CMS Open Enrollment Extension for Plan Year 2020

CMS’s primary goal is to provide a seamless Open Enrollment experience for HealthCare.gov consumers and ensure that those Americans who want coverage offered through the Exchange can enroll in a plan. In an abundance of caution, to accommodate consumers who attempted to enroll in coverage during the final hours of Open Enrollment but who may have experienced issues, starting at 3:00PM EST today, December 16 we are extending the deadline to sign up for January 1 coverage until 3:00AM EST December 18. This additional time will give consumers the opportunity to come back and complete their enrollment for January 1 coverage. While the website and the call center remained open for business on December 15, with over half a million consumers enrolling throughout the day, some consumers were asked to leave their name at the call center.  Those consumers who have already left their contact information at the call center do not need to come back and apply during this extension because a call center representative will follow up with them later this week.

The Declining Number of Rural Medical Students 

As workforce shortages persist in rural health care, a new study from Health Affairs has identified a sharp decline in the number of medical students with rural backgrounds. Growing up in a rural setting is a strong predictor of a future decision to practice in a rural community, and the decline could mean a worsening in the shortage of physicians in rural areas of the country in the future. Although medical school positions increased by more than 30% from 2002 to 2017, the number of medical students from rural backgrounds decreased by 28%, according to the Health Affairs study. In 2017, only 4.3% of the incoming medical student body was comprised of students with rural backgrounds.

Surprise Medical Billing Legislation Hits Roadblock 

Days after House Energy & Commerce (E&C) Committee leaders reached a deal with Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Senator Lamar Alexander (R-TN) on surprise billing legislation, the House Ways & Means (W&M) Committee have unveiled a rival proposal. The E&C and HELP legislation was reported to be supported by the White House, and the new proposal hurts the chances of surprise legislation passing before the end of the legislative year. House W&M Chairman Representative Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) have called for surprise billing legislation to be delayed until next year.

Drug Pricing Legislation Moves Forward 

H.R. 3, the Elijah Cummings Lower Drug Costs Now Act is slated to move forward in the U.S. House of Representatives. The legislation focuses on lowering prices of prescription drugs and using those savings to fund vital health programs and research. Notably, this bill includes $10 billion for funding for Community Health Centers. The National Rural Health Association’s rural health voices blog has a write-up of the drug pricing legislation and the different provisions in the bill.

Federal Spending Bill Update

The news from Capitol Hill is that budget negotiators have reached an agreement ‘in principle’ for all 12 of the FY 2020 spending bills, and Politico reports that a vote on the legislation could be held as early as Tuesday, December 17, 2019. Politico writes, “Senate Appropriations Chairman Richard Shelby (R-Ala.) said staff members are working out “a few details.” He and Lowey announced the agreement with Sen. Patrick Leahy (D-Vt.), the ranking member of Senate Appropriations, and Rep. Kay Granger (R-Texas), ranking on House Appropriations.” The bill text has not been released, but details may emerge over the weekend or as late as Monday afternoon. Our team is looking forward to learning more about how the reported increase in investment towards domestic spending bills will impact the funding levels of our key rural health line items, such as funding for CHCs, the NHSC, and more.

The 19TH Rural Hospital Closure of 2019

The UNC Sheps Center reports that Ellwood City Medical Center has officially become the 19th rural hospital closure of 2019. According to the Pittsburg Post-Gazette, “A day after its CEO resigned, Ellwood City Medical Center has effectively closed its doors, at least temporarily, raising further doubts about the future of the Lawrence County hospital.” This year, the U.S. has experienced the greatest number of rural hospital closures than any year in the past decade.

U.S. Primary Care Compared

A new survey of more than 13,000 primary care physicians (PCPs) in 11 high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States), published this week in the Health Affairs journal, shows where the U.S. is falling behind, where we are keeping pace, and possible paths to improvement.

  • Only about half of U.S. physicians reported that they are usually notified when one of their patients is seen in the emergency department or admitted to a hospital, compared to 79% to 85% of physicians in the Netherlands and New Zealand who reported usually receiving these notifications
  • About half of U.S. physicians reported being able to exchange patient information, such as clinical summaries, laboratory tests and medication lists, with physicians outside their practices, in contrast to 72% to 93% of physicians in the Netherlands, New Zealand, Norway, and Sweden
  • U.S. physicians were the most likely to report offering patients electronic access to their health care information through portals and web tools that enabled them to make appointments, refill medications, and see visit summaries and lab tests online
  • PCPs in the U.S. and their counterparts around the world share significant challenges helping patients meet their health-related social needs, with about one-third of physicians in the U.S. saying that inadequate staffing, poor responses from social service agencies, or a lack of formal referral systems made it difficult to help provide patients with critical non-medical health-related services
  • Strengths of the U.S. healthcare system are that nearly all primary care practices have electronic medical records, and providers, health systems, and payers see the value of supporting patients’ unmet social needs and are looking for the best ways to support them

The authors conclude that a strong emphasis on primary care across our healthcare system and continued benchmarking of U.S. health care performance against that of other wealthy nations will point us to a higher-performing health system.

New 50-State Scan on the Non-Licensed Substance Use Disorder (SUD) Workforce

Through HRSA’s cooperative agreement with National Organizations of State and Local Officials (NOSLO), the National Academy for State Health Policy (NASHP) conducted a comprehensive 50-state scan of how each state Medicaid program pays for and oversees non-licensed SUD staff. Learn how state Medicaid agencies are developing and deploying a growing workforce of peers, counselors, and other qualified staff to supplement licensed SUD provider capacity. The report can be accessed here.

Catalog of Value-Based Initiatives for Rural Providers

This catalog summarizes programs implemented by the U.S. Department of Health & Human Services that support the transition of payment models from fee-for-service to value-based care.  Updated in October 2019 by the Rural Health Value team, the catalog includes the rural impact and participation for such programs as the Medicare Diabetes Prevention Program, the Million Hearts Cardiovascular Disease Risk Reduction Model, and the Hospital Value-Based Purchasing Program. Recent catalog additions include: the Emergency Triage, Treat, and Transport Model; the Maryland Total Cost of Care Model; and Primary Cares Initiatives.

Access the catalog here:  Catalog of Value-Based Initiatives for Rural Providers.