration of part B preventive vaccines at time of service, among others. Additional time for Q&A will be provided. Advanced registration is required.
CMS Oral Health Cross-Cutting Initiative
On July 23rd, the Centers for Medicare & Medicaid Services (CMS) released its first fact sheet highlighting the CMS’s Oral Health Cross-Cutting Initiative (CCI). The Oral Health CCI, led by the CMS Chief Dental Officer, is committed to ensuring equitable access to oral health care, eliminating disparities, expanding dental service availability, and effectively engaging stakeholders. The fact sheet provides an overview of the CMS’s work to improve access to oral health services across CMS programs, including strengthening coverage for Medicare, Medicaid, and Marketplace beneficiaries, and how it’s using data to identify trends, challenges, and opportunities in oral health care.
Medicare Finalizes Updates for Hospice Payment Rule
On July 30th, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that provides updates to the fiscal year (FY) 2025 Hospice Quality Reporting Program (HQRP). This rule finalizes new HQRP quality measures; finalizes a new data collection instrument, the Hospice Outcomes and Patient Evaluation (HOPE); summarizes responses to a request for information regarding potential social determinants of health (SDOH) elements; and provides updates on Health Equity activities, future quality measures, and public reporting requirements. The rule also finalizes changes to the Hospice Consumer Assessment of Healthcare Providers and Systems (Hospice CAHPS) Survey. This rule is effective October 1, 2024.
The Low-Volume Hospital Adjustment Before and During COVID-19
This brief from the North Carolina Rural Health Research and Policy Analysis Center provides an update to a 2016 analysis of the profitability of low-volume and non-low-volume rural Prospective Payment System hospitals under the Affordable Care Act’s qualifying criteria.
Strategies to Eliminate Inequity in PrEP Services in the U.S. South and Rural Communities
While pre-exposure prophylaxis (PrEP) is a key tool to ending the global HIV and AIDS epidemic by 2030, recent data show that only 30 percent of the 1.2 million Americans who are candidates for the medication proven to reduce the risk of getting HIV are actually taking it. A recent report from the Centers for Disease Control and Prevention revealed substantial differences in uptake by geography, race and ethnicity; what scientists call “PrEP deserts” are most commonly found in the rural South, where more than half of new HIV infections in the U.S continue to occur. In this study, researchers recognize that inequity in care is likely attributed to social determinants of health and structural issues beyond individuals’ control. They describe three approaches to potentially improve access in the South and in rural communities: 1) normalizing where providers prescribe PrEP routinely as a standard of care; 2) digitalizing, i.e., using technology, such as telehealth, as recommended in 2020 by the National Advisory Committee on Rural Health and Human Services; and 3) streamlining care using guidelines from the World Health Organization and the U.S. Public Health Service to explore different approaches, such as on-demand PrEP and HIV self-testing. See Learning Opportunities below for upcoming event addressing stigma in the rural Southeast.