In addition to seeking feedback from the public on maternal health, CMS also included other requests for information in the Hospital Inpatient Prospective Payment System (IPPS) proposed rule. This includes requests for information on how health care providers may prepare for climate change, social determinants of health (particularly related to homelessness), and measurement of health care quality disparities. Additionally, CMS is seeking feedback and comments on the appropriateness of payment adjustments that would account for additional resource costs associated with the procurement of surgical N95 respirators that are wholly domestically made. Rural stakeholders interested in providing input to CMS can review the full details, along with instructions on how to respond, in the Hospital Inpatient Prospective Payment System (IPPS) proposed rule.

The Centers for Medicare & Medicaid Services (CMS) released additional details about the proposed “Birthing-Friendly” hospital designation intended to drive improvements in maternal health outcomes and assist consumers in choosing hospitals. Initially, the publicly reported maternity care quality hospital (“Birthing-Friendly”) designation would be based on a hospital’s attestation to the Hospital Inpatient Quality Reporting Program’s Maternal Morbidity Structural Measure. Rural stakeholders interested in providing input to CMS on the “Birthing-Friendly” hospital designation should review the full details of the proposal, along with instructions on how to respond, in the Hospital Inpatient Prospective Payment System (IPPS) proposed rule (also posted above). Eventually, CMS intends to expand the criteria for which this designation would be awarded in the future. In the IPPS proposed rule, CMS also included a request for information on additional activities to advance maternal health equity.

The Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule. The proposal would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs and build on key priorities to address quality and maternity care. CMS proposes to continue policies finalized in the FY 2020 IPPS/LTCH PPS final rule to address wage index disparities affecting low wage index hospitals and also proposes to limit year-to-year decreases in hospitals’ wage indexes. This proposed rule includes changes to graduate medical education policies, including increased flexibility for rural hospitals participating in a rural track program. This rule also includes proposed revisions to the hospital and Critical Access Hospital Conditions of participation for infection prevention and control and antibiotic stewardship programs – Comment by June 17

 

In an open-access article on the JAMA Network, researchers describe their findings when 471,791 rural U.S. veterans with a history of mental health care use received video-enabled tablets to access services. The study included rural veterans identified by the U.S. Department of Veteran Affairs (VA) as a high risk for suicide and compared monthly mental health service utilization for patients who received VA tablets during COVID-19 with patients who were not issued tablets over 10 months before and after tablet shipment.

Also last week, HRSA announced $16 million in awards administered by its Maternal and Child Health Bureau to support pregnant people and parents with young children.

Over the course of two days (May 16-17), public and private sector leaders will discuss best practices and lessons learned during the COVID-19 pandemic.  Topics include the role of telehealth in underserved communities, achieving health equity through improved broadband connectivity, and telehealth as a model for integrating behavioral health care during the pandemic and beyond.

On Wednesday, the U.S. Department of Agriculture announced a new collaboration between federal agencies and local leaders and residents.  The Rural Partners Network is a whole-of-government approach that includes 16 federal agencies and regional commissions to help rural communities access government resources and funding. At launch, selected communities in Georgia, Kentucky, Mississippi, New Mexico, and certain Tribes within Arizona will participate to share local concerns and ensure rural communities have a voice in policymaking.

The National Rural Health Association (NRHA) team submitted comments in response to the OSHA COVID-19 notice of limited reopening of comment period.

NRHA recognizes the need to protect healthcare and healthcare support service workers from occupational exposure to COVID-19 in settings where people with COVID-19 are reasonably expected to be present.  As OSHA works towards permanent regulator solutions, we encourage the agency to recognize already established protocols given where healthcare providers are at this point in the pandemic.  NRHA maintains the position that adding burdensome standards, like the prior ETS proposes, will not protect patients or employees.  Rather it will pull limited staff and financial resources in directions that could be better used providing health care to patients, especially in rural areas.  We have heard from members across the country about loss of staff due to the mandatory vaccination requirements, which perpetuates significant workforce shortages in our rural health care facilities. 

Please feel free to reach out to Carrie (ccochran@ruralhealth.us) with any questions. 

The Appalachian Leadership Institute (ALI) is now accepting applications!

ARC is seeking 40 fellows from all 13 Appalachian states, and all walks of community life, for the Class of 2022-2023.

ALI is a FREE leadership and economic development program designed to help anyone who lives or works in Appalachia gain skills to strengthen their community. From October 2022 – July 2023, participants will attend six multi-day seminars across the Region, and end with a capstone graduation event held in Washington, DC.

Apply by June 1 at arc.gov/leadership.

On April 18, CMS issued a proposed rule for inpatient and long-term hospitals that builds on the Biden-Harris Administration’s key priorities to advance health equity and improve maternal health outcomes. In addition to annual policies that promote Medicare payment accuracy and hospital stability, the fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule includes measures that will encourage hospitals to build health equity into their core functions, thereby improving care for people and communities who are disadvantaged and/or underserved by the health care system. The rule includes 3 health equity-focused measures in hospital quality programs, seeks stakeholder input related to documenting social determinants of health in inpatient claims data, and proposes a “Birthing-Friendly” hospital designation.

For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record users, the proposed increase in operating payment rates is projected to be 3.2%. This reflects a FY 2023 projected hospital market basket update of 3.1% reduced by a projected 0.4 percentage point productivity adjustment and increased by a 0.5 percentage point adjustment required by statute. Under the LTCH PPS, CMS expects payments to increase by approximately 0.8% or $25 million.

Additional items in the proposed rule related to payment stability for hospitals include a policy that smooths out significant year-to-year changes in hospitals’ wage indexes and a solicitation for comments on payment adjustments for purchasing domestically made surgical N95 respirators. Specifically, CMS is proposing to apply a 5% cap on any decrease to a hospital’s wage index from its wage index in the prior FY; and is considering the appropriateness of payment adjustments accounting for additional costs of purchasing surgical N95 respirators made in the U.S.

More Information:

• Complete press release
• Proposed payment rule fact sheet
• Maternal health & health equity measures fact sheet
• White House statement on Reducing Maternal Mortality and Morbidity
• Proposed rule: Comment by June 17