Announcements from the Federal Office of Rural Health Policy

August 23, 2017

What’s New

Overview of MIPS for Small, Rural, and Underserved PracticesFriday, September 8 from1:00 – 2:30 pm ET. The Centers for Medicare and Medicaid Services (CMS) and the National Rural Health Association will host a webinar on the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program. Topics that will be covered include: overview of the Quality Payment Program, overview of MIPS, flexibilities and resources for small practices, overview of Virtual Groups, and resources offered by technical assistance organizations. Rural providers including Critical Access Hospital clinicians interested in learning more about the participation requirements of MIPS and options for voluntary reporting, particularly for Rural Health Clinics and Federally Qualified Health Centers, should plan to participate.

Women and OpioidsThe Office of Women’s Health released a final report on Opioid Use, Misuse, and Overdoes in Women. The study found that death rates from drug overdose for women are more pronounced in the rural South and Midwest. The report identified a possible explanation being that rural areas often lack access to treatment for substance use disorder.

Funding Opportunities

Address suicide research gaps in rural communities  – Apply by November 2. National Institutes of Health (NIH) will provide up to $300,000 to colleges and universities, local governmental bodies, nonprofit agencies, and other eligible organizations to uncover the risk factors for, and the burden of suicide. NIH requests that applicants link mortality data to health care data related to suicidality, specifically on the type, severity, and timing of suicide predictors. Recent CDC research shows higher suicide rates in rural areas with some evidence of a widening gap compared to urban communities. Of note, the next meeting of the National Advisory Committee on Rural Health and Human Services September 11 -13, 2017 will also focus on the burden of rural suicide.

Drinking Water and Waste Disposal for Rural and Native Alaskan Villages – Ongoing. The U.S. Department of Agriculture, USDA Rural Development will provide up to 75% of project costs with a matching 25% from the state of Alaska, or local contributions, to a rural Alaskan village or hub. The grant must be used to remedy a dire sanitation condition such as a recurring instances of waterborne communicable disease. A recent CDC Morbidity and Mortality Weekly Report suggests that water quality decreases as areas become more rural.

Rural Health  Research

Regulating Network Adequacy for Rural Populations: Perspectives of Five StatesThe University of Minnesota Rural Health Research Center released a policy brief describing a study to explore how California, Kentucky, Montana, Texas, and Wisconsin define insurance network adequacy and how much consideration is given to rural issues in regulating their networks. Featured statistics including these states’ rural population, rural percent of total population, rural area in square miles, number of marketplace networks, and percent that are narrow networks.

Improving Rural Oral Health: Responses from Six States – The University of South Carolina Rural Health Research Center released a policy brief detailing the response of Colorado, Iowa, New Mexico, North Carolina, Pennsylvania, and South Carolina to the Department of Health and Human Service’s Oral Health Strategic Framework. The study shows that, despite the fact that use of preventive dental service in rural areas has declined, several states were found to have innovations around advancing oral health for rural children.

Policy Updates

Questions about Rural Health Policy Updates? Write to

CORRECTION: CMS Final Rule: Hospital Inpatient Services. The previous summary of the CMS final rule for hospital inpatient services incorrectly stated the estimated change in Medicare uncompensated care payments for rural Disproportionate Share Hospitals (DSH). CMS estimates rural hospitals to receive a 17.3% increase in DSH payments compared to 10.9% for urban hospitals (82 FR 38563), likely because rural hospitals tend to serve more uninsured lower-income patients than urban hospitals that often see more patients with Medicaid.

CMS cancels cardiac bundled payment programs – comment by October 16. After delaying the Episode Payment Models (EPMs) or cardiac care to January 1, 2018, CMS now proposes to cancel the bundled payment program. EPMs were designed to provide episode-based payments for care related to heart attacks and coronary bypass surgeries as well as incentive payments for cardiac rehabilitation services. While many rural hospitals including Critical Access Hospitals were not required to participate in this bundled payment model, cancellation of the rule may reduce hospitals’ financial incentive to lower costs and improve quality throughout the full episode of care, including post-acute care provided in settings such as rural hospital swing beds.

CMS revises joint replacement bundled payment program – comment by October 16. Beginning January 1, 2018, CMS proposes to make the Comprehensive Care for Joint Replacement (CJR) model mandatory in only 34 of the 67 selected metropolitan areas. CMS would allow voluntary participation for hospitals in the other 33 areas and low-volume or rural hospitals in any of the 67 areas. To avoid automatic withdrawal from the program on February 1, 2018, CMS proposes to allow low-volume and rural hospitals only the month of January 2018 to elect to participate. Participating rural hospitals can focus on improving transitions of care and care coordination to maximize the opportunity for shared savings. Even rural hospitals choosing not to participate can arrange payment from participating CJR hospitals to share responsibility for quality and clinical outcomes as post-acute care providers.

CMS reveals new Hospice Compare Website. Approximately 25% of hospice providers are located in rural areas. On August 16, CMS revealed a new compare site to make it easier for patients and their families to find hospice services in their local area and compare hospices on specific quality of care metrics. Hospice care is an end-of-life Medicare benefit available to patients who have a prognosis of 6 months or less to live. Once a patient elects hospice care, the focus shifts from curative treatment to palliative (pain and symptom relief) care: this care is generally provided where the patient lives. Visit the CMS website or for more information.

340B Drug Pricing Program final rule delayed – Comment by September 20. HRSA published a notice on August 21 announcing that the effective date for a final rule for the 340B Drug Pricing Program has been delayed to July 1, 2018 to “allow for a sufficient amount of time to more fully consider the regulatory burdens that may be posed by this final rule.” The 340B program helps many rural covered entities get medications to people who need them at a lower cost.

Be prepared: new 340B registration components coming soon. Are you with a Critical Access Hospital, Rural Referral Center, or any other covered entity participating in the 340B Drug Pricing Program? Annual recertification is right around the corner, and HRSAs Office of Pharmacy Affairs is currently updating the 340B OPA Information System (340B OPAIS). Changes will be complete in mid-September: begin to prepare for these changes by referring to the website and subscribing to the mailing list for additional announcements and educational resources to assist you in becoming familiar with the changes. Changes for covered entities will include two-part authentication and other enhanced security features, such as the requirement for the Authorizing Official (AO) and Primary Contact (PC) to create a user-name and password, and for the AO and PC for a single 340B ID to be different individuals. Questions regarding the registration component of the new 340B OPAIS or any other emergent 340B issues can be directed to the 340B Prime Vendor Program at (888) 340-2787 or by sending an email to

Resources, Learning Events and Technical Assistance

TODAY! License Portability for Telehealth – Wednesday, August 23 from 2:30 – 4:00 pm ET The Association of State Territorial Health Officials (ASTHO) is partnering with HRSA to host this webinar to share information on interstate licensure compacts as a method for increasing access to care and addressing workforce gaps. The webinar will feature presentations on the Interstate Medical Licensure Compact and the Psychology Inter-jurisdictional Compact. Speakers include representatives from the HRSA Office for the Advancement of Telehealth, Federation of State Medical Boards, and the Association of State and Provincial Psychology Boards.

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 of the CDC 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 ET.  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. 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.

Financial distress and Closures of Rural Hospitals – September 21 at 1:00 pm ET. The Rural Health Research Gateway will host a webinar with George Pink, PHD, and Mark Holmes, PhD of the North Carolina Rural Health Research and Policy Analysis Center to present new data about closed rural hospitals and their pre-closure disposition. A model predicting financial distress and closure in rural hospitals will be described. Characteristics of hospitals at high risk of financial distress will be identified and trends in risk of financial distress among rural hospitals analyzed. Since 2005, 122 rural hospitals have closed – 80 of them since 2010.

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

Multisector community health partnerships for health equity. The National Academies of Science, Engineering, and Medicine (NASEM) released materials from its December 2016 workshop on engaging stakeholders from all sectors at the community level to build partnerships to improve health. The report includes discussion of financing community partnerships; how local, state, and federal governments can support these partnerships, and examples of different approaches in rural and urban communities. For example, NASEM highlights how community health workers in rural Oregon activated minority community members to take on more engaged decision-making roles for housing development and other projects identified in a community health needs assessment (p. 40). Rural communities looking for more strategies can review keys to collaboration from the Build Health Challenge and additional examples from local health departments around the country. Rural communities looking for more examples of rural cross-sector partnerships for community health improvement can review the 7 rural winners of the Robert Wood Johnson Foundation Culture of Health prize.

Approaching Deadlines

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