FORHP Announcements – January 31

January 31, 2017

Announcements from the Federal Office of Rural Health Policy

What’s New

Medicare ACO Track 1+ ModelCMS offers new details on the Medicare Accountable Care Organization Track 1+ model, which will begin in 2018. The model will qualify as an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act by incorporating more downside risk than is currently present in Track 1 of the Medicare Shared Savings Program.  It is designed to help small practices move toward performance-based risk and to allow small hospitals, including rural, to participate.   

Request for MACPAC Nominations  – February 24. The Government Accountability Office (GAO) is requesting nominations for new members to the Medicaid and CHIP Payment and Access Commission (MACPAC). The U.S. Comptroller General appoints MACPAC’s 17 commissioners, who come from diverse regions across the United States and bring broad expertise and a wide range of perspectives on Medicaid and CHIP, review Medicaid and CHIP access payment policies, and make recommendations to Congress. Appointments take effect May 1, 2017.

Request for MedPAC Nominations – March 10:  The GAO is also accepting nominations for Medicare Payment Advisory Commission (MedPAC) appointments that will be effective May 1, 2017. MedPAC is an independent congressional agency that advises the U.S. Congress on issues affecting the Medicare program and is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare. This is an opportunity for rural providers and stakeholders to submit nominations for MedPAC members who can bring their perspective and expertise on the financing and delivery of health care services in rural areas.

Funding Opportunities

NURSE Corps Loan Repayment Program – February 23. HRSA’s Bureau of Health Workforce has opened the application cycle for the program that supports registered nurses (RNs), advanced practice registered nurses (APRNs), and nurse faculty by paying up to 85% of their unpaid nursing education debt. To receive loan repayment, nurses must work full-time at a an eligible, accredited school of nursing or an eligible Critical Shortage Facility (CSF). Participants will join thousands of NURSE Corps members across the nation to meet the health care needs of underserved communities, including rural areas, and ensure a strong and sustainable nursing workforce for the future.

Broadband Service for Rural Communities – March 13.  The U.S. Department of Agriculture (USDA) will grant ten rural communities awards ranging from $100,000 to $3 million to fund broadband services for public and private use.  Grant funds may be used to: (1) deploy service at the Broadband Grant Speed to critical community facilities, rural residents, and rural businesses, (2) construct, acquire, or expand a community center, and/or (3) equip a community center that provides free access to service to community residents for at least two years.   USDA’s Community Connect grants are available to private and non-profit organizations, most state and local governments and federally-recognized Tribes.

Prevention of Opioid Misuse in Women – April 7.  Twelve public and/or private non-profit entities will be awarded up to $100, 000 for cooperative agreements with the U.S. Department of Health & Human Services (HHS) to develop programs that prevent the misuse of opioids by women.  Projects must include collaboration among local and regional organization and target gaps in reaching underserved populations, particularly girls aged 10-17 and women aged 50 and older. For projects targeting the health professional audience, applicants may want to consider using the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach to substance use disorders.

Policy Updates

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New CMS Care Management Webpage: CMS recently unveiled a new Care Management webpage on the Physician Fee Schedule website. This new webpage includes documents such as fact sheets and FAQs that will be useful for rural providers on chronic care management services, transitional care management, and similar services under the Medicare physician fee schedule.  Rural providers should bookmark the new webpage and check back often for new content.

New Regulations on Substance Use Disorder Patient Records – Effective February 17. In mid-January, the Substance Abuse and Mental Health Services Administration (SAMHSA) published its final rule updating the Confidentiality of Alcohol and Drug Abuse Patient Records regulations for the facilitation and exchange of patient substance use records.  This final rule addresses privacy concerns of patients seeking treatment for substance use disorder and provides further guidance on patient consent.  All programs or providers that receive federal funding including rural providers and programs are subject to the provisions of this final rule.  For more information, visit SAMHSA’s Substance Abuse Confidentiality Regulations Webpage.

AHRQ Seeks Information From Healthcare Delivery Organizations – February 28. The Agency for Healthcare Research and Quality (AHRQ) is seeking comments from healthcare delivery organizations about current challenges they are facing as well as solutions they are implementing as they strive to become learning healthcare systems.  This is an opportunity for rural accountable care organizations and other rural providers to provide input on their challenges and achievements.  As discussed in this request, a learning healthcare system is as an organization that is designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care.  Recommendations on ways in which AHRQ can assist healthcare providers in achieving their learning network goals are also being requested.  Comments can be submitted on or before February 28, 2017.

New Deadline for Hospital Data Submission – March 13  The Centers for Medicare & Medicaid Services (CMS) recently announced that the deadline for submitting 2016 electronic clinical quality measure (eCQM) data has been extended from February 28 to March 13. The extension allows hospitals and critical access hospitals (CAHs) participating in the Hospital Inpatient Quality Reporting (IQR) or Medicare Electronic Health Records (EHR) Incentive (i.e., “meaningful use”) programs additional time to submit the necessary eCQM data to avoid a 2.7% payment reduction in 2018. Under these programs, CMS requires hospitals and CAHs to report on at least four eCQMs using 2014- or 2015-certified EHRs. Of note, CMS is considering modifying the number of required eCQMs for 2017 reporting for future rulemaking. CMS also notes that it plans to address stakeholder concerns and challenges related to EHR systems and eCQM reporting in the FY 2018 Inpatient Prospective Payment System (IPPS) rule.  Rural providers and other stakeholders interested in commenting on these and other issues should plan to submit comments on the proposed rule, which should be published in late spring 2017.

New Home Health Care Rules.  In the first update since 1989, CMS’ final rule for home health agencies (HHAs)  modernizes and streamlines requirements to incorporate recent advances and medical practices that focus on patient-centered, data-driven, and outcome-oriented care. Among the changes, CMS now requires HHAs to inform all beneficiaries of patient rights and responsibilities prior to care delivery, assess all admitted patients’ risk for re-hospitalization, and implement agency-wide quality assessment and performance improvement (QAPI) programs. Of note for HHAs in rural areas disproportionately affected by physician shortages, CMS revised its policy to allow licensed practical nurses (LPNs) acting within their state licensure requirements and state scope of practice laws to receive verbal orders for home health services, although statute requires that only physicians establish the home health plan of care. The final rule takes effect July 13.

Resources, Learning Events and Technical Assistance

Small and Rural Practices Webinar on MIPS – Wednesday, February 1 from 1:00 – 2:15 pm ET. This webinar will provide information for small, rural, and underserved practices on the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program.  During the webinar, CMS will provide information about the following MIPS topics: Eligibility; Participation in 2017; Data submission methods; Performance categories; Scoring; and Resources for small, rural, and underserved practices.

Resource of the Week

The Catalog of Value-Based Initiatives for Rural Providers has been made available online by Rural Health Value. This document catalogs and summarizes rural-relevant, value-based programs recently implemented by the Centers for Medicare & Medicaid Services (CMS), including the Center for Medicare & Medicaid Innovation (CMMI). Its purpose is to help rural leaders and communities identify HHS value-based programs appropriate for rural participation.

Approaching Deadlines

Comment: Health Workforce Connector – February 3
Comment: PACE Innovation Act – February 10
NURSE Corps Loan Repayment Program – February 23
AHRQ Seeks Information From Healthcare Delivery Orgs – February 28
Community Facilities Program – Ongoing