CMS Updates Enrollment Information for Rural Emergency Hospitals

The Centers for Medicare & Medicaid Services (CMS) updated Chapter 10 of the Medicare Program Integrity Manual to instruct Medicare Administrative Contractors (MACs) on how to process enrollment applications for rural hospitals and Critical Access Hospitals converting to the Rural Emergency Hospital (REH) designation beginning January 1, 2023.  Included are instructions on how the change of enrollment form CMS-855A should be completed and the steps the MACs should take to review, approve, or deny the applications.  This guidance reflects the enrollment requirements for REHs published in the final 2023 Medicare Hospital Outpatient Prospective Payment Rule.

Understanding Barriers to COVID-19 Testing

Researchers used funding from the NIH-supported RADx-UP program to better understand barriers in underserved communities – rural and urban, as well as racial and ethnic minority populations – in Kansas.   The most commonly reported barrier was fear of lost income or employment resulting from quarantine.  Common barriers reported in both rural and urban communities were access issues, such as lack of transportation and lack of support for languages other than English.  Three subthemes appeared to be dominant in rural counties. Under the theme of “political beliefs,” the subtheme “politicization of COVID-19 mitigation and response efforts” was an identified barrier for most rural counties.  See Approaching Deadlines below for a RADx-UP opportunity that closes in January.

2017-2021 ACS 5-Year Estimates Data Now Available

The U.S. Census Bureau released new statistics from the 2017-2021 American Community Survey (ACS) 5-Year Estimates, now available at These estimates provide data for all Pennsylvania counties, municipalities, and other geographic areas regardless of population size.

Some highlights from the Pennsylvania State Date Center include:

  • Approximately 47.0% of renter households in PA spent more than 30.0% of their income on housing costs, compared to 40.0 percent of renter households nationally.
  • The counties with the highest percentage of renters experiencing a housing cost burden were Centre (58.0%), Pike (57.4%), Lawrence (52.5%), Monroe (51.9%), and Philadelphia (51.9%).
  • Between 2012-2016 and 2017-2021, 43 counties experienced a statistically significant increase in median household income.

Visit the Data Center’s Research Briefs page to read this brief and past releases.

New Site for Telehealth Centers of Excellence

 A new website from the two HRSA-supported Telehealth Centers of Excellence – The Medical University of South Carolina and the University of Mississippi Medical Center – offers a wealth of expertise and resources for telehealth organizations, researchers, providers, and other stakeholders.  Sign up for their newsletter to learn about publications, upcoming events, and webinars; use the contact form on the website to ask questions or schedule a consultation.

Policy Brief Released on New Changes to Medicare Shared Savings Program

This Rural Health Value Policy Brief summarizes the changes made to the Medicare Shared Savings Program that will take effect in January 2023 and 2024.  It discusses how the changes would reduce barriers to participation for potential or reentering Accountable Care Organizations that operate in rural areas. The Federal Office of Rural Health Policy funds Rural Health Value to provide technical assistance, raise awareness, and engage in communication strategies to support rural provider participation in value-based care.

Maternity Health Care Professional Target Area Scores are Now Available

  Scores that identify areas experiencing a shortage of maternity healthcare professionals are now available, including areas that are rural and partially rural.  The information is found in the Find Shortage Area Tool at the HRSA Data Warehouse, an interactive databank showing up-to-date information on the supply of primary care, dental, and mental health providers down to the county level.  Learn more about the criteria for determining Maternity Care Health Professional Target Areas in the Federal Register notice published earlier this year.

HHS Proposes New Protections to Increase Care Coordination and Confidentiality for Patients with Substance Use Challenges

This week, the U.S. Health and Human Services Department, through the Office for Civil Rights (OCR) and the Substance Abuse and Mental Health Services Administration (SAMHSA), announced proposed changes to the Confidentiality of Substance Use Disorder (SUD) Patient Records under 42 CFR part 2 (“Part 2”), which protects patient privacy and records concerning treatment related to substance use challenges from unauthorized disclosures. Specifically, the proposed rule increases coordination among providers and increases protections for patients concerning records disclosure to avoid discrimination in treatment. While substance use challenges exist in both rural and urban communities, “many rural areas and populations have disproportionately suffered from a growth in the use of opioids, heroin, prescription medications, and methamphetamines (meth)” according to a 2019 brief from the Rural Policy Research Institute. Comments are due by January 31.

The Impact of the COVID-19 Pandemic on Rural Health Clinics’ Operations and Cancer Prevention and Control Efforts. 

 This brief from the RUPRI Center for Rural Health Policy Analysis shows a significant rise in the percent of Rural Health Clinics providing telehealth services during the pandemic – 23% pre-pandemic increasing to 92.2% during the pandemic.  However, roughly one in five of the more than 150 RHCs examined experienced a temporary closure.  Cancer-related prevention and control services including cancer screening, HPV vaccination, and tobacco cessation services dropped pre- vs. peri-pandemic.

National Association of Rural Health Clinics Fellowship Program is Now Accepting Applications

  The program is designed for mid-career professionals with a commitment to making a further impact in rural health practice and policy.  Applicants must have experience in either the Rural Health Clinic setting or a rural health care system.  The fellowship requires a full-time, in-person commitment for either a 4-week continuous timeframe, or two, 2-week periods in May, June, or July 2023. The selected candidate will reside in Alexandria, Virginia during the fellowship period and work within the NARHC DC Office, Monday-Friday, 9 a.m-6 p.m. Lodging and travel expenses will be fully covered by the program, and an $8,000 stipend will be provided the fellow directly. Applications are due by January 2.