From Fierce Healthcare

The Biden administration released a proposed rule that grants more regulatory flexibility for small, rural hospitals in a bid to curb a worrying trend of facility closures.

The Centers for Medicare and Medicaid Services’ proposed rule released on June 30, 2022 outlines the conditions of participation for a facility to become a Rural Emergency Hospital, which enables a facility to offer emergency care, observation and other outpatient services.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential healthcare services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure in a statement.

CMS’ goal for the new designation is to enable small facilities in rural areas and critical access hospitals to “right-size their service footprint and avoid potential closure,” according to a fact sheet on the rule

An emergency hospital can offer additional medical and outpatient services that don’t exceed an annual per-patient average of 24 hours, the fact sheet added.

Overall, the conditions of participation closely align with current conditions for critical access hospitals. However, CMS is seeking comments on specific standards for the rural facilities, such as whether the agency should require a facility to also provide outpatient surgery services if surgical labor is necessary.

“CMS is also requesting comments regarding whether it is appropriate for a [rural emergency hospital] to allow a doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a clinical nurse specialist, with training or experience in emergency medicine, to be on call and immediately available by telephone or radio contact and available on-site within specified timeframes,” the fact sheet said.

The rule does not outline the payment rates for such rural emergency hospitals, but CMS hinted that information will likely be included in the 2023 Outpatient Prospective Payment System-Ambulatory Surgical Center payment rule set to be released in July.

The new designation was created in a spending bill last year intended to help stem a deluge of hospital closures in rural areas. HHS said that, since 2010, there have been 138 rural hospitals that closed, with 19 closing down in 2020 alone.

Provider relief funding to help offset the financial impacts of the COVID-19 pandemic helped to temporarily stave off closures, said George Pink, a professor with the University of North Carolina’s Rural Health Research Program, during a webinar Wednesday sponsored by the Bipartisan Policy Center.

The proposed CoP are detailed at: https://public-inspection.federalregister.gov/2022-14153.pdf

The due date for comments is August 29, 2022.

Understanding health coverage can be confusing, but the Coverage to Care (C2C) initiative is making it easier. The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released newly updated C2C resources to help those consumers you serve understand their health coverage and to get health care services they need.

The following resources are now available on the C2C website:

• Roadmap to Better Care – Explains what health coverage is and how to use it to get primary care and preventive services. (English | Spanish)
• Roadmap to Behavioral Health – A companion guide for mental health and substance use service, to be used in conjunction with the Roadmap to Better Care. (English | Spanish)
• Getting the Care You Need: Guide for People with Disabilities – Provides information to ensure that people with disabilities understand their rights so that they receive equal access to quality health care services. (English | Spanish)
• Chronic Care Management (CCM) Resources – Discusses the benefits of CCM for patients with multiple chronic conditions and provides health care professionals with resources to implement CCM into their practices.
  • Connected Care Toolkit (English)
  • Postcard for Health Care Professionals (English)
  • Postcard for Patients (English | Spanish | Chinese | Haitian Creole | Korean | Arabic | Vietnamese | Russian)
  • Poster for Patients (English | Spanish)
• Managing Diabetes: Coverage & Resources – Includes tips to help patients manage diabetes, as well as information on Marketplace and Medicare coverage. (English | Spanish)
• Preventive Services Flyers – Use these flyers to take advantage of services available at no cost under most health coverage.
  • Adult (English | Spanish)
  • Women (English | Spanish)
  • Men (English | Spanish)
  • Teens (English | Spanish)
  • Children (English | Spanish)
  • Infants (English | Spanish)
• Prevention: Put Your Health First Tabloid – Use this infographic to learn more about how to put your health first. (English | Spanish)
• My Health Coverage at-a-Glance – Shows how to keep track of health plan information and payment in a customizable format. (English | Spanish)

C2C will release these resources in additional languages (Arabic, Chinese, Haitian Creole, Korean, Russian, and Vietnamese) later this summer, so we encourage you to continue to visit go.cms.gov/c2c and sign up for our listserv to be sure to receive any updates.

Health literacy is an essential part of health equity. To learn more about health equity related initiatives, visit CMS OMH at go.cms.gov/omh or the C2C initiative at go.cms.gov/c2c.

During July, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) observes Disability Pride Month and the 32^nd anniversary of the Americans with Disabilities Act (ADA). Enacted on July 26, 1990, the ADA prohibits discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, transportation, and telecommunications.

61 million adults in the United States have some type of disability, with the most prominent disabilities being mobility; followed by cognition meaning having serious difficulty concentrating, remembering, or making decisions; independent living; hearing; vision; and self-care. As individuals continue to learn about the effects of long-term COVID-19, or “long COVID,” multiple sections of the ADA have also been updated to protect those with long COVID from discrimination.

American Indian/Alaskan Native and Black individuals have the highest rates of individuals living with a disability. Individuals living with disabilities face poorer overall health outcomes, including increased likelihood of obesity (38.2%), heart disease (11.5%), and diabetes (16.3%). Individuals living with disabilities are also less likely to have access to adequate health care, with 1 in 3 individuals living with a disability not having access to a usual health care provider and having an unmet health care need due to high costs.

CMS OMH is focused on ensuring people with disabilities have access to quality health care services and information. The anniversary of the ADA offers us an opportunity to reaffirm this commitment and share resources that you can use to help empower individuals living with intellectual and developmental disabilities.

Resources

• Visit CMS OMH’s Improving Access to Care for People with Disabilities webpage to find tools and resources that can help you improve services and help patients understand their rights.
• Just updated! Getting the Care You Need: Guide for People with Disabilities is a consumer facing resource has now been updated in English and Spanish and is included in the Coverage to Care resources. This resource will be available in additional languages soon.
• Review the Autism Spectrum Disorder (ASD) Disparities in Medicare Fee-For-Service Beneficiaries data snapshot to learn more about racial and geographic ASD disparities among those with Medicare.
• Download the Improving Health Care for People with Disabilities issue brief, which outlines data sources that health care organizations and researchers can use to better understand the impact that social determinants of health have on people with disabilities.
• Download the How to Improve Physical Accessibility at Your Health Care Facility resource which helps health care providers, staff, and administrators in a variety of outpatient settings improve the accessibility of their health care facility.
• Review the How Does Disability Affect Access to Health Care for Non-Dual Eligible Beneficiaries? data highlight, which examines access and utilization among adults with Medicaid who are not dually eligible for Medicare and who reported difficulty accessing needed health care.
• Download the Disability Access in COVID-19 Vaccine Distribution Fact Sheet and HHS Office of Civil Rights Guidance on Federal Legal Standards Prohibiting Disability Discrimination in COVID-19 Vaccination Programs for more information and resources about providing equitable COVID-19 vaccine access for individuals living with disabilities.

Certain families who are eligible for Pennsylvania’s Pandemic Electronic Benefits Transfer (P-EBT) program retroactively for the 2021-2022 school year due to COVID-19-related absences have begun to receive benefits.

P-EBT, developed by Congress and funded through the United States Department of Agriculture (USDA), helps families cover the cost of breakfasts and lunches their children would have been eligible to receive for free or at reduced price through the National School Lunch Program (NSLP).

Once believed to be a short-term program, P-EBT has now transformed into a longer-term federal response to the national public health crisis. We first saw P-EBT in Pennsylvania in the spring of 2020. The program was re-authorized last year to cover the entire 2020-21 school year. A new round of P-EBT has been approved for Pennsylvania for the 2021-2022 school year by the USDA Food and Nutrition Service (FNS).

Receiving P-EBT does not affect immigration status or eligibility for other DHS benefits such as the Supplemental Nutrition Assistance Program (SNAP) or Medicaid (Medical Assistance, or MA, in Pennsylvania).

Learn more about P-EBT in Pennsylvania at dhs.pa.gov/P-EBT

P-EBT Parent Portal

Haven’t received your card or need a replacement? 
The new P-EBT Parent Portal allows parents to check their child’s eligibility for benefits based on information that schools have submitted for the 2021-2022 school year and begin the automated process for requesting P-EBT cards. Families with eligible children will also be able to request a replacement through the portal.

Check Eligibility Using the P-EBT Parent Portal

1.  Who is eligible for P-EBT?

For the 2021-2022 school year, school children who receive free or reduced-price school meals through NSLP are potentially eligible for these P-EBT benefits. P-EBT-eligible students will receive a benefit based on the number of days they were absent from the classroom due to COVID-19 if:

• The child’s school was closed or had reduced hours for at least five (5) consecutive days due to COVID-19; and
• The student was absent from the classroom due to COVID-19.

P-EBT eligibility is based on data provided by schools. If the school indicates that the school did not meet the program’s school closure or absence criteria, or the child did not have excused absences related to COVID-19, P-EBT cannot be issued.

2.  Applying for NSLP

Families of students who entered kindergarten in Fall 2021 or entered a different school district for the 2021-2022 school year can fill out an application for free or reduced-price school meals by visiting your school district’s website or by applying through COMPASS.

P-EBT Benefits Basics

1.  When will I receive my benefits?

Eligible students will receive P-EBT benefits distribution in several stages:

• First Stage: June/July 2022 — Currently being issued; provides benefits to students who were eligible between September 2021 and November 2021.
• Second Stage: Mid- to late July — The second stage will provide benefits to students who were eligible between December 2021 and February 2022.
• Third Stage: Mid- to late-August: The third stage will provide benefits to students who were eligible between March and May 2022.

If a student does not receive a benefit in the first stage, it does not mean that they will not receive a benefit in further stages. Students who receive P-EBT benefits in the first stage do not make up the total number of students who are potentially eligible for P-EBT.

2.  How will I receive my benefits?

The Department of Human Services (DHS) will be loading the student’s 2021-2022 benefits onto current P-EBT cards. Families who have previously received and activated P-EBT cards should keep them as DHS will be reusing these cards, if possible, based on the information the schools submitted. Parents who have a standard EBT card for other benefits such as SNAP and cash assistance and have children who were deemed eligible for P-EBT will have their P-EBT benefits loaded to their EBT card, if possible.

3.  How much will I receive?

The benefit amount for each eligible student for each stage will vary based on the individual student’s circumstances. The maximum daily rate for P-EBT during the 2021-22 school year is $7.10.

Families can use their P-EBT benefits to purchase almost any unprepared food item in participating grocery stores or food markets that accept EBT, and the program follows the same rules as SNAP for eligible purchases.

P-EBT Questions & Assistance

Families needing further assistance, seeking answers to questions about P-EBT eligibility, or needing to report an issue have multiple ways of contacting DHS:

• Online P-EBT Frequently Asked Questions: DHS P-EBT Guide
• Submit an Online Inquiry: DHS P-EBT Inquiry Form
• Eligibility & Card Assistance: P-EBT Parent Portal
• Call the P-EBT Hotline: 484-363-2137

Please fill out as much information as possible on the above forms, as this will help DHS to research an issue and try to resolve it.

As part of the Biden-Harris Administration’s ongoing effort to strengthen rural health, the Centers for Medicare & Medicaid Services (CMS) is releasing a new proposed rule protecting access to emergency care and additional outpatient services for people in rural communities. CMS is establishing the Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs). The proposed rule will allow small rural hospitals to seek this new health care provider designation and provide continued access to emergency services, observation care, and additional medical and outpatient services. In accordance with the statutory legislation, REHs will be eligible to receive payment for services provided on or after January 1, 2023. This is a significant step in building on the Administration’s efforts to reduce health care disparities and maintain access to services in rural communities.

Rural communities represent a fifth of the U.S. population, and the Department of Health and Human Services (HHS) is committed to improving health outcomes and promoting health equity in rural America. Since 2010, 138 rural hospitals have closed — with a record-breaking 19 hospitals closing in 2020 alone. These closures occur disproportionately within communities with a higher proportion of people of color and communities with higher poverty rates. Rural communities experience shorter life expectancy, higher mortality, and have fewer local health care providers, leading to worse health outcomes than in other communities. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

“The availability of the new Rural Emergency Hospital provider type will maintain access to essential health care services and help to reduce disparities in rural communities,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is committed to advancing health equity, driving high-quality person-centered care, and promoting the sustainability of our programs. Today’s action to strengthen rural health furthers our goal of ensuring everyone served by our programs the has access to quality, affordable health care.”

To address these concerns, CMS is implementing a new Medicare provider designation called REHs, which will provide an opportunity for small rural hospitals and CAHs to right-size their service footprint and avoid potential closure so they can continue to provide essential services for their communities. The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals.

Allowing providers to take advantage of the new designation will ensure that people in rural communities will be able to receive critical outpatient services, including emergency, maternal health, behavioral health, and substance use disorder services.

Today’s action takes steps to ensure the health and safety of all patients, while accounting for the access and quality of care needs of rural communities. In addition, the proposed rule includes several updates for CAHs. Specifically, CMS is proposing to add a definition of “primary roads” to the current location and distance requirements, which is used to determine if facilities qualify as CAHs. The proposed rule also contains proposals allowing CAHs that are a part of a larger health system (containing other hospitals and/or CAHs) to unify and integrate their infection control and prevention and antibiotic stewardship programs, medical staff, and quality assessment and performance improvement programs (known as QAPI) to ensure consistent and safe care. Finally, and importantly, CMS is proposing to establish a patient’s rights Condition of Participation for CAHs to provide for clear requirements for the protection and promotion patient’s rights.

The release of this proposed rule, which is a result of multiple engagements with stakeholders and a Request for Information (RFI), is the first step in the implementation of this new provider type. CMS anticipates including further discussion on important aspects for REHs, such as Medicare enrollment, payment, quality reporting, and more in the upcoming Calendar Year 2023 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule. Stakeholders are encouraged to review both proposed rules, as applicable, and submit formal comment by each respective deadline. All feedback will be taken into consideration as CMS develops its final, comprehensive policies for REHs later this year. For today’s rule, the comment period closes on August 29, 2022.

For more information on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.federalregister.gov/public-inspection/current

To read the Fact Sheet on the Rural Emergency Hospital and Critical Access Hospital Conditions of Participation, visit: https://www.cms.gov/newsroom/fact-sheets/conditions-participation-rural-emergency-hospitals-and-critical-access-hospital-cop-updates-cms-3419

To read the Fact Sheet on HHS actions to strengthen rural health, click here: https://www.hhs.gov/sites/default/files/rural-health-fact-sheet.pdf

Grant Awarded Under the Single Family Housing Self-Help Technical Assistance Program

U.S. Department of Agriculture (USDA) State Director Bob Morgan announced that the Department has partnered with Threshold Housing Development Inc. to invest $470,000 to help meet the demands of the growing housing needs in rural Pennsylvania.

“Rural America is a place everyone can call home,” Morgan said. “Expanding opportunities for homeownership strengthens rural communities and helps families and individuals build wealth and achieve financial stability. Well-built, energy efficient, affordable housing is essential to the vitality of communities in rural America.”

This Rural Development investment will be used for the completion of seven new homes and nine acquisition rehabs.

The technical assistance grant will work in conjunction with USDA’s 502 Self-Help Program, which assists low and very low-income families to obtain affordable housing through new construction or acquisition rehab.

Families choosing new construction will receive on-site technical support from Threshold Housing Development, Inc., and work together mutually with other families in the program, providing 65% of the construction labor to build their homes. By participating in the construction process, these families will realize significant cost savings, enabling them to own a brand-new home with an affordable mortgage payment.

With Threshold’s guidance, families opting for acquisition rehab will purchase and rehab their own homes. They’ll learn to evaluate the scope of rehab work that potential houses require, as well as receive training, monitoring, and assistance during the rehab process of the home they choose.

Background:

The Mutual Self-Help Housing Program provides grants to qualified organizations to help them carry out local self-help housing construction projects.

Through this program, USDA has worked with nearly 230 organizations to provide a unique opportunity for families and individuals to lower the overall purchase price of a new home by investing “sweat equity” into the construction.

Since its inception in 1966, the program has helped nearly 56,000 families build their own affordable and safe homes. Through this program, the Biden-Harris Administration has partnered with community organizations to help 261 families and individuals in socially vulnerable communities build their own homes.

The Department Increases Total Funding to Up to $4 Million to Help More Rural and Tribal Communities Access Placemaking Assistance

U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small announced that USDA is accepting applications for cooperative agreements to help eligible entities provide planning, training and technical assistance to foster placemaking activities in rural and Tribal communities.

The funds are being made available through the Rural Placemaking Innovation Challenge (RPIC). USDA is increasing RPIC funding to up to $4 million to assist more rural communities access placemaking assistance. The previous funding level was $3 million.

Today, USDA is inviting eligible entities to apply for up to $250,000 to help rural and Tribal communities create plans to enhance capacity for high-speed internet access; preserve cultural and historic structures; and support development in transportation, housing and recreational spaces.

This technical assistance will help communities convene partners and identify community needs to develop placemaking plans. These plans will help rural areas build back better and stronger. The entities must support participating rural communities for up to two years.

Learn more about this USDA Stakeholder Announcement.