Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States

A new rural policy brief is available from the RUPRI Center for Rural Health Policy Analysis:

Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States

Jason Semprini, MPP; Fred Ullrich, BA; Keith Mueller, PhD

This policy brief analyzed administrative rules and legislative statutes governing each state’s pharmacy practice. Key features of telepharmacy regulations were investigated for comparative analysis. Twenty-one states currently authorize retail telepharmacy, but between these states the regulatory activity varies considerably.

Please click here to read the brief.

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ESRD PPS CY 2021 Proposed Rule; COVID-19: New and Expanded Flexibilities for RHCs & FQHCs

July 6, 2020

On July 6, CMS issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2021. This rule also proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI and proposes changes to the ESRD Quality Incentive Program (QIP).

In addition to the annual technical updates for the ESRD PPS, the proposed rule proposes the following:

  • An addition to the ESRD PPS base rate to include calcimimetics in the ESRD PPS bundled payment
  • Changes to the eligibility criteria and determination process for the Transitional add-on Payment adjustment for New and Innovative Equipment and Supplies (TPNIES)
  • Expansion of the TPNIES to include new and innovative capital-related assets that are home dialysis machines
  • A change to the low-volume adjustment eligibility criteria and attestation requirement to account for the COVID-19 public health emergency
  • An update to the ESRD PPS wage index to adopt the new Office of Management and Budget delineations with a transition period
  • Information received from two manufacturers whose products, a dialyzer and a cartridge for a home dialysis machine, are being considered for TPNIES in CY 2021

Additionally, the proposed rule proposes the following updates to the ESRD QIP:

  • Scoring methodology changes to the ultrafiltration rate reporting measure
  • Updates to the National Healthcare Safety Network validation study

The proposed CY 2021 ESRD PPS base rate is $255.59, an increase of $16.26 to the current base rate of $239.33. This proposed amount reflects the application of the proposed wage index budget-neutrality adjustment factor (.998652), the proposed addition to the base rate of $12.06 to include calcimimetics, and a proposed productivity-adjusted market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.8 percent), equaling $255.59 (($239.33 x .998652) + $12.06) x 1.018 = $255.59).

The proposed rule also includes:

  • Annual update to the wage index
  • Update to the outlier policy
  • Low-volume eligibility criteria and attestation requirement
  • Impact analysis

For More Information:

See the full text of this excerpted CMS Fact Sheet (issued July 6).

Webinar: Preparing for Price Tansparency

Date: June 20, 2020

Time: 2:00 PM – 3:00 PM Central


In this webinar, we will review the background, intent, and final rule surrounding Price Transparency. We will also cover the requirements, consider the challenges, and evaluate strategies to meet the hospital transparency mandates that will become effective January 2021.

New Brief: Provision of Mental Health Services by Critical Access Hospital-Based Rural Health Clinics

Residents of rural communities face longstanding access barriers to mental health (MH) services due to chronic shortages of specialty MH providers, long travel distances to services, increased likelihood of being uninsured or under-insured, limited choice of providers, and high rates of stigma. As a result, rural residents rely more heavily on primary care providers and local acute care hospitals to meet their MH needs than do urban residents. This reality highlights the importance of integrating primary care and MH services to improve access to needed care in rural communities. Critical Access Hospitals (CAHs) are ideally positioned to help meet rural MH needs as 60 percent manage at least one Rural Health Clinic (RHC). RHCs receive Medicare cost-based reimbursement for a defined package of services including those provided by doctoral-level clinical psychologists (CPs) and licensed clinical social workers (LCSWs).

This policy brief explores the extent to which CAH-based RHCs are employing CPs and/or LCSWs to provide MH services, describes models of MH services implemented by CAH-based RHCs, examines their successes and challenges in doing so, and provides a resource to assist CAH and RHC leaders in developing MH services. It also provides a resource for State Flex Programs to work with CAH-based RHCs in the development of MH services.

**The report may accessed on the Flex Monitoring Team website.


CMS Announces Plans to End the Blanket Waiver Requiring Nursing Homes to Submit Staffing Data

June 25, 2020

Today, the Centers for Medicare & Medicaid Services (CMS) announced plans to end the emergency blanket waiver requiring all nursing homes to resume submitting staffing data through the Payroll-Based Journal (PBJ) system by August 14, 2020. The PBJ system allows CMS to collect nursing home staffing information which impacts the quality of care residents receive. The blanket waiver was intended to temporarily allow the agency to concentrate efforts on combating COVID-19 and reduce administrative burden on nursing homes so they could focus on patient health and safety during this public health emergency.

The memorandum released today also provides updates related to staffing and quality measures used on the Nursing Home Compare website and the Five Star Rating System.

To view the memorandum to states and nursing home stakeholders, visit:


Medicare Care Choices Model One-Year Model Extension Announcement

June 25, 2020

The Centers for Medicare & Medicaid Services (CMS) will extend the Medicare Care Choices Model (MCCM) by one calendar year, through December 31, 2021, allowing more Medicare beneficiaries to access supportive care.

MCCM tests a new option for Medicare beneficiaries to receive supportive care services from selected hospice providers. It evaluates whether those services can improve the quality of life and care received by Medicare beneficiaries, increase patient satisfaction, and reduce Medicare expenditures.

Under the extension, participating MCCM hospices will be able to enroll eligible beneficiaries through June 30, 2021 and provide MCCM services for them through December 31, 2021. The extension will not affect the model’s other existing operations or policies.

The extension will apply to hospices already participating in the model; no new hospices will be enrolled. CMS will contact hospices participating in the model in the coming days and invite them to apply for the voluntary extension.

For more information on the model, please see its webpage.

Questions or Feedback?

If you have questions or feedback, please email the MCCM model team at

Federal Office of Rural Health Policy Announcement

June 4, 2020

Awards for Delta States Rural Development Network. The Federal Office of Rural Health Policy awarded approximately $12 million to 12 awardees for the 2020 Delta States Rural Development Network Program.  This three-year program will support organizations located in the eight Delta States (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee) to promote the planning, implementation, and development of health care networks at the community level. These health care networks consist of partner organizations working together to address unmet local health needs and health disparities in the rural Delta region.

HHS Makes Awards to Combat COVID-19 in Rural Tribal Communities.  The U.S. Department of Health & Human Services (HHS) awarded $15 million to 52 Tribes, Tribal organizations, urban Indian health organizations, and other health services providers to Tribes across 20 states to prepare, prevent, and respond to COVID-19 in rural tribal communities. 

HHS Makes Awards to Expand the Addiction Workforce On Tuesday, the U.S. Department of Health & Human Services (HHS) awarded $20.3 million to 44 recipients to increase the number of fellows at accredited addiction medicine and addiction psychiatry fellowship programs. The awardees will train addiction specialists at facilities in high need communities that integrate behavioral and primary care services. Addiction specialists have the knowledge and skills to provide comprehensive behavioral healthcare to under-served populations during the COVID-19 pandemic.

TRACIE Report on COVID-19 Challenges to Rural Health.  The Technical Resources, Assistance Center, and Information Exchange (TRACIE) is a site created by the Assistant Secretary for Preparedness and Response at the U.S. Department of Health & Human Services.  In this report, TRACIE explains and provides data for pandemic challenges specific to rural populations and health care facilities.  More information and resources for emergency preparation and response can be found on the TRACIE website. 

GAO: Infection Control Deficiencies in Nursing Homes Before the Pandemic.  The U.S. Government Accountability Office (GAO) is an independent, nonpartisan agency that works for Congress.  For this report, the GAO found that about 40 percent of surveyed nursing homes had infection prevention and control deficiencies from 2013 to 2019.

ARHQ: Hospital Burden of Opioid-Related Inpatient Stays.  The Agency for Healthcare Research Quality (AHRQ) examines the costs of opioid-related hospitalizations, with a comparison of metropolitan and rural hospitals.  The report is part of AHRQs Healthcare Cost and Utilization Project, a collection of data and analysis tools to enable research on a broad range of health policy issues.

Learning About Local Health Workforce Through Commute Patterns.  To learn more about the available supply of nurses and allied health workers at local levels, researchers at the University of Washington Center for Health Workforce Studies looked at commute patterns found in the American Community Survey.  The report says a key takeaway for researchers and workforce planners is a need to measure local supply based not only on where people report working, but also where they live. 

Federal Office of Rural Health Policy FAQs for COVID-19.  A set of Frequently Asked Questions (FAQs) from our grantees and stakeholders, updated regularly. 

COVID-19 FAQs and Funding for HRSA Programs.  Find all funding and frequently asked questions for programs administered by the Health Resources and Services Administration (HRSA).

CDC COVID-19 Updates.  The Centers for Disease Control and Prevention (CDC) provides daily updates and guidance, and ongoing Clinician Outreach and Communication Activity (COCA).

Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties.  The RUPRI Center for Rural Health Policy Analysis provides up-to-date data and maps on rural and urban confirmed cases throughout the United States.  An animated map shows the progression of cases beginning January 21.

Rural Response to Coronavirus Disease 2019.  The Rural Health Information Hub has created a guide to help you learn about activities underway to address COVID-19.

CMMI Payment Model Flexibilities in Response to COVID-19

June 4, 2020

The Soronavirus has taken a devastating toll on Americans across the country, in lives lost and economic impacts. The health care system is no different. Providers have been greatly affected as they strive to do the right thing by delaying elective surgeries; they have faced disruption in critical revenue streams, and simultaneously experienced increased costs for Personal Protective Equipment. That’s why President Trump signed legislation providing $175 billion for the health care system, in addition to $100 billion in advance and in accelerated payments to Medicare providers.

But we still need to do more to ensure that our health care system is resilient and prepared to address any crises. Under the Trump Administration, the Centers for Medicare and Medicaid Services (CMS) has been doing just that by advancing innovative payment and service delivery models to help move our health care system from one that pays for volume to one that rewards providers for keeping patients healthy, improving health outcomes, and lowering costs. The need for this transformation is even greater as our country confronts not just the coronavirus but the possibility of future pandemics.

In response to the coronavirus pandemic, CMMI has initiated numerous flexibilities in its commitment to value-based care. Learn more about these flexibilities through a CMS leadership blog post and the CMS Innovation Center COVID-19 flexibilities web page.

Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results

June 2, 2020

Yesterday (June 1, 2020), under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) unveiled enhanced enforcement for nursing homes with violations of longstanding infection control practices. This announcement builds on the previous actions CMS has taken to ensure the safety and security of America’s nursing homes as the nation battles coronavirus disease 2019 (COVID-19), and is a key step in the Trump Administration’s Guidelines for Opening Up America Again.

Full press release