Announcements from the Federal Office of Rural Health Policy

November 9, 2017

What’s New

The Latest on Rural Health from the CDC.  In the latest edition of its Morbidity and Mortality Weekly Report (MMWR) Rural Health Series, researchers at the Centers for Disease Control and Prevention (CDC) examined differences in occupational exposure to vapor-gas, dust, and fumes between a cohort of rural and urban adults in Iowa.  While previous studies have focused exclusively on agricultural workers, this study assessed airborne occupational exposures in other types of jobs in rural settings as well.  COPD is one of the leading causes of death, and the American Thoracic Society estimates that 15% of COPD cases can be attributed to occupational exposures.  The findings of this report, which show that rural workers – including those who have never farmed – are more likely than urban workers to have high occupational exposures, allow for further exploration of interventions needed to reduce respiratory conditions related to work.

New Medicare Diabetes Prevention Program. Earlier this year, the Centers for Disease Control and Prevention (CDC) reported that 62% of rural counties do not have a Diabetes Self-Management Education program. For 2018, the Medicare Physician Fee Schedule is expanding the Medicare Diabetes Prevention Program (MDPP), an evidence-based lifestyle change curriculum shown to prevent type 2 diabetes among beneficiaries with prediabetes. Organizations in health care and community settings can implement the CDC-recognized Diabetes Prevention Program and, after enrolling as a MDPP supplier, may receive Medicare reimbursement for their services beginning April 1, 2018.  The National Institutes of Health explains the importance of screening for prediabetes and provides resources and referrals to support patients in this effort.

Help NIH Understand Rural Pregnancy. The National Institutes of Health (NIH) PregSource research project aims to improve national maternity care by getting first-hand accounts of the physical and emotional aspects of pregnancy, labor, delivery, and early parenthood. NIH plans to identify specific challenges facing subgroups of women, such as women with disabilities or those living in rural areas. Women have no hospital obstetric services in as many as 45% of rural counties, and recent research shows the losses continue. More information may help researchers and policymakers better address this access problem. Rural health care providers may also consider implementing model programs to improve their prenatal and obstetric care. Providers and researchers may also be interested in the HRSA Maternal and Child Health Bureau challenge competition offering $375,000 in prizes to innovators who develop low-cost technologies to improve prenatal care in remote and medically underserved areas.

NIH Health Disparities Research Centers. The National Institutes of Health (NIH) announced five-year funding for 12 centers of excellence focused on research, training, and community engagement to reduce health disparities. Each of these specialized centers will emphasize at least one of several populations facing social disadvantages, including marginalized racial and ethnic groups, people from less privileged socioeconomic situations, and residents of underserved rural communities. The two centers focusing on rural populations are the Arkansas Center for Health Disparities at the University of Arkansas for Medical Sciences, focused on chronic disease risk factors, and the new Transdisciplinary Research, Equity, and Engagement Center for Advancing Behavioral Health at the University of New Mexico, focused on behavioral health.

Funding Opportunities

Treasury Loans for Rural Economic Development – January 9. In the Community Development Financial Institution (CDFI) Bond Guarantee program, the U.S. Department of Treasury will provide up to $500 million in long-term credit to CDFIs pursuing large-scale development projects such as commercial real estate, affordable housing units, schools, child care centers, municipal infrastructure, or health care centers – all of which can help improve the socioeconomic conditions that influence health in rural communities. Nearly 30% of CDFIs primarily serve rural communities where a slower recovery from the recession has limited residents’ economic opportunities. Rural hospitals may consider partnering with their local CDFI to finance community-building efforts.  Read about CDFI investments to create jobs and improve health care in underserved areas.

Policy Updates

Questions about Rural Health Policy Updates? Write to

Comments Requested: 2019 Health Insurance Marketplace (HIM) Changes – November 27.  CMS has released for public comment proposed changes to the HIM for individuals and small businesses that would take effect in 2019.  Of interest to State Offices of Rural Health and others are several proposals that would provide states more options in defining essential health benefits (EHBs), an enhanced role in certifying qualified health plans (QHP), and additional flexibilities in the operation and establishment of insurance exchanges.  Other proposed changes that may be of interest to rural providers and stakeholders would reduce regulatory burdens, streamline state and issuer requirements, and simplify eligibility and enrollment processes for consumers.

Comments Requested: PACE Quality Measures – November 30.  CMS has posted four draft quality measures for the Programs of All-Inclusive Care for the Elderly (PACE) program. Rural PACE providers and stakeholders can use this opportunity to provide feedback on the measures.

New from CMS: Making Sure EHR Information is Shared. New CMS guidance has been posted requiring that clinicians who are eligible for the Merit-Based Incentive Payment System (MIPS) show that they have not knowingly limited the interoperability of their certified electronic health record (EHR) technology. This requirement aims to prevent actions that block the exchange of health information. MIPS-eligible clinicians can avoid a negative payment adjustment by attesting to three statements about how they implement and use certified EHR technology (CEHRT).

Payment and Rules for Hospital Outpatient Services. CMS released its final rule updating 2018 payment and policy for the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The rule finalizes a $1.6 billion payment reduction for Medicare Part B drugs purchased through the 340B Drug Pricing Program. CMS exempted rural Sole Community Hospitals (SCHs) for 2018, estimated to save those hospitals $199 million, while Critical Access Hospitals (CAHs) are not affected and will continue to be paid 101% of reasonable costs. Hospitals participating in 340B must recertify by December 6. Overall, CMS estimates rule changes for 2018 will increase OPPS payments by 1.4%, or $690 million, compared to 2017, with larger increases at rural hospitals (2.7%) than urban hospitals (1.3%). Of note, CMS has maintained the 7.1% payment increase for outpatient services performed at SCHs and will extend for two more years the current moratorium on enforcing the direct supervision requirement for outpatient services at CAHs and small, rural hospitals.

Updates to Policy for End-Stage Renal Disease – CMS issued a final rule to update 2018 Medicare payment rates and polices for dialysis facilities via the End-Stage Renal Disease (ESRD) Prospective Payment System. The rule is effective January 1, 2018 and provides a 0.5% overall payment rate increase, implements policies for dialysis services furnished to individuals with acute kidney injury (AKI) by dialysis facilities, and updates the ESRD Quality Incentive Program (QIP). Most rural dialysis facilities will experience the 0.3% payment increase, but 132 rural hospital-based dialysis facilities will experience a 0.4% payment increase. In payment year 2021, some of the changes to the ESRD QIP will result in estimated payment reductions for 325 rural facilities (-0.19%).

Updates to Home Health Payment Rates and Policy – CMS issued a final rule to update 2018 Medicare payment rates and polices for home health services. The rule is effective January 1, 2018 and includes an overall payment reduction to home health providers of 0.4% ($80 million), which includes the statutory sunset of the rural add-on provision. Most rural home health agencies will experience this as a payment reduction of 2.5%. The rule also includes changes to both the home health quality reporting program and the home health value-based purchasing program. Additionally, CMS will not be implementing changes to the case-mix methodology, referred to as the home health groupings model (HHGM).

Updates to Medicare Clinician Payment and Quality Reporting – On November 2, CMS issued final rules on payment and quality for Medicare clinician services furnished in 2018. In the Physician Fee Schedule final rule, rural clinicians may be especially interested in updates to payment rates (+0.41%), policies for the Medicare Diabetes Prevention Program, new billing codes for chronic care management for FQHCs and RHCs, revisions to simplify the assignment methodology for Medicare Shared Savings Program ACOs that include FQHCs and RHCs, and the addition of seven new telehealth billing codes. Under the Quality Payment Program (QPP) final rule, rural clinicians may be interested in the increased threshold for MIPS eligibility (>$90,000 in Part B allowed charges or >200 Medicare Part B beneficiaries), new bonus points for small practices and for treating complex patients, the introduction of a voluntary group reporting option, and the increased weighting the MIPS Cost performance category (10% for 2018). CMS will host a webinar on November 14 from 1:00-2:30 PM ET to provide an overview of the latest QPP rule.

DEA Classifies Fentanyl as Schedule I. Citing “imminent hazard to the public safety,” the U.S. Department of Justice Drug Enforcement Agency (DEA) temporarily added several fentanyl analogs to Schedule I, effective October 26, 2017 through October 28, 2019. These fentanyl analogs now join drugs such as heroin and LSD in Schedule I, classified by the DEA as having “no currently accepted medical use and a high potential for abuse.” Drug overdoses are the leading cause of injury death in the U.S., with rates in rural areas higher than in urban since 2006. Abuse of synthetic opioids such as fentanyl increased the death rate by more than 72% from 2014 to 2015. Health care providers in rural areas may consider implementing promising strategies and evidence-based models for addressing opioid misuse.

Resources, Learning Events and Technical Assistance

Federal Activities for National Rural Health Day – November 13 – 16.  On Thursday, November 16th the Federal Office of Rural Health Policy will join the National Organization of State Offices of Rural Health (NOSORH) to celebrate National Rural Health Day. All events are viewable online and open to the public:

  • Monday, Tuesday and Wednesday at 3:00 pm ET, TwitterChats hosted by @HRSAgov will feature experts discussing Healthcare Workforce, Social Determinants of Health, and Behavioral Health.  Join using hashtag #OurRural.
  • Tuesday at 3:30 pm ET, HRSA’s Bureau of Health Workforce will host a Grand Rounds Webinar describing the health workforce needs in rural communities and share innovative, best practices among rural areas for the recruitment and retention of health professionals.
  • Wednesday at 1:30 pm ET, experts from the Centers for Disease Control and Prevention will discuss research on Injury and Prevention Control in Rural America.
  • Thursday, beginning at 9:30 am ET, staffers and experts from across HHS will gather at HRSA to webcast a series of events showcasing FORHP’s collaboration with federal partners, demonstrate the telehealth innovation called Project ECHO used by several federal programs, and hold a panel discussion beginning at 1:30 pm ET on federal efforts to address the opioid epidemic.

Each session will include time for questions and answers.  Submit questions in advance or during the events to

Protecting Agricultural Producers – Thursday, November 16 at 1:00 pm ET.  The AgriSafe Network hosts this 30-minute webinar to discuss their Total Farmer Health Initiative as well as other health and safety resources for rural health professionals and agricultural communities.

Antibiotic Stewardship for CAHs – Thursday, November 16 at 2:00 pm ET. Earlier this year, the Centers for Disease Control and Prevention (CDC) worked with FORHP, the American Hospital Association and The Pew Charitable Trusts on a guide to help small and rural hospitals address the growing crisis of antibiotic resistance. It’s a task that’s critical to improving patient outcomes and reducing healthcare costs.  This webinar for Critical Access Hospitals (CAHs) hosted by the CDC  will walk through the materials and resources developed for antibiotic stewardship that takes into account the challenges of limited staffing and resources for smaller facilities.

Respiratory Health of Agricultural Workers – Thursday, November 16 at 3:00 pm ET.  The AgriSafe Network will host this free one-hour webinar that will help rural health clinicians learn about respiratory hazards and symptoms associated with agricultural activities.

Approaching Deadlines

Pilot Project: IHS Youth Treatment – November 12
Comments Requested: Rural Rental Housing Loans – November 13
Survey: CMS Tests New Cost Measures – November 15
Loan Repayment for Health Disparities Research – November 15
Comments Requested: Improving Care for Medicare Beneficiaries – November 20
Survey: Federal Strategy for Childhood Lead Exposure – November 24
Comments Requested: HHS Partnerships with Faith Communities – November 24
Comments Requested: 2019 Health Insurance Marketplace (HIM) Changes – November 27
Comments Requested: PACE Quality Measures – November 30
Support for Rural Financial Institutions – November 30
Revitalize Rural Rental Housing – December 1
MIPS Virtual Group Election – December 1
USDA Community Food Projects – December 4
Recertify in 340B Drug Pricing Program – December 6
Rural Health Care Services Outreach Program – December 6
Enrollment for 2018 Medicare Advantage and Prescription Drug Plans – December 7
Public Health Crisis Response – December 11
Improve Tribal Road Safety – December 11
Rural Utilities Service Assistance for Communities – December 11
Deadline for Health Insurance Enrollment – December 15
Assessment for Preventing Medical Errors – December 15
Improving Rural Community Airports – December 15
New Geographic Service Areas for HIV Intervention – January 2
Nominations: HHS Advisory Committee on Minority Health – January 3
Researching Health Behavior for Young People – January 7
Treasury Loans for Rural Economic Development – January 9
Preventing Intimate Partner Violence – January 16
Drinking Water and Waste Disposal for Rural and Native Alaskan Villages – Ongoing
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