Last week, the Centers for Medicare & Medicaid Services issued a proposed rule outlining new policies for Medicare Advantage (MA) and Prescription Drug (Part D) plans for Contract Year 2025.  The proposals would set guidelines on compensation for agents and brokers, add a range of behavioral health providers to the current list that MA plans must contract with, require plans to notify enrollees mid-year of any supplemental benefits that are available to them but have not been used yet, conduct annual health equity analyses of prior authorization policies, and offer more enrollment opportunities in plans that integrate Medicare and Medicaid for dually eligible managed care enrollees.  Enrollment in MA has been growing in recent years, especially in rural areas where 45.1 percent of beneficiaries were enrolled in MA plans as of January 2023.

Read the full article: Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Plan Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly, and Health Information Technology Standards

The Centers for Disease Control and Prevention and the National Organization of State Offices of Rural Health have joined with two philanthropic organizations with experience in minority communities – Well-being and Equity (WE) in the World and Well Being In the Nation (WIN) Network – to collaborate on guidelines for what it will take to bring health equity to rural areas.

See the Rural Health Equity Roadmap

From Becker’s Healthcare

Only 45% of U.S. rural hospitals currently offer labor and delivery services, and in 10 states, less than 33% do, according to the Center for Healthcare Quality and Payment Reform.

Over the past decade, more than 200 rural hospitals across the country have ceased delivery services, despite such facilities delivering nearly 1 in 10 babies in the U.S., according to the American Hospital Association.

Low Medicaid reimbursements, rising costs and ongoing staff shortages have led many rural hospitals to close labor and delivery units, leading to a higher number of maternity care deserts — counties without a hospital or birth center offering obstetric care and without any obstetric providers.

Areas where there is low or no access affect up to 6.9 million women and almost 500,000 births across the U.S., a year, according to March of Dimes, a nonprofit aiming to improve maternal and child health. In maternity care deserts alone, about 2.2 million women of childbearing age and almost 150,000 babies are affected.

Couple this with the rise in rural hospital closures (37 facilities have closed since 2020) and rural America has a serious problem on its hands.

“Low Medicaid reimbursement is our greatest challenge, especially in Indiana where rates paid to hospitals have not been raised in over 30 years. This is especially detrimental in rural areas where a higher number of births are covered by Medicaid,” Eric Fish, MD, president and CEO of Schneck Medical Center, in Seymour, Ind., told Becker’s. “In Indiana, over half of babies born on an annual basis are covered by Medicaid, which pays 57 cents on the dollar of the cost of providing care. This means hospitals, specifically in rural areas, are experiencing significant financial losses. Increasing Medicaid reimbursement is imperative to keep these services open and to preserve access in the future.”

Many more rural communities are at risk of losing maternity care because of the financial challenges rural hospitals are facing. Rural hospitals typically lose money on obstetric care, so if a hospital can’t make enough money on other services to offset those losses, it may be forced to eliminate maternity care to prevent the hospital from closing entirely.

Another challenge for rural communities is the ability to recruit and retain health care providers — especially obstetricians.

“In Indiana, 87% of rural residents live in areas with a primary care shortage. Across the country, rural hospitals have been creative in forming strategic regional partnerships, including working with larger hospitals and health systems for care coordination, provider training and other resources,” Dr. Fish said. “Such partnerships help rural patients receive care in their communities while a specialist from a larger system can manage high-risk patients as necessary and support the rural provider in planning for delivery in the community. Solutions are needed to increase the pipeline of health care workers, including incentives for providers who choose to serve rural communities, student loan repayment and more.”

The lack of obstetrics workforce and expertise has been a growing issue in rural America, both for providers and obstetric nurses.

“We have spent upwards of $3 million annually for traveling obstetric nurses to keep our unit staffed 24/7/365, but it is the right thing to do for southwest Iowans in order to decrease the excessive mileage required to reach the nearest obstetrics unit,” Brett Altman, DPT, CEO of Atlantic, Iowa-based Cass Health, told Becker’s. “Low volume obstetrics is not profitable and is one of the key drivers for why so many obstetric units have closed in rural areas as these hospitals hit financial headwinds in addition to concerns of competency.”

With 50% of deliveries in rural areas being funded by Medicaid, the most significant impact would be improved Medicaid reimbursement for maternal care services in rural areas, according to Dr. Altman.

“To help cover the losses associated with obstetrics, perhaps rural hospitals offering obstetrics could qualify for a special exception through Medicaid with an add-on payment program or an annual lump-sum payment, similar to [prospective payment system] hospitals that have received disproportionate numbers of low-income patients, based on the hospital’s disproportionate OB patient percentage,” he said.

It’s no secret that rural hospitals are especially feeling the pinch coming out of the pandemic, but federal financial support or an add-on payment program would go a long way toward ensuring the long-term sustainability of many.

The other big issue rural communities have to contend with is population declines and fewer younger people having children in rural areas, but there are strategies some hospital leaders have found effective in combating these trends.

“Our strategy has been to expand our footprint using a hub-and-spoke model to keep our delivery numbers high enough to maintain competency,” Dr. Altman said. “Over the past three years, we’ve been doing outreach with one of our OBGYNs to three smaller rural hospitals in southwest Iowa, which has increased the number of our deliveries by roughly 50%. It is a win for those outreach communities to have maternal health services available making them more viable places for young people to live, a win for Cass Health, and most importantly a win for young moms in underserved rural areas by creating local access to maternal health services.”

The Federal Office of Rural Health Policy wrapped up a week of recognizing and honoring the heartfelt drive, innovation, and care of providers, administrators, caregivers, researchers, community organizers, and policymakers at every level of government – all working to improve the health and well-being of more than 60 million people living in rural America.

If you missed any of the events, you can come back to view – and share – what happened on HRSA’s page for National Rural Health Day 2023. There, you’ll find:

• Recordings of events;
• Federal investments nationally and state-by-state;
• Infographics describing how HRSA’s investments have been used to address the most pressing issues in rural health;
• Videos showcasing the work of grantees of the Rural Communities Opioid Response Program;
• An episode of the Exploring Rural Health podcast with the CEO of the National Organization of State Offices of Rural Health, the org that started National Rural Health Day back in 2011.

Read more about FORHP’s ongoing efforts supported by HRSA, by the U.S. Department of Health & Human Services, and by the White House; continue to follow what we’re doing on our website and in our Rural Health Updates newsletter, and look for @HRSAgov on social media.

Happy National Rural Health Day.  We hope to see you again next year and every day in between.

The White House issued A Proclamation on National Rural Health Day, 2023

America’s rural communities are indispensable to who we are as a Nation, where over 60 million people who live in rural America fuel our economy and help forge our future.  On National Rural Health Day, we recommit to investing in rural communities and delivering affordable, quality health care so that generations of rural Americans can thrive.

President Biden calls upon the people of the United States to reaffirm our dedication to the health and well-being of rural America and proclaims November 16, 2023, as National Rural Health Day.  

https://powerofrural.org/

#PowerofRural #NationalRuralHealthDay #mnhealth #mnruralhealth

The White House and the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is releasing several resources to help support federal agencies, states, local and tribal governments to better coordinate health care, public health, and social services. Specifically, the White House is releasing the first ever U.S. Playbook to Address Social Determinants of Health – PDF.  To accompany this, the Department of Health and Human Services (HHS) is releasing a Call to Action to Address Health Related Social Needs, and a Medicaid and CHIP Health-Related Social Needs Framework – PDF. This builds on the Administration’s work to advance health equity by acknowledging that peoples’ social and economic conditions play an important role in their health and wellbeing.

“It is clear that the health of our people does not exist in a vacuum, but it is affected by our access to stable housing, healthy food, and clean air to breathe,” said HHS Secretary Xavier Becerra. “It is crucial for HHS to tackle health care and public health holistically by addressing patients’ social conditions. Today’s announcement will help to provide opportunities to improve equal access to health care for every American and make progress toward a health system that improves health care outcomes for all Americans instead of advantaged few.”

The social and economic conditions of the environments where people are born, live, learn, work, play, worship, and age affect a wide range of health, functioning, and quality-of-life outcomes. Recognizing this, the first piece of today’s announcement is the U.S. Playbook to Address Social Determinants of Health. The Playbook highlights ongoing and new actions that federal agencies are taking to support health by improving the social circumstances of individuals. This includes initiatives by HHS, Department of Agriculture (USDA), Department of Housing and Urban Development (HUD), the Department of Veterans Affairs (VA), the Environmental Protection Agency (EPA), and other federal agencies to align investments to finance community infrastructure, offer grants to empower communities to address health related social needs, and encourage coordinated use of resources and data to improve health outcomes.

The second resource is Medicaid and Children’s Health Insurance Program (CHIP) Health-Related Social Needs (HRSN) Framework – PDF. This document will provide guidance for more states, beyond the current seven, to structure programs that address housing and nutritional insecurity for enrollees in high-need populations. An example is a program providing medically tailored meals or helping homeless youth find and obtain housing. The guidance will also include an accompanying CMS Informational Bulletin – PDF (CIB).

The final document is HHS’s Call to Action to Address Health Related Social Needs – PDF to encourage cross-sector partnerships among those working in health care, social services, public and environmental health, government, and health information technology to create a stronger, more integrated health and social care system through shared decision making and by leveraging community resources, to address unmet health related social needs. No one sector can do this work alone, so HHS is issuing a Call to Action to collaborate so that together we can achieve a future in which everyone, regardless of social circumstances, has access to aligned, high-quality, person-centered health and social care systems that can improve health and well-being. This Call to Action builds on the nation-wide call to action in the White House Challenge to End Hunger and Build Healthy Communities and complements the Biden-Harris Administration’s work to implement the National Strategy on Hunger, Nutrition, and Health – PDF.

OCCHE wants to remind you of an important opportunity for organizations seeking to improve facility sustainability and enhance resilience to climate-related threats: The office will be launching a “ catalytic program ” early in 2024 to support health care providers in taking advantage of the tax credits, grants and other supports made available by the historic Inflation Reduction Act (IRA) for projects to address climate change. The legislation creates unprecedented opportunities for health sector organizations to make investments in clean energy, building efficiency, infrastructure resilience and more. OCCHE’s planned initiative will occur through collaboration with federal partners including the Environmental Protection Agency and Department of Energy and will feature national webinars as well as breakout sessions by provider type to help organizations assess their needs and opportunities. More details on the initiative will be provided during a November 30th information session which you can sign up for here.

Reminder: In September, HHS announced a new Environmental Justice Community Innovator Challenge funding opportunity. This Challenge aims to engage local problem solvers on community level solutions that advance environmental justice and health equity. This effort is part of HHS’ broader work to support disadvantaged communities and Tribes facing the brunt of environmental injustices, including health harms due to climate change. Phase 1 of the Challenge is now open! The deadline for submissions is January 30, 2024, at 11:59 p.m. ET . To view an overview of the Challenge, include the judging criteria, rules, and entry submission requirements, click here.

Sign up for the webinar

Department Highlights Partnership on National Rural Health Day

On National Rural Health Day, the U.S. Department of Agriculture (USDA) today announced its partnership with the National Rural Health Association (NRHA) to provide technical assistance to rural hospitals across the nation.

USDA is awarding NRHA a $2 million cooperative agreement to implement a technical assistance pilot program for hospitals located in rural communities of 50,000 or less.

The technical assistance will help rural hospitals better manage their financial and business strategies to improve performance, prevent further hospital closings, and strengthen the delivery of health care for rural communities.

NRHA is a national nonprofit membership organization providing leadership on rural health issues through advocacy, communications, education and research.

To learn more, read full STAKEHOLDER ANNOUNCEMENT.

Series examines the ways in which the financial and emotional toll of providing and paying for long-term care are wreaking havoc on the lives of millions of Americans.

Today, KFF Health News and The New York Times published the first phase of an investigation into America’s long-term care crisis, which has left many in the boomer generation facing the prospect of exhausting their financial resources as the price tag for care explodes. Dying Broke, the investigative series, uses KFF polling, original analysis and interviews with experts and impacted individuals and their families to examine the challenges facing families and caregivers in navigating long-term care.

The financial and emotional toll of providing and paying for long-term care is wreaking havoc on the lives of millions of Americans. Paid care, either at home or in a facility, is often so expensive that only the wealthy can afford it, and many of the for-profit companies providing care raised their prices sharply during the pandemic. The ongoing shortage of health care workers is also worsening the situation.

The project found that nearly three million older Americans who need long-term help are not receiving it, in large part because of the high costs of assisted living facilities, nursing homes and aides at home. The United States spends less on long-term care than do most wealthy countries. As part of this project, KFF conducted polling to help shed light on the U.S. public’s awareness of, attitudes about and experiences with long-term care services and supports.

The series tells the stories of some of the many people who must drain their lifetime savings to pay for care as well as the stories of the spouses and children, particularly daughters, who must make tremendous sacrifices to provide care. The first articles appear today on kffhealthnews.org and nytimes.com.

“There’s a reason this topic is a staple of so many family Thanksgiving dinner conversations,” said Jordan Rau, a senior correspondent at KFF Health News. “The kinds of no-win choices facing the people and their families we profile in these articles are ones that can happen to anyone—and too often do.”

“In interviewing many families with aging relatives, I was struck by how woefully unaware people are of how much long-term care can cost,” said Reed Abelson, health care reporter at The New York Times. “Many are amazingly resilient in finding ways to get care for their loved ones, but the lack of available help means people are often making tremendous sacrifices, both financially and emotionally, to provide support.”

The series includes reporting from Jordan Rau, senior correspondent at KFF Health News; Reed Abelson, health care reporter at The New York Times and JoNel Aleccia, formerly at KFF Health News. Holly K. Hacker, KFF Health News’ data editor, and Albert Sun, a graphics editor at The New York Times, conducted data analysis.

Read Dying Broke