On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care — particularly in rural and underserved areas. These proposed changes play a key role in the Biden-Harris Administration’s Unity Agenda — especially its priorities to tackle our nation’s mental health crisis, beat the overdose and opioid epidemic, and end cancer as we know it through the Cancer Moonshot — and ensure CMS continues to deliver on its goals of advancing health equity, driving high-quality, whole-person care, and ensuring the sustainability of the Medicare program for future generations.

“At CMS, we are constantly striving to expand access to high quality, comprehensive health care for people served by the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s proposals expand access to vital medical services like behavioral health care, dental care, and cancer treatment options, all while promoting access, innovation, and cost savings in the Medicare program.”

“Integrated coordinated, whole-person care — which addresses physical health, behavioral health, and social determinants of health — is crucial for people with Medicare, especially those with complex needs,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.

The proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the CY 2022 PFS conversion factor of $34.61. This conversion factor accounts for the statutorily required update to the conversion factor for CY 2023 of 0%, the expiration of the 3% increase in PFS payments for CY 2022 as required by the Protecting Medicare and American Farmers From Sequester Cuts Act, and the statutorily required budget neutrality adjustment to account for changes in Relative Value Units.

Modernizing Coverage for Behavioral Health Services

In the 2022 CMS Behavioral Health Strategy, CMS set goals to remove barriers to care and improve access to, and the quality of, mental health and substance use care. To help address the acute shortage of behavioral health practitioners, the agency is proposing to allow licensed professional counselors, marriage and family therapists, and other types of behavioral health practitioners to provide behavioral health services under general (rather than direct) supervision. Additionally, CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient’s primary care team.

CMS is also proposing to bundle certain chronic pain management and treatment services into new monthly payments, improving patient access to team-based comprehensive chronic pain treatment. Lastly, CMS is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.

Expanding Access to Accountable Care Organizations

ACOs are groups of health care providers who come together to give coordinated, high-quality care to their Medicare patients. The Medicare Shared Savings Program covers more than 11 million people with Medicare and includes more than 500,000 providers.

CMS is proposing changes to the Medicare Shared Savings Program that, if finalized, represent some of the most significant reforms since the final rule that established the program was finalized in November 2011 and ACOs began participating in 2012. Building on the CMS Innovation Center’s successful ACO Investment Model, CMS is proposing to incorporate advance shared savings payments to certain new Medicare Shared Savings Program ACOs that could be used to address Medicare beneficiaries’ social needs. This is one of the first times Traditional Medicare payments would be permitted for such uses and is expected to be an opportunity for providers in rural and other underserved areas to make the investments needed to become an ACO and succeed in the program. CMS is also proposing that smaller ACOs have more time to transition to downside risk, further helping to grow participation in rural and underserved communities. CMS is also proposing a health equity adjustment to an ACO’s quality performance category score to reward excellent care delivered to underserved populations. Finally, CMS is proposing benchmark adjustments to encourage more ACOs to participate and succeed, which would help achieve the goal of having all people with Traditional Medicare in an accountable care relationship with a healthcare provider by 2030.

Improving Access to Colon Cancer Screening

Colon and rectal cancer were the second-leading cause of cancer deaths in the United States in 2020, with higher colorectal cancer death rates for Black Americans, American Indians, and Alaska Natives. To reduce barriers to getting a colonoscopy, CMS is proposing that a follow-up colonoscopy to an at-home test be considered a preventive service, which means that cost sharing would be waived for people with Medicare. Additionally, Medicare is proposing to cover the service for individuals 45 years of age and above, in line with the newly lowered age recommendation (down from 50) from the United States Preventive Services Task Force.

Proposing Payment for Dental Services that are Integral to Covered Medical Services

Medicare Part B currently pays for dental services when that service is integral to medically necessary services required to treat a beneficiary’s primary medical condition. Some examples include reconstruction of the jaw following accidental injury or tooth extractions done in preparation for radiation treatment for jaw cancer. CMS is proposing to pay for dental services, such as dental examination and treatment preceding an organ transplant. In addition, CMS is seeking comment on other medical conditions where Medicare should pay for dental services, such as for cancer treatment or joint replacement surgeries, as well as on a process to get public input when additional dental services may be integral to the clinical success of other medical services.

More Information:

• PFS fact sheet
• Quality Payment Program fact sheet
• Medicare Shared Savings Program Proposals fact sheet
• Blog
• Proposed rule

The National Rural Health Association’s (NRHA) Government Affairs team added a new advocacy tool to their website!

Each year at NRHA’s Policy Institute, the Chartis Center for Rural Health releases data about rural providers across the country. The map has links to the 2022 state-specific reports on the impact federal policies have on rural health care providers and their patients.  The Chartis data sets show the annual revenue loss, potential job loss, and potential GDP loss, for each provider based on each policy.

If you have questions, please reach out to Josh Jorgensen (jjorgensen@ruralhealth.us).

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), today announced more than $1.75 billion in Provider Relief Fund payments to 3,680 providers across the country. With this disbursement, HRSA has distributed approximately $13.5 billion from the Provider Relief Fund to nearly 86,000 and nearly $7.5 billion in American Rescue Plan (ARP) Rural payments to more than 44,000 providers since November 2021.

“Health care providers have been tireless in protecting their communities and working to maintain access to health services during the pandemic,” said HRSA Administrator Carole Johnson. “Provider Relief Fund resources continue to make it possible for providers to recruit and retain key personnel, implement safety measures, and keep their doors open to care for their patients.”

In September of 2021, HHS opened applications for $25.5 billion in COVID-19 provider funding. With this latest round of payments, nearly $21 billion of this funding has been distributed. Phase 4 payments reimburse smaller providers for a higher percentage of losses during the pandemic and include bonus payments for providers who serve Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries.

Providers can use Provider Relief Fund payments received in the first half of 2022 to cover losses and expenses until June 30, 2023. With these latest payments, approximately 92 percent of all Phase 4 applications have been processed. Remaining applications require additional manual review and HRSA is working to process them as quickly as possible.

Provider Relief Fund payments have played an important role in the national response to COVID-19, helping health care providers prevent, prepare for, and respond to the coronavirus. Health care providers can use the payments for a variety of COVID-related expenses. These include maintaining access to care for patients by addressing workforce challenges through recruitment and retention efforts (PDF).

View a state-by-state breakdown of all Phase 4 payments disbursed to date.

View a state-by-state breakdown of all ARP Rural payments disbursed to date.

As individual providers agree to the terms and conditions of Phase 4 payments, it will be reflected on the public dataset.

For additional information, visit www.hrsa.gov/provider-relief.

Maira Nawaz, a student in Integrated B.S. in Health Policy and Administration/Master of Health Administration program within the Penn State Department of Health Policy and Administration (HPA), received the 2022 Jennifer S. Cwynar Community Achievement Award in April 2022. Nawaz, of Mechanicsburg, Pennsylvania, is also pursuing a minor in information sciences and technology.

The award from the Pennsylvania Office of Rural Health (PORH) recognizes community achievement by a Penn State senior majoring in Health Policy and Administration who has demonstrated service and commitment to a community or an underserved population, preferably, but not exclusively, in a rural area of Pennsylvania. The award was established in memory of Jennifer S. Cwynar, a 2008 graduate of HPA and a 2008 undergraduate intern at PORH.

Nawaz was nominated by Diane Spokus, Ph.D., M.Ed., MCHES®, associate director of professional development in HPA. Spokus lauded Nawaz for her dedicated and detail-oriented work ethic, commitment to community service, and her focus on public health. She noted that Nawaz can be depended on to follow through and who continually seeks professional development opportunities and service to others. “Students like Maira, who participate in various internship experiences, and who are involved in clubs and volunteer their time to worthwhile causes, are excellent role models. They will be great future health care leaders.”

During her academic career, Nawaz expanded her knowledge through internships at Mount Nittany Physician Group Primary Care practices in rural central Pennsylvania; Atlantic Health System in New Jersey; the American Lung Association; and WellSpan Health in York, Pennsylvania. Nawaz broadened her operational and administrative skills by standardizing the rooming process for patients, calculated Medicare net revenue, streamlined guidelines, analyzed and evaluated insurance enrollment data, assisted in improving interactive voice response systems and member websites, and created user stories for members to improve customer satisfaction during support calls. She also executed smoking cessation tasks such as Amazon’s Alexa project, a Juul costs project, and smoking prevalence in veterans; organized health promotion community events; wrote articles for local newspapers on moral courage; and worked with the LatinX community to improve health care opportunities and awareness. These experiences gave her a deep appreciation for the social determinants of health and population health.

While at Penn State, Nawaz served as the guest speaker liaison for the Penn State Chapter of the American College of Healthcare Administrators (ACHCA) Club Executive Team. She participated in the UNICEF Club, was a member of the Pakistani Student Association, and volunteered at the Central PA Food Bank, Country Meadows Senior Center, and was a Holy Spirit Hospital Junior Volunteer.

“We are very pleased to present this award to Maira Nawaz and to honor the legacy of Jennifer Cwynar, who was an exceptional student and intern with our office,” said Lisa Davis, director of PORH and outreach associate professor of HPA. “This is one way in which we can encourage excellence in those who will become leaders in advocating for the health of vulnerable populations.”

PORH formed in 1991 as a joint partnership between the federal government, the Commonwealth of Pennsylvania, and Penn State. The office is one of 50 state offices of rural health in the nation and is charged with being a source of coordination, technical assistance, networking, and partnership development.

PORH provides expertise in the areas of rural health, population health, quality improvement, oral health, and agricultural health and safety. PORH is administratively located in the Department of Health Policy and Administration in the College of Health and Human Development at Penn State University Park.

To learn more about the Jennifer S. Cwynar Community Achievement Award or the Pennsylvania Office of Rural Health, visit porh.psu.edu.

Registration is open for the upcoming virtual Training for New Clinical Directors. Join the next training March 8-10 to boost your career and elevate your leadership development. This training provides the core knowledge and addresses the core competencies that all health center Clinical Directors need to function as effective managers, leaders, and advocates for their health centers and communities. The comprehensive course package includes interactive learning, small group case study discussions, peer networking, follow-up resources, and a coaching program. Receive up to 11.5 elective CMECs from the American Academy of Family Physicians (AAFP) or CDECs from the National Network for Oral Health Access (NNOHA). For more information contact Katja Laepke at klaepke@nachc.com.

David Schmitz, MD, the director of the University of North Dakota Family Medicine Residency and one of the creators of the Community Apgar Project, will be the keynote speaker for the Pennsylvania Rural Recruitment Summit. Co-sponsored by PACHC, the summit is happening April 20, 2022, at the Penn Stater Conference Center Hotel in State College. Dr. Schmitz will speak about how communities can identify strengths and challenges related to recruiting critical healthcare professionals like family medicine physicians. The summit will bring together healthcare entities, clinicians, statewide organizations, and community leaders to listen and learn, together finding a path forward to ensure access to high quality and high value health care for rural Pennsylvanians. Registration is now open. Cost is $100 per person. You are encouraged to bring along leaders from your community. Contact Judd Mellinger-Blouch to find out about how you can encourage community leaders to attend, including a special discount arrangement.

PennLive is following up their report on the historic increase in Black students in medical school and why that’s important with a series of profiles of Black health care professionals in central Pennsylvania who have paved the way and now serve as role models for future doctors and nurses. Dr. Bolanle Limann, chief medical officer for Harrisburg-based Hamilton Health Center, is the subject of the first profile in the series. Dr. Limann oversees clinical operations for the health center’s six locations in Dauphin and Perry counties, bringing to bear both her skills as a physician and her knowledge of business. Read more.

The annual expense of child care for an infant exceeds the annual cost of in-state tuition at a public four-year university in 34 states, according to the most recent data from the Economic Policy Institute. The cost of child care can be a key influencer in decisions about entering or leaving the workforce, and especially in health care where women make up the majority of the front-line workforce (66%) and managers (59%), according to research from McKinsey. In Pennsylvania, infant care costs as a share of public college tuition are 81.5%. Average annual cost of infant care is $11,842, while Pennsylvania’s in-state tuition for four-year public college is $14,534, one of the highest tuition rates in the country. Infant care costs as a share of median family income is 17.5% with a median family income: $67,828.

As an extension of PACHC’s benefits to health centers, we partner with Commonwealth Group Purchasing (CPG), a group purchasing organization developed by and for Community Health Centers. CPG provides vetted vendors and cost savings leveraged through group purchasing. There is a no-obligation service to help you assess your current purchasing from medical and business suppliers to current needs in telehealth and recruitment solutions. To learn more, click here or contact Julie Korick, PACHC Chief Operations and Finance Officer