April in Brief: HRSA Works to Strengthen and Expand Health Care Access

Posted on by lad3

In April, HRSA announced investments to: support community-based doulas; strengthen home visiting supports for parents, infants, and children; expand our investments in state responses to the maternal mortality crisis; launch the largest investment we’ve ever made in Community Health Worker training; and build new data tools to reduce health disparities through health centers.

HRSA also distributed $1.75 billion in Provider Relief Fund payments, released a Request for Information on ways to strengthen and improve the Organ Procurement and Transplantation Network, and launched a new Health Equity Fellowship Program.

In April 2022, the Health Resources and Services Administration took action to support underserved communities, improve maternal health, grow the health care workforce, and reduce health disparities, including:

Health Resources and Services Administration Announces Availability of New Funding to Support Community-Based Doulas
HRSA announced the availability of $4.5 million for hiring, training, certifying, and compensating community-based doulas in areas with high rates of adverse maternal and infant health outcomes.

HRSA Awards $16 Million to Strengthen the Maternal, Infant, and Early Childhood Home Visiting Program, Announces $9 Million Available to Expand State Maternal Health Innovation and Implementation Program
HRSA announced approximately $16 million to strengthen Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Programs through seven awards supporting eight states. These awards will advance data and technology innovations to support positive maternal and child health outcomes in states and communities, and focus on addressing health disparities.

HRSA also announced the availability of up to $9 million through the State Maternal Health Innovation and Data Capacity Program to expand the State Maternal Health Innovation and Implementation Program. This program supports state-level development and implementation of proven strategies to improve maternal health and address maternal health disparities.

HRSA Announces $226.5 Million to Launch Community Health Worker Training Program
HRSA announced the availability of $226.5 million in American Rescue Plan funding to launch the Community Health Worker Training Program. This new program will increase the number of community health workers who play a critical role in connecting people to care, including COVID care; mental health and substance use disorder prevention, treatment and recovery services; chronic disease care; and other important health services.

HRSA Announces $90 Million to Support New Data-Driven Approaches for Health Centers to Identify and Reduce Health Disparities
HRSA announced the availability of nearly $90 million in American Rescue Plan funding to support new data-driven efforts for HRSA Health Center Program-supported health centers and look-alikes to identify and reduce health disparities.

HRSA Distributing $1.75 Billion in Provider Relief Fund Payments to Health Care Providers Affected by the COVID-19 Pandemic
HRSA announced more than $1.75 billion in Provider Relief Fund payments to 3,680 providers across the country. Provider Relief Fund payments have played an important role in the national response to COVID-19, helping health care providers respond to the coronavirus, including retaining and supporting the workforce.

HRSA Releases Request for Information on Ways to Strengthen and Improve the Organ Procurement and Transplantation Network
HRSA released a Request for Information (RFI) seeking input on ways to strengthen and improve the Organ Procurement and Transplantation Network (OPTN). The RFI will support HRSA’s efforts to increase accountability in OPTN operations, modernize performance of the OPTN IT system and related tools, and improve engagement with donors and patients. Comments are due by May 9th.

New Opportunities at HRSA for Early-Career Professionals
HRSA also announced the new HRSA Health Equity Fellowship Program to provide early career professionals with an opportunity to contribute directly to the Biden-Harris Administration’s work to advance racial equity and support underserved communities.

See News & Announcements on HRSA.gov.

CMS Proposes to Update Medicare Enrollment and Eligibility Rules

Posted on by kow5101

On April 22, CMS issued a proposed rule to implement sections of the Consolidated Appropriations Act, 2021 (CAA) that would simplify Medicare enrollment rules and extend the coverage of immunosuppressive drugs for certain beneficiaries.  Section 120 of the CAA makes changes to Original Medicare by revising the effective dates of coverage and allowing for the establishment of new special enrollment periods (SEPs) for individuals who meet exceptional conditions.  Section 402 of the CAA extends immunosuppressive drug coverage under Part B for certain individuals whose Medicare entitlement based on end-stage renal disease (ESRD) would otherwise end.  This rule also proposes other non-CAA-related changes to improve state payment of Medicare premiums, and a technical change related to how enrollment forms are referenced in regulations. According to MedPAC, about one-fifth of Medicare beneficiaries live in rural areas.  Comment by June 27. 

Comments Requested on the New Questions for the Census Survey 

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In April 2020, the U.S. Census Bureau launched a new project to inform on a range of topics experienced by households during the COVID-19 pandemic.  New questions for the Household Pulse Survey are being formulated, for example,  changing the focus of one vaccination question from reasons for not receiving the vaccine to reasons for not receiving a vaccine booster dose. The Department of Commerce invites the general public and other Federal agencies to comment on proposed and continuing information collections. Comments Requested by May 18. 

The Centers for Medicare & Medicaid Services Focus on Health Equity

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The Centers for Medicare & Medicaid Services, CMS, has a new, proactive plan to bring more equitable health outcomes to people in underserved and disadvantaged communities.  The CMS Framework for Health Equity calls for improved data collection, more culturally appropriate services, and broader access to health-related social services for those who receive care paid for by the nation’s largest health insurer.  This public health insurance covers nearly 64 million enrolled in Medicare and more than 83 million beneficiaries of Medicaid and the Children’s Health Insurance Plan. Health equity goals for the 2022 Strategic Plan include incentivizing other insurers to enter single-issuer rural counties in the individual market.  CMS will host a Health Equity Symposium today at 1:00 pm to provide more details on the health equity plan.

Biden Harris Administration Proposes Rule to Fix “Family Glitch” and Lower Health Care Costs

Posted on by lad3

President Biden and Vice President Harris believe that health care is a right, not a privilege. They promised to protect and build on the Affordable Care Act (ACA), lowering costs and expanding coverage so that every American has the peace of mind that health insurance brings.

The Biden-Harris Administration continues to deliver on that promise. Thanks to the landmark American Rescue Plan, ACA premiums are at an all-time low, while enrollment is at an all-time high. Four out of five Americans can find quality coverage for under $10 a month, and families are saving an average of $2,400 on their annual premiums—$200 in savings every month back to families. The Administration has lowered costs and increased enrollment to a record high of 14.5 million Americans—including nearly 6 million who newly gained coverage. With the addition of Missouri and Oklahoma, two states that expanded Medicaid last year, nearly 19 million low-income Americans are enrolled in the ACA’s Medicaid expansion coverage, adding up to a record nearly 80 million children, pregnant women, seniors, people with disabilities, and other low-income Americans covered by Medicaid.

Read more.

The ‘Massive’ Task Awaiting State Medicaid Agencies

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From Route Fifty, March 23, 2022

The end of a public health emergency would mean states losing hundreds of billions in funding for the health care program, and verifying whether millions of enrollees are still eligible.

State Medicaid officials around the country are growing increasingly worried about the mammoth and high stakes task of reevaluating who among roughly 80 million people will still be eligible for Medicaid when the Biden administration declares the national Covid-19 public health emergency to be over—a move expected in July.

With health advocates and state officials acknowledging a lot could go wrong, they are worried people will be mistakenly thrown off of the program, which provides health coverage to low-income Americans.

“It’s a pretty massive undertaking for us,” Nicole Comeaux, New Mexico’s Medicaid director said in an interview. “Really our goal is that everybody stays in the coverage who are eligible for it.”

On top of that challenge, state officials face added pressure because the end of the public health emergency, which began in January 2020, would mean roughly $90 billion a year in increased federal Medicaid funding states have been receiving would suddenly screech to a halt. That could happen as soon as the end of September.

Earlier in the pandemic, Congress and the Trump administration increased the federal government’s share of paying for Medicaid, known as the Federal Medical Assistance Percentage, or FMAP, by 6.2%. The move was a response to people losing health care coverage from their jobs in the early days of the pandemic.

In return for getting the extra money, approved in the March 2020 pandemic relief law known as the Families First Coronavirus Response Act, states were barred from removing anyone from their Medicaid rolls.

Meanwhile, the number of people enrolled in Medicaid and the related Children’s Health Insurance Program grew from 70.7 million in February 2020 to 84.8 million last September, according to federal figures.

When the public health emergency ends, Medicaid offices will have to return to determining whether everyone on the rolls is eligible—except with a lot more people to check compared to before the pandemic.

Recognizing the size of the task, the Centers for Medicare & Medicaid Services in March gave states up to 14 months after the end of the emergency declaration to reevaluate enrollees. But the rub for state budgets is that the increased federal help will have disappeared long before the end of those 14 months.That means it could make sense for them to get their Medicaid rolls in order ahead of the deadline.

Read more.

Nearly Half of Rural Hospitals Lose Money on Childbirth Services

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A large number of rural hospitals that cease obstetrics programs wind up closing later, researcher says.

About 40% of rural hospitals are losing money on their obstetrics programs, but many continue to provide the service because of its importance for community health, a new study shows.

Losing child-birth services can also be a harbinger of hard times for a rural hospital, oftentimes serving as a precursor to closure.

A study conducted by the University of Minnesota Rural Health Research Center found that some rural hospitals keep their obstetrics programs open even after they have stopped being financially viable.

In large part, researcher Julia Interrante said, rural hospitals that close their obstetrics units are more likely to close their doors for good.

“Usually the obstetrics unit will close, and then other services will start to close before the entire hospital closes,” she said. “It’s not always the case – sometimes we see things where hospitals will enter into mergers or move those services to another hospital location… But often when they end up closing OB services, then it usually kind of leads toward the hospital closing.”

A survey of obstetric unit managers or administrators at nearly 300 rural hospitals found that whether the program was in the black wasn’t as important to these leaders as how much the community needed it.

Hospitals reported they needed 200 births per year to maintain safety standards and to remain financially viable. More than 40% said they had fewer births than needed to sustain operations financially.

“I think that’s really striking,” Interrante said. “But so many of them also reported understanding the need and importance of having those services in rural communities, because people are still giving birth, and they have to have somewhere to go.”

The survey respondents said it was important to keep the obstetrics units open because of the complications patients could encounter if they had to drive long distances to give birth.

About two-thirds of survey respondents said meeting their community’s needs was the most important factor in keeping their obstetrics units open, even if there weren’t enough births in the area to warrant it financially. Only 16.5% said their top priority in making that decision was the financial aspect. Nearly 13% said their top priority was staffing.

Nationally, birth rates have been falling since 2008, according to the U.S. Census Bureau.  Birth rates tend to be higher in rural areas, around 1,900 births per every 1,000 women, compared to 1,600 births for 1,000 women in urban areas. However, because there are fewer women of child-bearing age in rural areas, hospitals tend to see fewer births per year.

“Many hospital administrators in rural communities care deeply about the health of pregnant rural residents,” Katy Backes Kozhimannil, director of the Rural Health Research Center and lead author of the study, said. “Rural hospital administrators prioritized local community needs over finances and staffing, keeping obstetric units open because local pregnant patients need care. Policy investments are needed to help rural hospitals and communities support safe, healthy pregnancies and births.”

Interrante said insurance reimbursement is one issue rural hospitals face in keeping the obstetrics units open. Rural areas tend to have more patients on Medicaid, she said, which only reimburses a percentage of what it costs hospitals to provide those services. According to the CDC, half of the women who give birth in rural areas are on Medicaid, compared to 41.9% in urban areas.

More than a quarter of those responding to the survey said they were not sure if they would continue providing obstetrics. Or they said they expected to stop offering the service, indicating a continued downward trend in health care access, researchers said.

“The responses from the rural hospital administrators strongly highlight the fact that they provide obstetric services because they are so necessary and important for the health of rural communities they serve,” Bridget Basile Ibrahim, a co-author of the study, said. “For many of the patients who give birth at these hospitals, it would be a huge burden for them to travel to the next nearest hospital to give birth.”

Researchers concluded that any policies to improve rural obstetrics care should take into account community needs, clinical safety, and rural hospital finances. How low-volume, rural hospitals are reimbursed should be investigated to ensure those hospitals’ financial viability, they said.

HHS Region 3 Director Named

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Dr. Ala Stanford has been named Regional Director for HHS Region 3.

Dr. Stanford gained national recognition during the COVID-19 pandemic using the infrastructure of her pediatric surgery practice to create a grassroots organization to focus on testing, contact tracing and vaccination in communities devoid of access to care and resources. Her focus on the most vulnerable populations disproportionately impacted by COVID-19 saved lives.

Dr. Stanford is a practicing physician for over 24 years. She is board certified by the American Board of Surgery in both pediatric and adult general surgery. She is former director of the Center for Minority Health and Health Disparities of Temple University School of Medicine in Philadelphia, PA, a member of the Philadelphia Board of Health COVID-19 advisory board and trusted national leader and public health advocate. In addition to opening a Center for Health Equity to improve health outcomes in communities with the lowest life expectancy, her organization was responsible for providing nearly 100,000 COVID-19 tests and vaccinations. She was recognized by Admiral Rachel Levine and Surgeon General Vivek Murthy as demonstrating best health practices and a national model during a public health crisis.

Dr. Stanford has received many accolades, notably a: 2021 Top 10 CNN Hero, and 2021 George H.W. Bush Points of Light Award Recipient. Most recently she led a FEMA mission, Region 3 Team to vaccinate students in Philadelphia School District and a mobile vaccination unit in hard hit Southeastern Pennsylvania neighborhoods.

Dr. Stanford said, “I am humbled to be named HHS’s new Regional Director, especially at this critical time in our nation’s recovery efforts. Ensuring communities across Region 3 have access to the information and resources they need to stay safe and healthy, with a particular emphasis on advancing equity, will be my top priority, in all aspects of health care.”

Welcome Dr. Stanford!