Section 1332 of the Patient Protection and Affordable Care Act permits states to apply for State Innovation Waivers (aka Section 1332 Waivers or State Relief and Empowerment Waivers) to pursue innovative strategies for providing high value and affordable individual health insurance regardless of income, geography, age, gender, or health status.  As a follow-up to the guidance released last year, CMS has created concept papers and templates for four waiver concepts to help states develop new approaches to providing health coverage: State Specific Premium Assistance, Adjusted Plan Options, Account-Based Subsidies, and Risk Stabilization Strategies.  In 2018, rural areas had fewer insurers offering individual health insurance and higher average adjusted premiums compared to urban areas.

On July 10, 2019, CMS put on public display a proposed rule that would implement two new mandatory Medicare payment models under section 1115A of the Social Security Act—the Radiation Oncology Model (RO Model) and the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model). The proposed RO Model is an innovative payment model designed to improve the quality of care for cancer patients receiving radiotherapy treatment and reduce provider burden by moving toward a simplified and predictable payment system. The ETC Model is one of five new payment models CMS announced last week aimed at transforming kidney care to improve access to high quality care and reducing Medicare expenditures. The rule details the proposed geographic units of section for model participation, Core Based Statistical Areas (CBSAs) for the RO Model and Hospital Referral Regions (HRRs) for the ETC Model, with implications for rural participation. The proposed rule is scheduled to be published in the Federal Register on July 18, and public comments are due 60 days after publication.  Click here for more information.

On July 11, 2019, CMS released a proposed rule that would remove the regulatory text that sets forth the current required process for states to document whether Medicaid payments in fee-for-service systems are sufficient to enlist enough providers to assure beneficiary access to covered care and services consistent with the Medicaid statute. In the proposed rule, CMS noted that states have raised concerns over the administrative burden associated with the current regulatory requirements. CMS also issued on July 11 an informational bulletin announcing the agency’s strategy to measure and monitor beneficiary access to care across Medicaid. For more information on rural Medicaid issues in general, the Rural Health Research Gateway provides a selection of policy briefs on the topic. Click here for more information.

On July 11, 2019, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Home Health Prospective Payment System (Home Health PPS). This includes routine updates to the home health payment rates for calendar year (CY) 2020 and a proposal to implement a new home infusion benefit for beneficiaries in CY 2021. The proposed rule would also increase Medicare payments to home health agencies (HHAs) by 1.3 percent ($250 million) overall, which reflects a 0.2 percent decrease in CY 2020 payments due to the rural add-on percentages mandated through CY 2022 by the Bipartisan Budget Act of 2018. Unlike previous rural add-ons, which were applied to all rural areas uniformly, the extension provided varying add-on amounts depending on the rural county (or equivalent area) classification. The average increase in payments to rural providers overall is 4.7 percent. RHIhub provides additional information on Rural Home Health Services as well as helpful FAQs. Click here for more information.

The Federal Communications Commission (FCC), under its existing Rural Health Care Program authority, is proposing a three-year, $100 million Connected Care Pilot program that would support bringing telehealth services directly to low-income patients and veterans.  It would provide an 85 percent discount on connectivity for broadband-enabled telehealth services that connect patients directly to their doctors and are used to treat a wide range of health conditions.  The Notice of Proposed Rulemaking (NPRM) adopted by the Commission seeks comment on testing the new program. In particular, the NPRM seeks comment on the appropriate budget, duration, and structure of the Pilot, along with other issues. Comments are due 30 days after publication in the Federal Register, and reply comments are due 60 days after publication in the Federal Register. For more information, visit the Center for Connected Health Policy, part of the HRSA/FORHP-supported National Telehealth Policy Research Center.  Click here to access additional information.

On July 18, 2019, the Health Resources and Services Administration (HRSA) awarded approximately $20 million for Rural Residency Planning and Development Program (RRPD) grants. Recipients across 21 states will receive up to $750,000 over a three-year period to develop new rural residency programs while achieving accreditation through the Accreditation Council for Graduate Medical Education.

“Health care in America is under increasing strain due to many factors, including workforce gaps. This is a particular problem, because heart disease, cancer, and chronic lower respiratory disease are found at higher rates among rural Americans than urban Americans, and this is contributing to an ever-growing health disparity gap that must be slowed and eventually stopped.  Rural residency grants are an effective tool that will help rural communities recruit and retain high quality healthcare providers who can improve access to healthcare and health outcomes for patients,” said U.S. Department of Health and Human Services, Deputy Secretary Eric D. Hargan.

Read the news release.

On July 11, 2019, the Health Resources and Services Administration (HRSA) presented ten states with the 2019 Medicare Beneficiary Quality Improvement Project Quality Performance Awards. These awards recognize achieving the highest reporting rates and levels of improvement in Critical Access Hospitals over the past year.

The 10 top performing states are: Pennsylvania, Massachusetts, Michigan, Utah, Alabama, Nebraska, Illinois, Maine, Minnesota, and Wisconsin. These states built on their previous successes by investing funding from HRSA’s Federal Office of Rural Health Policy (FORHP) into quality improvement projects and developing technical assistance resources that improve high-quality care in their communities. States also work collaboratively with every CAH and their respective partners to share best practices and utilize data to drive quality improvement in their hospitals.

Read the news release

Interested in seeing what programs HRSA has funded in your state?  That information can be easily found on the  data.HRSA.gov home page. Scroll down to see an interactive map where data also can be downloaded in Excel or PDF formats.

Check it out at data.hrsa.gov.

The number of clinicians who participated in MACRA’s Advanced Alternative Payment Model track increased from 2017 to 2018, while the number of clinicians who participated in MACRA’s Merit-based Incentive Payment System decreased, according to preliminary data CMS released last week. CMS Administrator Seema Verma also noted that more clinicians are expected to receive a positive payment adjustment in 2020 based on their performance under the programs in 2018. (Source: Modern Healthcare‘s “Transformation Hub,” 7/12)

The Trump administration during the week of July 15, 2019, announced that it will immediately start enforcing a final rule that bars health care providers and clinics that receive Title X family planning grants from providing or referring patients for abortion care. The announcement comes as an appeals court reconsiders whether to issue an emergency order to block the final rule while lawsuits challenging the regulation continue. (Source: The Hill, 7/15)