Category: Current Affairs

CMS Issues FY 2024 IPPS/LTCH PPS Proposed Rule

May 4, 2023

CMS Issues FY 2024 IPPS/LTCH PPS Proposed Rule

On April 6, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2024 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

The FY 2024 IPPS/LTCH PPS proposed rule went on display at the Office of the Federal Register Public Inspection Desk and www.federalregister.gov on April 6, 2023, and was published today May 1, 2023. To view the published version of the FY 2024 IPPS/LTCH PPS proposed rule, go to the following web address and click on PDF under Printed Version: https://www.federalregister.gov/documents/2023/05/01/2023-07389/medicare-program-proposed-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals

Proposed changes to the Hospital Inpatient Quality Reporting (IQR) Program and other quality reporting programs are included in the regulation. Details regarding proposals for various quality reporting programs can be found on the pages listed below:

  • Hospital Readmissions Reduction Program (HRRP) pp. 27024
  • Hospital Value-Based Purchasing (VBP) Program pp. 27024 – 27051
  • Hospital-Acquired Condition (HAC) Reduction Program pp. 27051 – 27055
  • Hospital IQR Program pp. 27078 – 27117
  • PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program pp. 27117 – 27138
  • Promoting Interoperability Program pp. 27155 – 27173

CMS will accept comments on the FY 2024 IPPS/LTCH PPS proposed rule until June 9, 2023, at 5:00 p.m. Eastern Time and will respond to comments in the FY 2024 IPPS/LTCH PPS final rule, to be issued by August 1, 2023. Comments can be submitted electronically or via regular mail or express/overnight mail. Please review the FY 2024 IPPS/LTCH PPS proposed rule for specific instructions for each method and submit using only one method.

For further assistance regarding the information, please contact the Inpatient Value, Incentives, and Quality Reporting (VIQR) Outreach and Education Support Team at https://cmsqualitysupport.servicenowservices.com/qnet_qa?id=ask_a_question or (844) 472-4477.

New Rural Health Voice Podcast on Advanced Nursing Degrees

May 1, 2023

New Rural Health Voice Podcast on Advanced Nursing Degrees

The latest Rural Health Voice podcast hosted by NRHA past president Beth O’Connor of the Virginia Rural Health Association discusses why rural Virginia needs advanced degrees in nursing with Laurie Anne Ferguson of Emory and Henry, which just launched a master’s in nursing program. “We do know that while some of us have traveled and lived all over, most people tend to stay or go back to where they grew up when they establish a career or start families,” Ferguson says. “By educating nurses in this region, we would be more strategic in being able to recruit … There is (also) a nurse faculty shortage, and one of the ways to solve that shortage is to grow our own.”

Podcast Here

New Journal of Rural Health (JRH) Articles on OUD Treatment, supporting CAHs, More

May 1, 2023

New Journal of Rural Health (JRH) Articles on OUD Treatment, supporting CAHs, More

The Journal of Rural Health, a quarterly journal published by the National Rural Health Association, serves as a medium for communication among health scientists and professionals in practice, educational, research, and policy settings.

JRH is a peer-reviewed international journal devoted to advancing professional practice, research, theory development, and public policy related to rural health.

Several new articles on the following topics were recently published online:

Access to full-text online articles is reserved for members. To access the journal, contact NRHA’s membership team with any questions about logging in.

How Midwives Can Help with Declining Rural OB Care

May 1, 2023

How Midwives Can Help with Declining Rural OB Care

Some midwives say home births could help more patients in the wake of rural hospital maternity ward closures that have left many families with no obstetric care options nearby. In recent years, several rural Northeast Ohio hospital systems have closed their maternal care centers, forcing patients to drive farther and leaving some with no maternity ward at all. Instead of taking on the burden of extra travel, some rural families are looking to midwives to help fill gaps in care. Let’s share rural-specific strategies to prevent rural maternal morbidity and mortality and address disparities and shortages at NRHA’s 46th Annual Rural Health Conference May 16-19 in San Diego.

Medicaid Changes Loom as COVID-era Regulations End

May 1, 2023

Medicaid Changes Loom as COVID-era Regulations End

Ending the COVID-19 PHE will require states to disenroll Medicaid recipients who were eligible for coverage as a result of COVID-era regulations. During a recent conference held by the Rural Health Association of Arkansas, an NRHA member, David Mantz of Dallas County Medical Center said hospitals won’t turn away patients who lose their Medicaid coverage, explaining that this would lead to more uncompensated care. It is estimated 15 to 30 percent of Arkansans will be disenrolled from Medicaid. NRHA hopes to help rural health stakeholders continue to communicate COVID-19 vaccine efficacy and safety with the Rural Vaccine Confidence Initiative toolkit.

California Finds 6% Higher Mortality After Closure

May 1, 2023

California Finds 6% Higher Mortality After Closure

In January, Madera Community Hospital — the only hospital in all of Madera County, Calif. — was forced to close due to financial loss. Now the nearest emergency health care facilities are at least 30 miles away. A recent study found the mortality rate increased in rural California communities by 5.9 percent upon the closure of a hospital. Additionally, the American Hospital Association says persistent high costs, the end of the PHE, and the expected departure of millions of Americans from the Medicaid rolls spell trouble for hospitals. NRHA will share strategies to maintain rural health care access and keep rural hospitals open at NRHA’s 8th Rural Hospital Innovation Summit May 16-19 in San Diego.

University Launches Ambitious Effort to Reduce Disparities

May 1, 2023

University Launches Ambitious Effort to Reduce Disparities

Over the past two decades, life expectancy in rural areas has declined, with one major factor being the prevalence of diabetes. To improve the health and well-being of rural and minority populations, UVA School of Medicine has launched a new Center for Health Equity and Precision Public Health. Additionally, new research led by NRHA member Jan Probst of the Rural and Minority Health Research Center looks at how close some ZIP codes were to different kinds of health care and access in areas with higher proportions of racial and ethnic minorities. Your chance to explore the intersection of health equity and social determinants with the experts is at NRHA’s 46th Annual Rural Health Conference and 28th Health Equity Conference May 15-19 in San Diego.

Convenience vs Compliance: How Much is it Costing You?

April 28, 2023

Convenience vs Compliance: How Much is it Costing You?

Federal law requires that rural health clinics (RHCs) are HIPPA compliant. An RHC could face stiff fines and penalties if they are not compliant or if there is a breach. In today’s age of electronics, many RHCs are already using the various EHR/EMR programs that are available to them.

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Public Health Emergency Ends May 11th – Implications for Rural Health Clinics

April 28, 2023

Public Health Emergency Ends May 11th – Implications for Rural Health Clinics

The COVID-19 Public Health Emergency (PHE) initially declared on January 27, 2020, will conclude on May 11, 2023. Please note: this is a separate emergency declaration from the COVID-19 National Emergency declared by the President that can be ended via a joint resolution from Congress. For a full explanation of these provisions please review the recent NARHC webinar.

RHC Specific Waivers

The conclusion of the PHE will end the below waivers:

Certain Staffing Requirements. 42 CFR 491.8(a)(6)

  • During the PHE, CMS waived the requirement that a NP, PA, or CNM be available to furnish patient care services at least 50% of the time the RHC is operating.

Temporary Expansion Locations. 42 CFR §491.5(a)(3)(iii)

  • During the PHE, CMS waived the requirement that RHCs be separately considered for Medicare survey and certification if services were expanded into more than one permanent location, including areas that would not typically meet RHC location requirements. Upon termination of the PHE, these expanded locations will be subject to location requirements and separate survey and certification.

Bed Count for Provider-Based RHCs

  • During the PHE, CMS permitted provider-based RHCs subject to their clinic-specific, grandfathered upper payment limit to increase their hospital bed count to 50+ without losing their grandfathered status. At the conclusion of the PHE, grandfathered RHCs must lower their bed count or lose their grandfathered payment status.

Nursing Home Visits

  • During the PHE, CMS removed the requirement that RHCs in an area without a current home health area shortage needed a written request and justification in order to provide home nursing services.

Virtual Communication Services

  • During the PHE, CMS allowed for online digital evaluation and management services (99421, 99422, and 99423) to be reimbursed under G0071. After the PHE, G0071 should only be used for G2012 and G2010. This was one of the first telecommunications flexibilities granted to RHCs during COVID, but the passing of the CARES Act allowed many more services to be done via telehealth during the PHE and beyond.

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RHC COVID-19 Program Reminders and Updates

April 28, 2023

RHC COVID-19 Program Reminders and Updates

The Rural Health Clinic (RHC) COVID-19 Testing & Mitigation (RHCCTM) program final reporting requirements are open for RHCs or their parent TIN organizations to complete on RHCcovidreporting.com. As a reminder, this program allocated $100,000 per eligible RHC in 2021 for COVID-19 testing-related and mitigation-related expenses and could be spent between January 1, 2021 and December 31, 2022.

The RHCCTM program closeout reporting requires RHCs to attest whether they fully spent, partially spent, or did not spend the funding. It is a simple one question attestation that does not require any submission of cost documentation.

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