A color-coded map of the U.S. provides a seven-day heat forecast that indicates where temperatures may reach levels that could harm health.  It’s a collaboration between the National Oceanic and Atmospheric Administration and the Centers for Disease Control and Prevention (CDC).  As part of this effort, the CDC also provides a HeatRisk Dashboard with resources for high-heat days, details on local air quality, and actions to stay safe in these conditions.  Finally, the CDC has a site with clinical guidance for heat health, focused initially on treating children with asthma, pregnant women, and people with cardiovascular disease.

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Also known as LIHEAP, the program provides federally funded assistance to reduce the costs of home energy bills, energy crises, weatherization, and post-disaster needs.  In fiscal year 2023, the Administration for Children and Families (ACF) invested $4 billion for grantees in each state and in five territories, with set-aside for tribal assistance.  In turn, these grantees assist households with low incomes, particularly those that have a high home energy burden and/or have members who are elderly, disabled, and/or a young child.  Any community-based organization can use ACF’s Cooling Season Outreach toolkit with fliers, videos, and social media content in several languages.  There’s also a LIHEAP search tool that individuals can use to find help.

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On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This rule aims to hold nursing homes accountable for providing safe and high-quality care for nearly 1.2 million residents living in Medicare and Medicaid-certified long term care facilities. Central to the rule are comprehensive minimum nurse staffing standard requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within LTC facilities.  As the long-term care sector continues to recover from the COVID-19 pandemic, the final standards also consider the local realities in rural and underserved communities via staggered implementation and exemptions processes. Highlights of finalized policies include a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. CMS also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. Finally, CMS finalizing to define “rural” in accordance with the Office of Management and Budget (OMB) definition. OMB designates counties as Metropolitan (metro), Micropolitan (micro), or neither. “A Metro area contains a core urban area of 50,000 or more population, and a Micro area contains an urban core of at least 10,000 (but less than 50,000) population. All counties that are not part of a Metropolitan Statistical Area (MSA) are considered rural”. As of 2022 the Rural Health Research & Policy Centers Nursing Home Chartbook, 87 percent of non-core counties have dually/Medicaid certified nursing homes while 82 percent of non-core counties have dually/Medicare-certified nursing homes.

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On April 18, the Health Resources and Services Administration released a final rule establishing an Administrative Dispute Resolution (ADR) process for the 340B Drug Pricing Program that is effective on June 18.  The federal 340B program allows certain hospitals and clinics, aka ‘covered entities,’ that treat low-income and uninsured patients to buy outpatient prescription drugs from manufacturers at a discount, and it is intended to help these providers stretch scarce federal resources as far as possible.  This rule finalizes new requirements and procedures to make the resolution of disputes between covered entities and manufacturers more accessible and efficient.

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Together, these rules from the Centers for Medicare & Medicaid Services (CMS), advance access to care, access to quality of care and aim to improve health outcomes across Medicaid fee-for-service (FFS) and managed care plans. The Access Rule addresses dimensions of access across both Medicaid FFS and managed care delivery systems, including increasing transparency and accountability, standardizing data and monitoring, and creating opportunities for states to promote beneficiary engagement.  The Managed Care Rule addresses standards for timely access to care and states’ monitoring and enforcement efforts; quality and fiscal and program integrity standards for state directed payments; the scope of in lieu of services and settings; establishment of a quality rating system (QRS) for Medicaid and CHIP managed care plans.

Read more on access to medicaid services and CHIP.

There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part, this is because methods to identify RHC encounters within Medicaid claims data are outdated. This brief from the Maine Rural Health Research Center describes a methodology for identifying RHC encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

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The new program aims to address social determinants of health and will have hospitals serve as community-based hubs, or regional leads, to direct strategy and coordinate the efforts of health care providers, community-based organizations (CBOs), and social service agencies within a designated rural community. Medicaid funds will support hub activities, such as leadership, data analysis, and management of community partnerships, and community partners may request funds to pay for additional space, purchase IT or other equipment, purchase a vehicle, or obtain new training for staff.  Additional ToRCH funds will be available to reimburse CBO partners for approved health related social needs services identified in the ToRCH communities, such as supplemental health-related transportation, food and nutrition education, home-delivered medically appropriate meals, and housing remediation to address health risks, on a per-person, per-service basis.  The first cohort of six hospitals will begin on July 1 of this year.

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The U.S. Department of Health & Human Services released details of a plan for more than 200 actions across the federal government to address high rates of suicide.  Populations in the United States disproportionately impacted by suicide include non-Hispanic American Indian and Alaska Native youth, middle-aged and older adults, non-Hispanic White males, rural populations, and veterans, among others. In particular, rural communities continue to see increases in suicide rates. According to 2023 data from the Centers for Disease Control and Prevention, suicides in non-urban environments increased 46 percent between 2000 and 2020.

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From Becker’s Financial Management

Rural hospital closures picked up in 2023 and nearly 700 rural hospitals face continued risk of closing due to serious financial challenges, with some states facing critical conditions in the short term.

The finding comes from the Center for Healthcare Quality and Payment Reform’s latest report, “Rural Hospitals at Risk of Closing.” Eight rural hospitals closed in 2023, as many as in 2022 and 2021 combined, according to the report. This followed a landmark 18 rural hospital closures in 2020, more than any year in the previous decade.

Based on the latest hospital financial information released by CMS in April 2024, CHQPR analyzes rural hospitals’ financial vulnerability in two ways: risk of closure and immediate risk of closure.

For the first category, there are hospitals at risk of closure in nearly every state. This is partly measured by financial reserve limitations that cannot offset hospital losses on patient services for more than six to seven years. In more than half of states, 25% or more of the rural hospitals are at risk of closing; in eight states, the majority of rural hospitals are at risk.

Immediate risk of closure is partly measured by tougher financial reserve limitations: those that could offset hospital losses on patient services two to three years at most. Over 300 rural hospitals are at immediate risk of closing because of the severity of their financial problems, with nearly half of rural hospitals in New York and Alabama facing such an outlook.

Given that immediate risk of closure is the more urgent of the two categories, Becker’s has ranked 25 states by the percentage of their rural hospitals at risk of closure in the next two to three years maximum. The listing for each state also contains broader information about the number of hospitals at risk of closure over the next six to seven years. The report from CHQPR assessing each state’s rural hospital health and risks can be found in full here.

New York
45% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
57% of rural hospitals — 29 — are at risk of closure in the next 6-7 years

Alabama
44% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
58% of rural hospitals — 30 — are at risk of closure in the next 6-7 years

Mississippi
34% of rural hospitals — 25 — are at immediate risk of closure in the next 2-3 years
52% of rural hospitals — 38 — are at risk of closure in the next 6-7 years

Connecticut
33% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years
67% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Tennessee
31% of rural hospitals — 17 — are at immediate risk of closure in the next 2-3 years
35% of rural hospitals — 19 — are at risk of closure in the next 6-7 years

Vermont
31% of rural hospitals — 4 — are at immediate risk of closure in the next 2-3 years
62% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Oklahoma
29% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
43% of rural hospitals — 34 — are at risk of closure in the next 6-7 years

Arkansas
29% of rural hospitals — 14 — are at immediate risk of closure in the next 2-3 years
53% of rural hospitals — 26 — are at risk of closure in the next 6-7 years

Maine
28% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years
44% of rural hospitals — 11 — are at risk of closure in the next 6-7 years

Virginia
27% of rural hospitals — 8 — are at immediate risk of closure in the next 2-3 years
30% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Kansas
26% of rural hospitals — 26 — are at immediate risk of closure in the next 2-3 years
56% of rural hospitals — 57 — are at risk of closure in the next 6-7 years

Florida
24% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Nevada
23% of rural hospitals — 3 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 5 — are at risk of closure in the next 6-7 years

New Mexico
21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years
25% of rural hospitals — 7 — are at risk of closure in the next 6-7 years

West Virginia
21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years
36% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

South Carolina
20% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
40% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

Massachusetts
20% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years
40% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Texas
18% of rural hospitals — 29 — are at immediate risk of closure in the next 2-3 years
48% of rural hospitals — 77 — are at risk of closure in the next 6-7 years

California
18% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 18 — are at risk of closure in the next 6-7 years

Louisiana
17% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years
44% of rural hospitals — 23 — are at risk of closure in the next 6-7 years

Pennsylvania
17% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 13 — are at risk of closure in the next 6-7 years

Missouri
16% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 21 — are at risk of closure in the next 6-7 years

Georgia
15% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 22 — are at risk of closure in the next 6-7 years

Colorado
12% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
21% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Alaska
12% of rural hospitals — 2 — are at immediate risk of closure in the next 2-3 years
18% of rural hospitals — 3 — are at risk of closure in the next 6-7 years

Congratulations to the 90 local government groups selected to receive training and funding through our READY Local Governments capacity-building program!  Fifteen are in Pennsylvania!

Each of the 90 participating local governments will receive nine-weeks of no-cost training designed to help them identify, manage and implement federally-funded projects. 🛠️ Many of the participant entities serve economically distressed or historically marginalized areas.

READY Local Governments is one learning track in our READY Appalachia initiative, which aims to increase the region’s capacity to solve its most pressing issues. ⏱️ Stay tuned to apply to our next READY learning track — READY Foundations!