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Announcements from the Federal Office of Rural Health Policy

May 17, 2017

What’s New

Updated Website for Mapping Health Trends.  The Centers for Disease Control and Prevention have updated their interactive database providing information about health status by geographic location.  The tool collects data from multiple sources on obesity, physical activity, eating habits and other behaviors and allows the users to sort by state and topic area and customize charts and maps, which may help rural stakeholders with funding applications and policy decisions.

Barriers to Telehealth.  The U.S. Government Accountability Office (GAO) has released a report showing that low uptake of telehealth services may be due to regulatory restrictions and inadequate reimbursement and payment methods.  The GAO found that Medicare, with many beneficiaries in rural areas, lags behind other federal programs in implementing telehealth services.

Resources for Cyber Security.  The U.S. Department of Health & Human Services has issued a number of updates and resources in the wake of ransomware threats to cyber security last week.  Though there are few reports of malicious software impacting organizations in the United States, the international cyber-attack did affect computer networks of some large corporations and health systems in Europe, Asia and Australia.  The updates are provided by HHS’ Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE). As an article in the Rural Monitor explained earlier this year, rural and smaller facilities may not be targeted more, but rural facilities tend to have less training, resources, and protections in place.

Funding Opportunities

Health Information Technology (IT) ResearchOngoing.  For rural providers who have participated in Meaningful Use and/or other CMS clinical Quality Measure Programs, two new funding opportunities from the Agency for Healthcare Research and Quality may offer an opportunity to contribute to improving health information technology (HIT). The first, New HIT Strategies for Patient-Reported Outcome Measures (U18) invites applicants to stimulate innovative research with data collected from patient-reported outcomes in primary care and other ambulatory care settings. The second, HIT to Improve Health Care Quality and Outcomes (R21) seeks to contribute to the evidence base for improved health care quality and outcomes through HIT. Applications to these programs will be accepted on a rolling basis.

Policy Updates

Questions about Rural Health Policy Updates? Write to ruralpolicy@hrsa.gov

Comments Requested: Updated Hospital Rates and Reducing Regulatory Burden – June 13.   CMS has proposed updates to the Medicare Hospital Inpatient Prospective Payment System (IPPS) and requests feedback from the public on efforts to reduce regulatory burden. This is an opportunity for rural stakeholders to provide CMS with a rural perspective on reducing regulatory burden and improving quality of care for rural patients.   Rural hospitals should note that two programs, the Medicare-Dependent Hospital (MDH) program and the Low-Volume Hospital (LVH) payment adjustment, will expire on October 1, 2017. CMS projects that the sunset of the MDH program, as required by MACRA, will reduce payments to current MDHs by $119 million. The proposed update would also establish an uncompensated care pool of $7 billion for Disproportionate Share Hospitals (DSH).  Changes to the distribution methodology are estimated to increase uncompensated care payments to rural hospitals by 31%.  For inpatient services at Critical Access Hospital (CAH) payable under Medicare Part A, the statute requires that a physician certify that an individual may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission.  This update proposes to de-emphasize review of the 96-hour requirement on or after October 1, 2017.  Medicare contractors including Quality Improvement Organizations (QIOs), Medicare Administrative Contractors (MACs), the Supplemental Medical Review Contractor (SMRC), and Recovery Audit Contractors (RACs) would not review medical records unless there are concerns of probable fraud, waste or abuse of the coverage requirement.

Comments Requested:  Long-Term Care Hospital Payments – June 13.  Along with the IPPS update, CMS has proposed updates to the Long-Term Acute Care Hospital (LTCH) Prospective Payment System (PPS) and the related LTCH Quality Reporting Program (LTCH QRP).  Nationwide, most inpatients are treated in acute care hospitals, but some are admitted to LTCHs. This proposal would update the LTCH PPS payment rate by 1%, consistent with the provisions of MACRA.  The overall impact on rural LTCHs would be a reduction of 0.7%.  Proposed changes to the FY 2020 LTCH QRP would add measures assessing pressure ulcer changes, compliance with a spontaneous breathing trial, and ventilator liberation rates.

Comments Requested: Interoperability Standards – July 31. Rural providers with experience using electronic health records can provide feedback to the Office of the National Coordinator for Health Information Technology (ONC) on a proposed framework for measuring and assessing healthcare interoperability standards. This framework would help health IT developers, health information exchange (HIE) organizations, and health care providers move towards a set of uniform measures to assess interoperability progress.

Participating in MIPS? CMS has released an interactive tool on the CMS Quality Payment Program website for clinicians to determine if they should participate in the Merit-based Incentive Payment System for 2017.  Rural clinicians that bill Medicare Part B more than $30,000 a year AND see more than 100 Medicare patients a year qualify for participation in 2017.  To learn more about participation criteria, review the MIPS Participation Fact Sheet or email questions to QPP@cms.hhs.gov.

Criteria for Home and Community-Based SettingsCMS released an informational bulletin that extends the transition period for states to demonstrate compliance with the home and community-based settings criteria until March 17, 2022 for settings that were operating before March 17, 2014.  States should continue progress in assessing existing operations and identifying milestones for compliance that result in final Statewide Transition Plan approval by March 17, 2019. Rural providers, State Offices of Rural Health, and other key stakeholders are encouraged to continue to work with states to ensure HCBS compliance activities are collaborative, transparent, and timely.

Resources, Learning Events and Technical Assistance

Substance Abuse in Rural Communities: Prevention and Treatment – Wednesday, May 17 at 2:00 pm ET**.   The Rural Health Information Hub (RHIhub) and NORC Walsh Center for Rural Health Analysis will introduce a new Rural Prevention and Treatment of Substance Abuse Toolkit providing best practices for implementing prevention programs, treatment and support services in rural communities. This webinar will feature two examples of successful programs funded by FORHP, including lessons learned. **As with all RHIHub webinars, the transcript, audio and PowerPoint slides for this event will be archived on the website for later viewing.  

CLAS for Rural Communities – Wednesday, May 17 from 3:00 – 4:30 pm. The second webinar in SAMHSA’s Rural Behavioral Health series will focus on Culturally and Linguistically Competent Behavior for diverse populations in rural communities.

Application Assistance: Building Communities of Recovery – Thursday, May 18 at 2:00 pm ETRural communities have been hit particularly hard by the opioid epidemic and our federal partners at the Substance Abuse and Mental Health Services Administration (SAMHSA) have announced funding for Building Communities of Recovery, a grant program to increase the prevalence and quality of Recovery Community Organizations.  RCOs are tax-exempt nonprofit organizations composed of a majority of individuals in recovery from substance abuse disorder.  This webinar will provide important information for the application process.  To join the event, enter conference number PWXW4130923 and passcode 1412471.  For additional information about the BCOR funding opportunity, contact Matthew Clune at matthew.clune@samhsa.hhs.gov.

Training Series for Health Care Providers on Prescribing Opioids – Ongoing. The CDC has launched 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. This is why the CDC created the 2016  Guideline for Prescribing Opioids for Chronic Pain and associated training. The first training,  Addressing the Opioid Epidemic: Recommendations from CDC is available in archive. Topics in the series include communicating with patients, treating chronic pain without opioids, and prescribing decision making.

Safety Training on Dairy Farms Using Mobile-Learning – Thursday, May 25 at 1:00 pm ET.  AgriSafe will host this hour-long webinar with a novel approach to delivering safety training to vulnerable workers in the dairy industry.

National Rural Institute on Alcohol and Drug Abuse – June 11-15.   Registration is now open for this annual event in Menomonie, Wisconsin that brings together federal agency representatives and rural alcohol and drug treatment professionals to conference on the latest in evidence-based practices for rural areas.

Approaching Deadlines

Comment: Advanced Alternative Payment Model – May 18
Comment: Accelerating Broadband Health Tech Availability – May 24

Improving Rural Economies – May 26
Comment: Delayed Rules For Home Health Agencies – June 2
Become an NHSC Site – June 6

Behavioral Health Workforce Education and Training – June 12
Diabetes Prevention Program in Underserved Areas – June 12
Comment: Updated Hospital Rates/Reducing Regulatory Burden – June 13
Comments:  Updates to Long-Term Care Hospital Payments – June 13
Relatives As Parents Program – June 15

NIDA Funding To Expand Treatment For Opioid Abuse – June 20
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

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