Announcements from the Federal Office of Rural Health Policy

April 12, 2017

What’s New

Perspectives on Rural Health.  The April 6th edition of the New England Journal of Medicine takes a deep dive into rural health with four articles, free to all readers, in the Perspective section.  Out of Sight, Out of Mind, is a commentary that was paired with the CDC’s recent report on mental and behavioral health for children in rural areas and suggests intervention in alternative settings such as school-based health centers.  The Maternal Health Compact looks at high rates of morbidity and mortality for childbirth in rural areas and considers ways that telehealth can improve outcomes.  A doctor explains how personal and professional  benefits outweigh the challenges of her rural practice in How Long Will You Be Staying Doctor? And in Thirty Miles at Sea, solutions for staffing the ED department on remote Nantucket Island involve much more than simply hiring doctors.

Commonwealth Fund: Findings on Rural Health. One Critical Access Hospital in Wisconsin used advance practice nurses to address a shortage in primary care physicians.  The innovative approach led to shorter stays, better quality of care, and greater patient satisfaction. This and other new models of care are outlined in a new report from The Commonwealth Fund, Transforming Care: Reporting on Health System Improvement. States like Pennsylvania use global payments to help rural hospitals struggling from loss of inpatient revenue, and rural providers are partnering more with community leaders to address social determinants of health.

CMS Selects Accountable Health Communities (AHCs).  The AHC Model is moving forward with identification of 32 local-level organizations that will bridge the gap between clinical and social need providers to address housing instability, food insecurity, utility needs, interpersonal violence, and transportation.   One example of how this can work in rural areas is offered by the Oregon Health & Science University, which plans to collaborate with more than 50 clinical sites across nine counties to coordinate services for residents.

Policy Updates

Questions about Rural Health Policy Updates? Write to

Ideas Requested:  Medicare Advantage and Part D Plan – April 24.  CMS has finalized 2018 payment and policy updates for Medicare Advantage and Part D plans, including policies that encourage safeguards when prescribing opioids.  CMS is also requesting public input on how these programs can be improved.  The request for information is an opportunity for rural providers, stakeholders, and consumers to offer ideas on benefit design, network composition flexibility, supporting doctor-patient relationships, and monitoring and measuring plans.  Provide feedback at and include “2017 Transformation Ideas” in the subject line.   

Comment: Delayed Rules For Home Health Agencies – June 2. CMS finalized new rules for home health agencies (HHAs) participating in Medicare and Medicaid to incorporate recent advances and practices that focus on patient-centered, data-driven, and outcome-oriented care. In the first update to home health rules since 1989, CMS revised its policy to allow licensed practical nurses acting within their state licensure and scope-of-practice requirements to receive verbal orders for home health services, which may benefit HHAs in rural areas disproportionately affected by physician shortages. On April 3, CMS delayed the effective date of these new rules from July 13, 2017 to January 13, 2018.

CMS Pauses Anti-Fraud Home Health Demonstration. CMS previously announced a three-year demonstration testing a pre-claim review process for home health services in five states with high rates of improper payments (IL, FL, TX, MI, and MA). Beginning in Illinois, the demonstration aimed to review home health claims to make sure that services are medically necessary before providing payment. On March 31, CMS announced a delay of at least 30 days to the home health pre-claim review demonstration in Illinois. Moreover, CMS will not expand the demonstration to Florida on April 1 as planned. Home health agencies should submit claims as normal during this pause. Further announcements will be posted on the demonstration website.

Final Rule:  Uncompensated Care Costs for Disproportionate Share Hospitals (DSH).  In this final rule, CMS clarifies that the Medicaid hospital-specific DSH limit is based only on uncompensated care costs.  That is, only those costs remaining after accounting for Medicare and other third party payments by or on behalf of Medicaid-eligible individuals.  This rule applies to all hospitals receiving Medicaid DSH funds, including Medicare-dependent hospitals, rural facilities, critical access hospitals, sole community hospitals, and Indian Health Service (IHS) areas.

Final Rule: Broadband Funding for Rural Areas. On March 28, the Federal Communications Commission (FCC) released a final rule describing its new funding model for 4G LTE service in remote areas of the country. An abbreviated term for Fourth Generation Long Term Evolution, 4G LTE is the fastest available broadband connection speed for mobile phones and wireless devices. Rather than funding legacy subsidies, the FCC will distribute up to $4.53 billion over the next ten years to preserve existing 4G LTE service and aid deployment in remote rural areas where high costs have deterred private sector investment. The FCC will soon list areas eligible for funding.   See Events section below for an upcoming webinar on broadband planning and funding.

Resources, Learning Events and Technical Assistance

Technical Assistance for Broadband Funding – Wednesday, April 19, 10:30 am to 2:30 pm ET.  The National Telecommunications and Information Administration at the U.S. Department of Commerce will hold a half-day workshop on broadband planning and funding.  Participants will learn how to assess community needs and steps to take for building infrastructure from experts with public and private sector experience.

Behavioral Health for Military Drone Operators – Tuesday, April 25, from 2:00 – 3:30 pm ET.  The Substance Abuse and Mental Health Services Administration will host a webinar on the role of operators supporting remotely powered aircraft missions, which bring unique behavioral health risks.  Participants will learn about stresses of the job affecting active and veteran military members and their families, and discuss effective resources.

Requirements for Emergency Preparedness – April 27 at 2:30 pm ET.  CMS will host a webinar reviewing requirements for providers and suppliers under the Emergency Preparedness Rule.  All providers affected by the rule, including Rural Health Clinics, Federally Qualified Health Centers, And Critical Access Hospitals, are encouraged to learn more about requirements that must be met by November 15, 2017.

Respiratory Disease in Farmers – Wednesday, April 26th at 1:00 pm ET.  The AgriSafe Network will host this hour-long webinar with a general overview of allergic and non-allergic respiratory diseases including asthma, chronic obstructive pulmonary disease, hypersensitivity pneumonia, and organic dust toxic syndrome. Viewers of this webinar will be able to recognize the similarities and differences in the presentation, diagnostic approach, and treatment modalities available.

Medication Assisted Treatment Training – ongoing weekly.  The Providers Clinical Support System offers free waiver training for prescribing medication for opioid use disorder (OUD).  The training is an 8-hour course, provided half-and-half in four-hour windows, required to obtain a Drug Enforcement Agency Drug Addiction Treatment Act waiver to prescribe buprenorphine, one of three medications approved by the FDA for the treatment of OUD.

**Save the Date:  CDC Rural Health Series Webinar – Wednesday, May 3, 2017 at 12:00 pm ET.  Watch this space a free webinar on the CDC’s report examining factors impacting mental and behavioral health for rural children.  The session will include details of one federal program addressing rural children’s needs at the community level and allow for Q&A.

Approaching Deadlines

HIT Advisory Committee Nominations – April 14
Comment:  New Bundled Payment Programs Delayed – April 19
AmeriCorps State and National Grants – April 19
AmeriCorps Indian Tribes Grants – April 19

AHRQ Telehealth Information Request – April 24
Ideas Requested:  Medicare Advantage and Part D Plan – April 24
Grants for the Benefit of Homeless Individuals – April 25
NHSC Scholarships – April 27
Nutrition Education on Indian Reservations – May 1
Regional Telehealth Resource Center Program
May 2
National Telehealth Resource Center Program – May 2
Next Generation ACO  – May 4
Youth Farm Safety Education – May 10
NURSE Corps Scholarship Program – May 11

Community Facilities Program – Ongoing
Summer Food Service Program – Ongoing