The final rule from the Centers for Medicare & Medicaid Services sets standards for Marketplaces and issuers, as well as requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters that help Marketplace consumers. The rule includes policies that extend the special enrollment period for low-income people to enroll in coverage in any month rather than only during Open Enrollment, provides states the ability to increase access to routine adult dental services such as cleanings, diagnostic X-rays, and restorative services like fillings and root canals, and sets network adequacy standards for the time and distance people travel to appointments with in-network providers. The rule standardizes certain operations across the Marketplaces to increase reliability and consistency for consumers. Lastly, the rule includes several policies impacting the Medicaid program, Children’s Health Insurance Program, and the Basic Health Program.
What Happens to Rural Hospitals During a Ransomware Attack? Evidence From Medicare Data
Researchers at the University of Minnesota Rural Health Research Center used data on hospital ransomware attacks from 2016 to 2021, describing disrupted operations at hospitals in rural and urban areas.
An Observational Study of Physicians and Nurse Practitioners Providing MAT
Researchers used data from electronic license renewals in 2021 to examine what factors affect the likelihood of providing medication-assisted treatment (MAT) for opioid use disorder. Physicians and nurse practitioners who were younger, practiced in a public or community health center, and offered a sliding fee scale in their practice had a greater likelihood of providing MAT. The study builds on previous research showing a lack of mental health services, professional burnout, and stigma associated with lower rates of MAT provision in rural areas, with a further look at organizational and personal barriers to prescribing.
ERS Shares Research on the Widening Gap in Urban-Rural Mortality
The Economic Research Service (ERS) at the U.S. Department of Agriculture analyzed natural-cause mortality data for adults aged 25-54 from two three-year periods – 1999 through 2001 and 2017 through 2019. Researchers found that the mortality rate from natural causes such as chronic disease and cancer in rural areas was only 6 percent higher than for city dwellers during the first period, but the gap widened to 43 percent by 2019.
New Oral Health Resources Available in Pennsylvania
PCOH staff have been working on a number of print projects this spring that we hope will be helpful to you in your own advocacy and work.
- Medicaid Provider Brochure: This tri-fold flyer helps explain the many reasons that dentists and PHDHPs should participate in Medicaid and provides information on recent updates to the program.
- Medicaid Patient Brochure: Many adults enrolled in Medicaid don’t even know they have a dental benefit. This flyer helps explain some of the dental benefits offered and shares links to additional resources.
- Finding Dental Care: This flyer is available in English and Spanish and lists high-level resources in PA to help everyone find care.
Thank you to CareQuest Institute for Oral Health for helping to fund this work. These materials are all able to be printed and shipped, or you can use the PDF file to share electronically or print yourself. Email info@paoralhealth.org to request printed materials.
Policy Alert! CMS Publishes Final Rule to Allow States to Select Adult Dental Coverage as an Essential Health Benefit
The Centers for Medicare & Medicaid Services (CMS) released the 2025 Notice of Benefit and Payment Parameters final rule, designed to enhance accessibility and reliability within the Affordable Care Act (ACA) Marketplaces. In Pennsylvania, we use Pennie (pennie.com).
One significant aspect of the new policies is the expansion of access to health care services, particularly the inclusion of adult routine dental care as a state option. Effective January 1, 2027, states can include adult routine dental services as an essential health benefit (EHB) within their plans offered through the marketplaces. However, states can begin the EHB benchmark application process on January 1, 2025.
Navigating Health Policy in an Election Year: Insights From a Health Policy Expert
On the April 2, 2024 episode of Managed Care Cast, we talked with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care® and a health policy professor at Penn State University. Topics discussed include President Biden’s recent prescription drug proposals, prior authorization practices, price transparency, and the potential impact of health policy on the upcoming election.
Listen to the Podcast here.
City-Country Mortality Gap Widens Amid Persistent Holes in Rural Health Care Access
In Matthew Roach’s two years as vital statistics manager for the Arizona Department of Health Services, and 10 years previously in its epidemiology program, he has witnessed a trend in mortality rates that has rural health experts worried.
As Roach tracked the health of Arizona residents, the gap between mortality rates of people living in rural areas and those of their urban peers was widening.
The health disparities between rural and urban Americans have long been documented, but a recent report from the Department of Agriculture’s Economic Research Service found the chasm has grown in recent decades. In their examination, USDA researchers found rural Americans from the ages of 25 to 54 die from natural causes, like chronic diseases and cancer, at wildly higher rates than the same age group living in urban areas. The analysis did not include external causes of death, such as suicide or accidental overdose.
The research analyzed Centers for Disease Control and Prevention death data from two three-year periods — 1999 through 2001 and 2017 through 2019. In 1999, the natural-cause mortality rate for people ages 25 to 54 in rural areas was only 6% higher than for city dwellers in the same age bracket. By 2019, the gap widened to 43%.
The researchers found the expanding gap was driven by rapid growth in the number of women living in rural places who succumb young to treatable or preventable diseases. In the most rural places, counties without an urban core population of 10,000 or more, women in this age group saw an 18% increase in natural-cause mortality rates during the study period, while their male peers experienced a 3% increase.
New Brief: Partnerships to Address Social Needs across Metropolitan and Non-Metropolitan Prospective Payment System Hospitals and Critical Access Hospitals
This policy brief used American Hospital Association (AHA) survey data to examine partnerships between hospitals and external organizations to address social needs. Hospitals were stratified by rurality (metropolitan or non-metropolitan) and type—prospective payment system (PPS) or critical access hospital (CAH) as well as by region, ownership status and accountable care organization (ACO) participation. We calculated a partnership score for all hospitals reflective of the number of types of partnerships and the number of ways that hospital partner to address social needs with scores ranging from 0 to 48. We also assessed what types of specific partnerships hospitals indicated. Key findings are noted below:
- The highest mean community partnership scores were seen in metropolitan PPS hospitals (24.0), followed by non-metropolitan PPS hospitals (20.4) and CAHs (16.8).
- Except for non-metropolitan PPS hospitals in the West, the Northeast had the highest mean partnerships across hospital types.
- Regardless of geography or type (CAH or PPS), non-profit hospitals and those participating in ACOs had higher mean partnership scores.
Most hospitals had partnerships with state and local agencies, though compared to other types of hospitals, a higher proportion of metropolitan PPS hospitals had partnerships with organizations that address specific social needs (e.g., food insecurity).
Authors: Whitney E. Zahnd, PhD; Khyathi Gadag, MHA; Kristin D. Wilson, PhD, MHA; Keith J. Mueller, PhD
Contact Information: Lead Author: Whitney Zahnd, PhD; whitney-zahnd@uiowa.edu
Senator Announces New Legislation to Expand Access to Maternal Care
U.S. Senator Maggie Hassan (D-NH) announced the introduction of her bipartisan Rural Obstetrics Readiness Act with Senators Susan Collins (R-ME), Katie Britt (R-AL), and Tina Smith (D-MN). The bill provides support for rural health care facilities to provide urgent obstetric care by helping to create training programs focused on obstetric emergencies, establish new federal grants to help these facilities buy specialized equipment for both training and patient care, and create a pilot program for rural facilities to get teleconsultations from maternal health experts to improve care. Please find the press release here. Please find NRHA’s Rural Maternal Health legislative priorities here.