What’s New

Widening Health Disparities in Appalachia.   New research examining health outcomes in the Appalachian region finds a widening gap for health disparities and a stronger association between poverty and life expectancy than in other parts of the country.  Higher mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease, diabetes, suicide, unintentional injury and drug overdose were among the conditions having a greater impact in the region and contributing to higher mortality. The HRSA-affiliated co-authors of the report compared disparities between Appalachia and the rest of the United States in the period of 1990-2013 and found a dramatic increase in that timeframe.  “What was surprising was that in the early 1990s, there wasn’t a great deal of difference in infant mortality,” co-author Gopal Singh told the Washington Post.  But while outcomes improved in the rest of the country, “the improvements have not been as rapid in Appalachia.”

Funding Opportunities

Students to Service (S2S) Loan Repayment Program – Opening Soon.  This month, the National Health Service Corp (NHSC) will begin accepting applications for their 2018 Students to Service Loan Repayment Program, providing up to $120,000 in tax-free funds to pay for tuition and other fees for students in their final year of medical or dental school. In exchange for loan repayment students agree to work at NHSC-approved sites, in many cases rural areas, upon completion of their primary care residency training.  The two-month window for applications will begin in mid-August; interested students can sign up now to be notified when that happens.

Policy Updates

Questions about Rural Health Policy Updates? Write to ruralpolicy@hrsa.gov

Comments Requested: Reducing Medicaid DSH Allotments – August 28. Federal allotments to states for the Medicaid Disproportionate Share Hospital (DSH) program are required to be reduced beginning in October 2017.  In this rule, CMS proposes a methodology for calculating state-specific reductions in Medicaid DSH allotments, estimated to range from 2% to 31% from current levels.  While CMS is not able to estimate the impacts of these reductions on DSH providers, input from rural Medicaid DSH providers and state Offices of Rural Health will help CMS determine potential effects of the proposed methodology on rural areas.  Comments should be submitted to www.regulations.gov by August 28.

Now Open: Quality Payment Program Hardship Exception Application. Under Merit-based Incentive Payment System (MIPS) scoring, MIPS-eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following reasons: 1) insufficient internet connectivity; 2) extreme and uncontrollable circumstances; or 3) lack of control over the availability of Certified EHR Technology. Some MIPS-eligible clinicians will be automatically reweighted (or exempted in the case of clinicians participating in a MIPS Alternative Payment Model) and do not need to submit an application for exception. Clinicians with this special status include those in practices deemed as rural by CMS.

Final Rule from CMS: Payment and Policy Changes for SNFs.  The final rule for Skilled Nursing Facilities (SNF) includes an overall payment increase of 1% ($370 million) in FY2018 over the previous year.  On average, rural areas will experience this as a 0.4% increase.  Highlights from the rule include changes to the market basket index, revisions to the SNF Quality Reporting Program and Value Based Purchasing Program, and clarifications to the process for complaint surveys.  Changes will go into effect on October 1, 2017.

Final Rule from CMS:  Rural IRFs.  CMS published a final rule for Inpatient Rehabilitation Facilities that includes an overall payment increase of 0.9% in FY 2018.  The rule also updates the wage index, a reminder that the coming fiscal year will end the phase-out of adjustment for 20 IRF providers that were designated as rural in FY 2015, but changed to urban in FY2016.  Other highlights include elimination of the 25% payment penalty for late submission of the IRF patient assessment and changes to the IRF Quality Reporting Program.  Changes will go into effect on October 1, 2017.

Final Rule from CMS:  Hospice Facilities.  Changes in the final rule for Hospice Facilities includes an overall payment increase of 1.0% ($180 million); rural areas will experience this as a 1.1% increase, on average.  The rule updates the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2018.  It also makes changes to the Hospice Quality Reporting Program that would continue to ensure high quality, accessible care, without added burden. CMS will begin making data from the hospice quality reporting program (HQRP) publicly available via a Hospice Compare Site to help customers make informed choices.  Changes will take effect October 1, 2017.

Resources, Learning Events and Technical Assistance

CMS All Tribes Call – Wednesday, August 9 from 2:30 – 4:00 pm ET. The Division of Tribal Affairs at the Centers for Medicare & Medicaid Services (CMS) holds All Tribes Calls and Webinars to get input from Indian Health Services (IHS) programs on how CMS regulation impacts the Indian health delivery system.  Wednesday’s call will provide guidance on the process to become a Medicaid Federally Qualified Health Center.

CMS Safety Net-Providers Open Door Forum – Thursday, August 10 at 2:00 pm ET.  Policy experts from HRSA will join CMS to discuss chronic care management services for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).  Other topics for this one-hour call include Physician Fee Schedule updates, Quality Payment Program updates and changes in beneficiary assignment to Accountable Care Organizations for FQHCs and RHCs.  The Forum provides an opportunity for a dialogue between CMS and safety net providers such as health centers, rural health clinics, critical access hospitals, and 340B safety net providers.

CMS New Diabetes Prevention Program – Wednesday, August 16, 1:30 – 3:00 pm ET.  CMS experts will provide a high-level overview of the policies for the Medicare Diabetes Prevention Program (MDPP) Expanded Model that’s been proposed for the 2018 Medicare Physician Fee Schedule.  This is a lifestyle change program to prevent the onset of type 2 diabetes among certain Medicare beneficiaries diagnosed with prediabetes.  Beginning in 2018, Medicare will cover services under the MDPP expanded model as a preventive service furnished in community and health care settings by designated coaches, such as trained community health worker or health professionals.  At this 90-minute online session, CMS will discuss the program, important to rural areas, where there is higher prevalence of diabetes and lower rates of participation in preventive care practices.  Register early for the event and submit  comments for the MDPP model through September 11, 2017.

Input Needed: CMS Behavioral Health Payment Model – September 8, from 10:00 am – 5:00 pm.  The Center for Medicare and Medicaid Innovation within CMS will hold a public meeting to discuss ideas for a behavioral health payment model to improve care and access to health services for beneficiaries.  Ideas shared will assist CMS consideration of a model to address behavioral health payment care and delivery.  There is a significant need for mental and behavioral health services in rural areas, including among rural children who are more likely to experience mental, behavioral, and developmental challenges than kids in urban and suburban areas, as reported by the CDC. Comments and ideas may also be submitted by mail or email. These comments and registration to attend in person must be submitted no later than August 25th.

Save the Date and Register for 3RNet’s Annual Conference – September 12-14.  The National Rural Recruitment and Retention Network (3RNet) will hold its annual conference in Scottsdale, AZ. 3RNet members represent over 5,000 communities across the U.S. that actively recruit physicians and other health care providers to work in rural areas.  Attendees will benefit from workshops and a speaker line up sharing insight on rural recruitment challenges, resources and tools.

Training Series for Health Care Providers on Prescribing Opioids – Ongoing. The CDC has an eight-part online training series to help health care providers apply CDC’s prescribing recommendations in their clinical settings through interactive patient scenarios, videos, knowledge checks, tips, and resources. Rural practitioners report their concern about the potential for opioid abuse, but at the same time report insufficient training in prescribing opioids. For this reason, the CDC created the 2016  Guideline for Prescribing Opioids for Chronic Pain and associated training. Topics in the series include communicating with patients, treating chronic pain without opioids, and prescribing decision making.

Resource of the Week

Navigating Value-Based Payment Initiatives. The Rural Health Value team has just released two resources that summarize select innovative demonstrations and programs for rural health care. The first is an updated Catalog of Value-Based Initiatives for Rural Providers, designed to help communities identify value-based programs most appropriate for rural participation. The second resource focuses on the State Innovation Model (SIM) Testing Awards, summarizing early accomplishments of rural-related activities in the first six states – Arkansas, Colorado, Idaho, Minnesota, Oregon, and Vermont – to receive these awards. Rural Health Value is supported by a cooperative agreement between FORHP, the RUPRI Center for Rural Health Policy Analysis, and Stratis Health to help rural providers understand and engage with the rapidly evolving health care payment and delivery system through analysis and technical assistance.

Approaching Deadlines

Funding for Children Affected by Substance Abuse – August 9
Developing Future Victim Specialists for Indian Country – August 9
Comments Requested: Researching Pregnancy Screening for Hepatitis B  – August 9
Survey on Aging and Disability – August 9
Telehealth Center of Excellence – August 21
Comments Requested: Payment Changes for Medicare Clinicians – August 21
Telehealth Network Grant for Substance Abuse – August 23
Funding for Buses and Transit Infrastructure – August 25
AHRQ Seeks Rural Experts – August 26
Comments Requested: Updates to Policy for End-Stage Renal Disease – August 28
Comments Requested: Reducing Medicaid DSH Allotments – August 28
State Systems Development for Maternal and Child Health – September 5
Rural Promise Neighborhoods – September 5
Housing farm laborers – September 11
Comments Requested: Policy for Hospital Outpatient Services – September 11
Comments Requested: Physician Fee Schedule/Diabetes Prevention – September 11
HIT Strategies for Patient-Reported Outcome Measures – Ongoing
HIT to Improve Health Care Quality and Outcomes – Ongoing
Community Facilities Program –  Ongoing
Summer Food Service Program – Ongoing

CMS NEWS

FOR IMMEDIATE RELEASE

August 2, 2017

Contact: CMS Media Relations

(202) 690-6145  CMS Media Inquiries

CMS finalizes 2018 payment and policy updates for Medicare hospital admissions

Final rule supports transparency, flexibility, program simplification and innovation in the Medicare program

Today, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2018 Medicare Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule, which updates 2018 Medicare payment and policies when patients are discharged from hospitals. The final rule relieves regulatory burdens for providers, supports the patient-doctor relationship in healthcare, and promotes transparency, flexibility, and innovation in the delivery of care for Medicare patients.

“This final rule will help provide flexibility for acute and long-term care hospitals as they care for Medicare’s sickest patients,” said CMS Administrator Seema Verma. “Burden reduction and payment rate increases for acute care hospitals and long-term care hospitals will help ensure those suffering from severe injuries and illnesses have access to the care they need.”

In the final rule, CMS is increasing the amount of uncompensated care payments made to acute care hospitals by $800 million to approximately $6.8 billion for fiscal year 2018. Uncompensated care represents healthcare services provided by hospitals or providers for which they don’t get reimbursed. Often uncompensated care arises when people don’t have insurance and cannot afford to pay the cost of care. CMS is also providing further clarification about discounts given to uninsured patients who meet the hospital’s charity care policy.

In relieving providers of administrative burdens and encouraging patient choice, CMS is finalizing a one-year regulatory moratorium on the payment reduction threshold for patient admissions in long-term care hospitals. CMS continues to evaluate this policy. CMS is also finalizing provisions that reduce clinical quality measure reporting requirements for hospitals that have implemented electronic health records.

Due to the combination of payment rate increases and other policies and payment adjustments, particularly in changes in uncompensated care payments, acute care hospitals will see a total increase in Medicare spending on inpatient hospital payments of $2.4 billion in fiscal year 2018. Based in part on the changes included in the final rule, overall payments to long-term care hospitals will decrease by $110 million in fiscal year 2018.

In addition to the payment and policy updates for Medicare hospital admissions, the final rule addresses changes to how the public is notified of Medicare terminations of certain providers and implements the statutory extension of the Rural Community Hospital Demonstration.

CMS also today issued a notice with comment period updating 2018 Medicare payment policies and rates for inpatient psychiatric facilities. CMS estimates that Medicare payments to inpatient psychiatric facilities will increase by $45 million, or nearly one percent, in fiscal year 2018.

For a fact sheet on the fiscal year 2018 Medicare Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-08-02.html

For a fact sheet on the fiscal year 2018 Medicare Inpatient Psychiatric Prospective Payment System notice with comment period, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-08-02-2.html

The fiscal year 2018 Medicare Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule (CMS-1677-F) and the fiscal year 2018 Medicare Inpatient Psychiatric Prospective Payment System notice with comment period (CMS-1673-NC) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection

What’s New

Report to President on Opioid Crisis.  On Monday, the Office of National Drug Control Policy convened a public meeting to review a draft report on the opioid epidemic.  The report summarizes initial findings of an investigation by the President’s Commission on Combating Drug Addiction and makes recommendations for executive-level action steps in policy and funding to increase treatment capacity, expand medication-assisted treatment options and enforce the Mental Health Parity and Addiction Equity Act.  Recently, the Association of American Medical Colleges acknowledged the rural upsurge of opioid use disorder and made recommendations for outreach and training for physicians on the front line.

American Indian/Alaska Native Health Study.   The Centers for Disease Control and Prevention (CDC) joins the HHS Office of Minority Health (OMH) to ask for participation in a survey of health-related behaviors in American Indian and Alaska Native (AI/AN) communities.  Using the CDC’s Behavioral Risk Factor Surveillance System, the effort aims to learn more about behaviors that impact health outcomes such as eating habits, tobacco use and physical activity.  The project is an opportunity to better understand health needs of AI/AN communities, identify health disparities, and find culturally-appropriate ways to address them.   Visit the Rural Health Information Hub for background on the importance of research and needs assessments in rural areas, particularly community-based participatory research in tribal communities.

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