What’s New
New Report: Rural-Urban Differences in Coverage from Private Insurers. Today, the Minnesota Rural Health Research Center released a new brief on the number of insurers available to consumers in rural and urban counties through the Federally-Facilitated Marketplace (FFM). The researchers found that, of the 2,512 counties served by FFMs, 34% had only one or two insurers offering coverage. Of those, 80% of the counties were rural.
To access the MN brief, visit: http://rhrc.umn.edu/wp-content/uploads/2016/08/Marketplace-Insurer-Participation.pdf
In June of this year, the U.S. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation released analysis of the Affordable Care Act’s impact on individuals living in rural communities. Key highlights from that report:
- Coverage: Rural individuals, like those living in urban and suburban areas, have seen large coverage gains under the ACA – about an 8 percentage point increase from before the first open enrollment period through early 2015.
- Premium tax credits: Among the 88 percent of rural HealthCare.gov consumers with premium tax credits, the average net monthly premium increased by $5, or 4 percent, between 2015 and 2016.
- Access to care: Individuals in rural areas have seen improvements in access to care; the share who report being unable to afford needed care declined by nearly 6 percentage points from before the first open enrollment period through early 2015.
To access the full HHS issue brief, visit: https://aspe.hhs.gov/pdf-report/impact-affordable-care-act-coverage-expansion-rural-and-urban-populations
While the vast majority of people live in places where issuer competition is strong, HHS recognizes more progress is needed to address unique, localized, longstanding market challenges that extend beyond the Marketplace. Before the ACA, rural communities faced unaffordable costs and had high uninsured rates. Today, many rural communities have much higher coverage rates and more affordable options. Uninsured rates fell by a third in rural areas through early 2015. The Administration remains committed to further improving access and coverage for individuals in rural communities.
Comprehensive Primary Care Plus (CPC+) – apply by September 15. The Centers for Medicare & Medicaid Services (CMS) have opened the application period for rural practices to participate in CPC+ in 14 regions and states across the country. CPC+ is a five-year primary care medical home model beginning January 2017. The goal of the model is to give primary care practices more flexibility in caring for their patients in the way they think will deliver the best outcomes and to pay them for achieving results and improving care. CPC+ is also an opportunity for practices of different sizes, structures, and ownership types to qualify for the Advanced Alternative Payment Model incentive payment through the proposed CMS Quality Payment Program.
September is National Recovery Month. Every September, the Substance Abuse and Mental Health Services Administration sponsors National Recovery Month to increase awareness and understanding of mental and substance use disorders and celebrate the people who recover. Visit the National Recovery Month website for a calendar of events nationwide, stories of recovery, and materials to promote your own Recovery Month celebration.
Funding Opportunities
Head Start for Migrant Families in Louisiana – September 15. The Administration for Children and Families will make ten awards, each for up to $1.5 million, for the purpose of expanding access to high-quality, comprehensive services to low-income, migrant and seasonal infants and toddlers and their families through Early Head Start-Child Care (EHS-CC) Partnerships, or through the expansion of Early Head Start services. Due to the federally-declared major disaster, only eligible organizations in Louisiana may apply.
USAC Rural Health Care Program – November 30. The Universal Service Administrative Company is an independent non-profit designated by the Federal Communications Commission (FCC) to distribute funds that increase the availability of telecommunication services, especially in rural areas. As long as applicants file their funding request during the filing window, they are guaranteed to receive at least a percentage of the request based on funding available. Last year, funding requests reached an historic high of $377 million of the $400 million annually available. Anticipating that requests may reach or exceed the $400 million cap, the FCC just announced new filing windows for FY2016 (7/1/17-6/30/17). The next filing window is from September 1 – November 30, 2016. If funds remains after all applications in that window are funded, the third filing window be February 1 – April 30, 2017 and all requests in that window would again receive an equal percentage of available funds. Register now to get more information on USAC’s Rural Health Care Program, at a webinar on Thursday, September 8 at 2:00 pm ET. The webinar will explain how to apply for funding and discuss the newly created eligibility for Skilled Nursing Facilities.
Policy Updates
**New: FORHP’s Policy Team is ready to answer any questions you may have about these updates at RuralPolicy@hrsa.gov.
Proposed Changes to Black Lung Clinics Program – comment by September 21. HRSA has released a federal register notice soliciting public comment on proposed changes to the Black Lung Clinics Program (BLCP). The BLCP aims to reduce the morbidity and mortality of occupationally-related coal mine dust lung disease through the provision of screening, diagnosis, and treatment services to active, inactive, retired, and disabled coal miners. BLCP grantees and external stakeholders are encouraged to review the notice and submit their feedback to blacklung@hrsa.gov.
Rate Changes for Long Term Care Hospitals. On August 22, CMS published its final rule updating payment rates and rules for long-term care hospitals (LTCHs) for fiscal year (FY) 2017. CMS estimates total payments to LTCHs will decrease by 7.1%, or $363 million, compared to FY 2016. In this second year of the three-year transition to the dual-rate LTCH payment system required by statute, discharges qualifying for site-neutral payment (approx. 45% of cases) will see a decrease of 23%, or $388 million, while those qualifying for standard LTCH payment rates (approx. 55% of cases) will see an increase of 0.7%, or $24 million. In addition to payment changes, CMS updated the LTCH Quality Reporting Program to include four new measures required by the IMPACT Act, and streamlined its rules under the 25% threshold policy, which adjusts payments when the number of cases an LTCH admits from a single hospital exceeds a specified threshold, generally 25%, though this limit is 50% for rural LTCHs given the relative scarcity of providers in rural communities. Finally, CMS also finalized its interim final rule establishing a temporary exception from the site-neutral payment rate for certain severe wound care discharges from certain rural LTCHs, which likely increases payment by $5 million for two providers. These changes are effective October 1, 2016.
Rate Changes for Hospital Inpatient Services. On August 22, CMS published its final rule updating payment rates and rules for hospital inpatient services for fiscal year (FY) 2017. CMS estimates total payments for inpatient services will increase by 0.95%, or about $746 million, compared to FY 2016, including changes due to the permanent withdrawal of the controversial two-midnight policy. CMS also made significant changes to the Medicare Disproportionate Share Hospital (DSH) payment adjustment. Beginning FY 2017, CMS will use the average of hospitals’ uncompensated care costs over three years, rather than only one. Beginning FY 2021, after editing the instructions for Worksheet S-10, CMS will phase in direct accounting of uncompensated care costs reported on the worksheet, replacing the current method which uses proxy data. Of note for rural providers, changes in the calculation and distribution of uncompensated care may benefit providers serving rural communities where patients continue to lack health insurance. CMS also implements several statutory provisions, including the requirement for hospitals and CAHs a to notify individuals receiving outpatient observation services for more than 24 hours using the standard Medicare Outpatient Observation Notice, and the extension of both the Low-Volume Hospital payment adjustment and the Medicare-Dependent Hospital program through FY 2017. These changes are effective October 1, 2016.
Resources, Learning Events and Technical Assistance
NHSC Application Technical Assistance – Thursday, September 8th, 7:00 – 9:00 pm ET. The National Health Service Corps (NHSC) Students to Service Loan Repayment Program (S2S LRP) provides up to $120,000 to medical or dental students in their final year of school in return for a commitment to provide primary health care for at least 3 years at an approved NHSC site in a Health Professional Shortage Area of greatest need. Watch this video to learn how the NHSC determines who receives loan payment awards and attend the webinar to make your application as competitive as possible. Dial-in 1-888-324-4392 , passcode 1058390.
3RNet Annual Conference, Nashville TN – September 13-15. The National Rural Recruitment and Retention Network opens its annual conference to anyone interested in learning more about topics surrounding the recruitment and retention of health care professionals in rural & underserved areas. Registration is now open for the event that will feature presentations by the Federal Office of Rural Health Policy and the National Health Service Corps, a review of the new 3RNet website and current issues impacting recruitment of health professionals in rural areas.
Approaching Deadlines
Comment: Hospital Outpatient Prospective Payment System – September 6
Comment: Physician Fee Schedule Updates – September 6
CMS Seeks Nominations for Medicare Committee – September 6
Rural Capacity Building for Community Development – September 13
Addressing Homelessness – September 14
Head Start for Migrant Families in Louisiana – September 15
Comprehensive Primary Care Plus (CPC+) – September 15
Comment: Proposed Changes to Black Lung Clinics Program – September 21