Announcements from the Federal Office of Rural Health Policy

August 16, 2017

Funding Opportunities

Preparing Local Health Departments for Accreditation – August 30.  Local health departments may be eligible to receive up to $15,000 to increase their readiness to achieve accreditation from the Public Health Accreditation Board (PHAB). Applicants may apply under no more than two categories of public health work, listed on page 2 of the Request for Proposal (RFP).  While the funding for accreditation prep is provided by a collaborative of the Centers for Disease Control and Prevention and the National Association of County and City Health Officials, eligibility is determined by the PHAB, and categories of work for successful applicants are toward PHAB standards.  A webinar to assist applicants will be held on Thursday, August 17 at 2:00 pm ET.

Behavioral Health Integration for Native Americans – September 16. The Indian Health Service (IHS) will make 12 awards of $500,000 each to Native American tribal governments and organizations to develop coordinated systems of care between behavioral health and primary care providers.  The effort is designed to improve the physical and mental health status of people with behavioral health issues and includes activities to improve quality of life for individuals suffering from mental illness, substance use disorders, and adverse childhood experiences.

Policy Updates

Questions about Rural Health Policy Updates? Write to

Comments Requested: Measuring Health Disparities – August 21.  The National Quality Forum (NQF) released its HHS-funded report recommending ways to use quality measurement to reduce health disparities and encourage interventions known to advance health equity. For example, noting how the lack of adequate transportation presents a significant barrier to care in rural communities, NQF highlights survey questions about the availability of transportation to medical appointments (NQF #2267) and suggests new measures to assess cooperation between health and transportation systems.  On a related note, the Transportation and Health Tool developed by the Centers for Disease Control and Prevention and U.S. Department of Transportation can help rural communities identify strategies for improving public health through transportation planning and policy.

Comments Requested: Health Data Exchange – August 25.  Next Friday will be the last in a 30-day public comment period on the Trusted Exchange Network and Common Agreement.  This provision of the 21st Century Cures Act is meant to establish a nationwide network for the exchange of health data, also known as interoperability.  Rural stakeholders across the Health IT spectrum – clinicians, policymakers, state and federal agencies, exchange service providers and organizations, and the private sector – can submit comments to until 11:59 pm ET on August 25th.

Can I Apply for a Quality Payment Program Hardship Exception? Last week, we announced the opening of the hardship exception application to obtain a reweighting of the Merit-Based Incentive Payment System (MIPS) Advancing Care Information category. This week, we want to share additional guidance regarding the application process. First, some MIPS-eligible clinicians are considered Special Status. These clinicians will be reweighted automatically and do not need to submit a Quality Payment Program (QPP) Hardship Exception Application. Special status for this purpose is limited to hospital-based MIPS-eligible clinicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, non-patient facing clinicians, and ASC-based MIPS-eligible clinicians. All other clinicians and groups eligible and not specifically included in that list, whether rural or urban, can receive a hardship exception but must apply first either online or through the QPP Service Center (1-866-288-8292, TTY: ). Applications are subject to annual renewal.

CMS Final Rule: Hospital Inpatient Services. The update to CMS payment rates and rules for hospital inpatient services takes effect on October 1, 2017.  Rural hospitals should note that two programs, the Medicare-Dependent Hospital (MDH) program and the Low-Volume Hospital (LVH) payment adjustment, will expire on that date.  CMS projects that the sunset of the MDH program, as required by MACRA, will reduce payments to current MDHs by $119 million.  For inpatient services at Critical Access Hospitals (CAH) payable under Medicare Part A, the statute requires a physician to certify that an individual may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission.  Once in effect, this final rule de-emphasizes review of the 96-hour requirement; Medicare contractors are not likely to review medical records unless there are concerns of probable fraud, waste or abuse of the coverage requirement.  The rule also establishes an uncompensated care pool of nearly $7 billion for Disproportionate Share Hospitals (DSH).  Changes to the distribution methodology are likely to increase uncompensated care payments to rural hospitals by 31%.  Also of note for rural providers, CMS finalized changes to the Hospital Inpatient Quality Reporting (IQR) program and the Electronic Health Record (EHR) Incentive program for hospitals and CAHs.  For example, CMS finalized a reduction in the 2018 EHR reporting period from the full year to a minimum of any continuous 90-day period during the calendar year.

Resources, Learning Events and Technical Assistance

CMS New Diabetes Prevention ProgramWednesday, 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.  Registration for this is now closed, but a recording will be made available on the MLN website.  You may also submit comments for the MDPP model through September 11, 2017.

Medicaid & Other Financing for Alcohol/Opioid Treatment – Thursday, August 17 at 3:00 pm ET.  The Substance Abuse and Mental Health Services Administration (SAMHSA) will host this 90-minute webinar to discuss a forthcoming update to their 2014 report, Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders.  Participants will learn how Medication Assisted Treatment (MAT) is currently covered under Medicaid at the state level, understand barriers to MAT coverage along with possible actions to improve coverage, and learn details of innovative financing models.

Webinar: CAHs and the Quality Payment Program – Monday, August 21 at 2:00 pm ET. CMS is hosting a webinar to explain how the Quality Payment Program (QPP) affects Critical Access Hospitals (CAHs), which CAH clinicians may be eligible, and what steps to take if you are a critical access hospital with eligible clinicians. Experts from FORHP will participate in the webinar to provide insight on  the Medicare Rural Hospital Flexibility Program.  To prepare for this session, we recommend reviewing the CMS QPP website for small, underserved, and rural practices.

Rural Cancer: Data, Disparities, and Determination – Wednesday, August 30 at 1:00 pm ET.  The Rural Health Information Hub will host this one-hour webinar with insights from the Centers for Disease Control and Prevention MMWR report on rates of cancer incidence and death released last month.  Co-author Jane Henley will share data on the rural-urban disparities in cancer incidence and mortality and examine factors contributing to these findings.

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

Many apologies for the broken links in last week’s Resource of the Week and thanks for letting us know.  Here it is again:

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

Comments Requested: Measuring Health Disparities – August 21
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
Comments Requested: Health Data Exchange – 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
Preparing Local Health Departments for Accreditation – August 30
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
Behavioral Health Integration for Native Americans – September 16
USDA Loans for Rural Broadband – September 30
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