Federal Office of Rural Health Policy Announcements

Date: March 31, 2022

HRSA Public Health Scholarship Program – Applications due June 1. The Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce will invest $39 million for 26 awards. Awarded recipients will provide scholarships to individuals for public health training in professional, graduate, and/or certificate programs. Eligible applicants are government entities, nonprofit organizations, and academic institutions with an existing public health training program and partnerships that can transition students into employment.  

One Stop Online for COVID Prevention and Treatment in Every County. The new website, COVID.gov, asks visitors to enter their county and then provides nearby locations for masks and respirators, vaccines and boosters, and all testing and treatment options. The site also maps out clinics and pharmacies with a test-to-treat option, where one can get tested and, if positive, immediately receive anti-viral pills. According to the White House, there are now more than 2,000 test-to-treat locations; the new website, announced yesterday, makes it easier to find them. 

Provider Relief Fund Reporting Period Closes Today. The Provider Relief Fund (PRF) Reporting Portal will close on March 31 for Reporting Period 2. Providers who received one or more PRF payment exceeding $10,000, in the aggregate, during the second Payment Received Period must report on their use of funds no later than March 31, 2022. Providers who fail to submit a completed report by the March 31 deadline will be subject to further enforcement actions such as repayment or exclusion from receiving and/or retaining future PRF payments. For more details, review the Reporting Non-Compliance Fact Sheet. To get started, providers must register in the Portal (if not yet completed). More information and resources can be found on the PRF Reporting web page.

Take Telehealth Technology Survey Today. Every two years, the HRSA-funded National Telehealth Technology Assessment Resource Center (TTAC)  asks a variety of questions about the types of technologies, roles, and future plans of organizations and individuals using telehealth technology. TTAC uses this data to 1) identify technologies of interest for future evaluations, toolkits, video series and other resources; 2) understand trends that are affecting the telehealth landscape regionally and nationwide; and 3) o determine how TTAC can better engage with its stakeholders. The survey takes less than 10 minutes and closes, Thursday, March 31st.

Census Bureau Updates Criteria for Defining Urban Areas. Last week, the U.S. Census Bureau published its final criteria for defining urban areas based on the results of the 2020 Decennial Census. Rather than distinctions for urbanized area or an urban cluster, all areas with a population of at least 5,000 and containing at least 2,000 housing units will be designated urban areas. The notice defines rural as territory not defined as urban. Some federal and state agencies use the Census Bureau’s urban-rural classification for allocating funds, setting standards, and implementing aspects of their programs. Stakeholders should be aware that the changes to the urban area criteria also might affect the implementation of these programs.

Ongoing: HRSA Payment Program for RHC Buprenorphine-Trained Providers.  In June 2021, HRSA launched an effort to improve access to substance use disorder treatment by paying for providers who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder. Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019. Approximately $1.2 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted. Send questions to DATA2000WaiverPayments@hrsa.gov. There is ongoing availability of a free online course for waiver eligibility training from the American Osteopathic Academy of Addiction Medicine and the Providers Clinical Support System.

Fiscal Year 2023 Hospice Payment Rate Update Proposed Rule – Comment by May 31

Date: March 30, 2022

On March 30, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-1773-P) that would provide routine updates to hospice-based payments and the aggregate cap amount for fiscal year (FY) 2023 in accordance with existing statutory and regulatory requirements. This rule proposes to establish a permanent mitigation policy to smooth the impact of year-to-year changes in hospice payments related to changes in the hospice wage index.

CMS is committed to addressing consistent and persistent inequities in health outcomes by improving data collection to measure and analyze disparities across programs and policies that apply to the Hospice Quality Reporting Program (HQRP). This rule discusses the HQRP including the Hospice Outcomes and Patient Evaluation (HOPE) tool; provides an update on quality measures (QMs) that will be in effect in FY 2023 as well as future QMs; and also provides updates on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey Mode Experiment. This rule also contains a request for information (RFI) on health equity and proposes updates to advancing a health information exchange.

Proposed Medicare Hospice Payment Policies:

This proposed rule proposes a permanent, budget neutral approach to smooth year-to-year changes in the hospice wage index. Specifically, CMS is proposing a permanent cap on negative wage index changes greater than a 5% decrease from the prior year (regardless of the underlying reason for the decrease) for hospices in the FY 2023 proposed rule.

Routine Annual Rate Setting Changes:

As proposed, hospices would see a 2.7% ($580 million) increase in their payments for FY 2023. The proposed 2.7% hospice payment update for FY 2023 is based on the estimated 3.1% inpatient hospital market basket update reduced by the productivity adjustment (0.4 percentage point). Hospices that fail to meet quality reporting requirements receive a 2-percentage point reduction to the annual market basket update for FY 2023.

The hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that is made to a hospice annually. The proposed cap amount for FY 2023 is $32,142.65 (FY 2022 cap amount of $31,297.61 increased by 2.7%.)

Hospice Quality Reporting Program:

This rule provides an update on the development of a patient assessment instrument, titled HOPE, which would contribute to a patient’s plan of care when adopted. This includes an update on the BETA testing and derivatives that will be achieved during this phase of testing, such as burden estimates and timepoints for collection, as well as additional outreach efforts that will be conducted during and after BETA testing and during future plans for adoption. CMS also discusses potential future quality measures within the HQRP based on HOPE and administrative data, including HOPE-based process measures and hybrid quality measures, which could be based upon multiple sources that include HOPE, claims, and other data sources.

This rule announces a potential future update to the CAHPS Hospice Survey, which is used to collect data on experiences of hospice care from primary caregivers of hospice patients. In particular, CMS is providing an update on a mode experiment whose goal was to test the effect of adding a web-based mode to the CAHPS Hospice Survey. 

In this proposed rule, CMS is seeking information on their Health Equity Initiative within the HQRP by describing our current assessment of health equity within hospice. CMS is also seeking input on a potential future structural measure as well as responses to specific questions that would further inform future efforts. 

More Information:

Impact of CMS Rule Changes on Rural GME, Part III: A Deeper Dive into Section 131

Date: March 31, 2022

Impact of the Centers for Medicare and Medicaid Services (CMS) Rule Changes on Rural Graduate Medical Education (GME), Part III: A Deeper Dive into Section 131

In this one-hour webinar session, the FORHP-supported Rural Residency Planning and Development (RRPD) -Technical Assistance Center will continue to share information about Medicare GME policy changes on a one-time opportunity to test low FTE resident caps and low or zero per resident amounts that may impact rural hospitals who plan to train physicians in Medicare-supported residency programs. This webinar is the third series on recent CMS Medicare GME policy changes to expand physician training in hospitals serving rural and underserved communities (view previously recorded Part I and Part II).

Webinar Date: April 12, 2022

Time: 12:00 PM ET

For Rural Facilities: How to Become a National Health Service Corps Site

Date: March 31, 2022

Facilities that provide outpatient, ambulatory, and primary health care services in high-need areas may apply through May 10 to become an approved site of the National Health Service Corps (NHSC). Eligible site types include facilities providing substance use disorder treatment, and facilities with prior NHSC status that is currently inactive. During this hour-long session hosted by the Rural Health Information Hub, federal and national experts will discuss the importance of this program for clinician recruitment and retention in rural areas. For general application assistance, the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce will hold  two upcoming Q&A sessions for applicants: one on Thursday, April 14 and another on Wednesday, April 27.

Assistance for Nurse Corps Scholarship Applicants

Date: March 31, 2022

The Health Resources and Services Administration’s Bureau of Health Workforce supports eligible nursing students with tuition, fees, and other educational costs in return for a minimum of two years’ service at a critical shortage facility in rural and underserved areas.  Program experts will answer questions about what goes into a successful application during this 90-minute webinar. 

Webinar Date: April 14, 2022

Time: 3:00 PM ET

Click to Register.

HRSA Recognizes Key Anniversaries and Works to Increase Health Care Access

Date: March 31, 2022

HRSA Recognizes Key Anniversaries and Works to Increase Health Care Access

In March, the Health Resources and Services Administration (HRSA) recognized the anniversaries of the American Rescue Plan, Affordable Care Act, and Health Center COVID-19 Vaccine Program, worked to implement President Biden’s National Mental Health Strategy, promoted access to gender affirming care and treatment, and distributed an additional $413 million in Provider Relief Fund payments.

In March, the HRSA, the division of the U.S. Department of Health and Human Services (HHS) devoted to improving health outcomes in underserved communities, promoting health equity, and supporting the health workforce, took the following actions:

Statement of HRSA Administrator Carole Johnson on President Biden’s National Mental Health Strategy
HRSA is working to implement President Biden’s national mental health strategy by taking action to dramatically expand the supply, diversity, and cultural competence of the mental health and substance use disorder workforce. As part of this strategy, HRSA Administrator Carole Johnson visited Nationwide Children’s Hospital in Columbus, Ohio to discuss the importance of mental health services, alongside Second Gentleman Doug Emhoff and HHS Assistant Secretary for Health Admiral Rachel Levine.

New HHS Study in JAMA Pediatrics Shows Significant Increases in Children Diagnosed with Mental Health Conditions from 2016 to 2020
A new HHS study, conducted by HRSA, finds significant increases in the number of children diagnosed with mental health conditions. The findings highlight the critical importance of HRSA’s work to support children’s mental health and well-being through expanding access to mental health services and growing the mental health workforce.

Fact Sheet: American Rescue Plan One Year Anniversary
HRSA marked the first anniversary of the American Rescue Plan by highlighting American Rescue Plan-funded efforts to support COVID-19 vaccination, testing, treatment, and masks for underserved populations and rural communities across the country; keep the doors of health centers open as they led the fight against the pandemic; provide direct resources to rural clinics and hospitals to help rural communities respond to COVID; make record numbers of scholarships and loan repayment awards to clinicians; and expand support for families and children’s essential needs.

HHS Recognizes One-Year Anniversary of Health Center COVID-19 Vaccine Program to Advance Equity in Pandemic Response
HRSA recognized the one-year anniversary of the Health Center COVID-19 Vaccine Program. To date, health centers have administered more than 20 million vaccines in underserved communities across the country through the HRSA program and partnerships with states.

HHS Distributing an Additional $413 Million in Provider Relief Fund Payments to Health Care Providers Impacted by the COVID-19 Pandemic
HRSA made more than $413 million in Provider Relief Fund (PRF) payments to more than 3,600 providers across the country. These funds help health care providers prevent, prepare for, and respond to the coronavirus.

Statement of HRSA Administrator Carole Johnson on the Affordable Care Act Anniversary
HRSA Administrator Carole Johnson recognized the anniversary of the Affordable Care Act and highlighted the sea change the law represented for HRSA’s ability to provide equitable access to high-quality health care. In honor of the anniversary, Deputy Administrator Diana Espinosa participated in a celebration hosted by the Centers for Medicare & Medicaid Services.

ICYMI: HRSA Promotes Access to Gender Affirming Care and Treatment in the Ryan White HIV/AIDS Program
HRSA released a letter encouraging Ryan White HIV/AIDS Program service providers to leverage their existing infrastructure to provide access to gender affirming care and treatment services to transgender and gender diverse individuals with HIV.

A Conversation with HHS Women Leaders to Celebrate Women’s History Month 
To honor Women’s History Month, HRSA Administrator Carole Johnson joined women leaders across the Department of Health and Human Services (HHS) for a conversation that highlighted HHS’ commitment to advancing the health and well-being of all women.

National Rural EMS & Care Conference

Date: March 29, 2022

Every year, the National Organization of State Offices of Rural Health (NOSORH), the Joint Committee on Rural Emergency Care, and the National Association of State Emergency Management Services (EMS) Officials host the National Rural EMS & Care Conference.

This year’s conference will take place virtually.

Conference Date: April 19-21, 2022

Due to the virtual format, the cost to attend has been reduced! The registration cost for individuals is $175 while an entire rural EMS agency can register for just $300! No limit on registrations per agency.

This one-of-a-kind meeting brings together EMS experts from across the country and from different sectors of the EMS field. Rural ambulance services, rural EMS directors, medical directors and officers, rural health care providers, ambulatory agencies and staff, state EMS officials, state rural health officials, hospital administrators, federal agency officials, and State Offices of Rural Health all come together to share their knowledge, best practices, new challenges, and emerging issues.

To learn more about the conference, see the agenda, and register, please visit the NOSORH website.

If you have any questions, please contact Matt Strycker, Program Manager, at stryckerm@nosorh.org or Trevor Brown, Program Coordinator, at trevorb@nosorh.org.

Seeking your feedback: FCC Rural Health Care Program Improvements

Date: March 29, 2022

Earlier this month, the Federal Communications Commission (FCC Commission) released a further notice of proposed rulemaking (FNPRM) to seek input to improve the Rural Health Care (RHC) Program. As you know, the RHC Program provides funding to health care providers for telecommunications and broadband services necessary to provide health care services. With the advancement of telehealth flexibilities in recent years, the National Rural Health Association (NRHA) understands the importance of the RHC Program when it comes to building out broadband services and wants to ensure member concerns are reflected.

NRHA is working its way through the FNPRM but requests member input to determine whether comments are necessary on some of the issues the Commission is seeking comment on. NRHA has identified these areas for potential comment:

Defining “rural area” for the purposes of program participation.

Currently, the RHC Program employs a definition of “rural area” that relies upon a health care provider’s location relative to the Census Bureau’s Core Based Statistical Area designation. However, until 2004, the Commission followed the definition used by the Federal Office of Rural Health Policy (FORHP) located within the Health Resources and Services Administration (HRSA).

NRHA asks, has the definition of rural been too limiting for program participation? Is it necessary to adopt a different definition? Perhaps the one used by FORHP should be implemented once again? Alternatively, NRHA has heard significant concerns that the amount of funding in the program has caused issues historically. Would expanding the program to include other entities cause further dilution of the funds?

Applying geographic cost factors to rurality tiers.

In particular, the Commission asks whether it would be beneficial to use the Rural Urban Commuting Area (RUCA) codes to determine rurality tiers?  Further, the Commission seeks comment on whether to eliminate rurality tiers altogether and establish rates based on an applicant’s census tract information. How do to properly apply geographic cost factors to rurality tiers?

Funding prioritization.

Adopted in 2019, the rates database lists eligible services in the program, median urban and rural rates for services by state, and underlying rate data used to determine the median rates. But the use of the database was waived in funding years 2021 and 2022 due to anomalies and inconsistencies. Now, the FCC is asking for comment on how best to fix those anomalies, which include examples of lower median rates in more rural tiers as compared with less rural tiers. If the Commission adopt a new rurality tier system, or an alternative to rurality tiers altogether, should the new system be used for funding prioritization as well?

Application processing, funding decisions, and appeals of decisions.

The Commission seeks comment on any additional measures beyond those already taken that could further enhance the efficiency of application processing and the speed at which funding commitment decisions are made. NRHA has heard significant feedback that the time from application to award is of significant concern. That said, are there suggestions providers have that would improve this process?

Digital equity and inclusion.

The Commission also seeks comment on how the proposals may promote or inhibit advances in diversity, equity, inclusion, and accessibility?

Your input will be helpful in crafting the direction of NRHA’s comments. If you have thoughts, please reach out to Josh Jorgensen (jjorgensen@ruralhealth.us) to discuss further. Comments are due to the FCC by April 14, 2022.

April NTP Medicare Update & Education Webinar

Date: March 29, 2022

Centers for Medicare and Medicaid Services National Training Program (NTP) Medicare Update & Education Webinar

Date: April 7, 2022

Time: 1:00 PM –2:30 PM ET

Join us as NTP shares Medicare updates and information about National Public Health Week (April 4-10), World Health Day (April 7), Earth Day (April 22), National Minority Health Month, and Alcohol Awareness Month. NTP will also have a presentation about the Medicare Ombudsman process. 

Register Here

After registration, you’ll get an email with a calendar appointment. This webinar will be recorded. When the recording is available you’ll get an announcement similar to this one.