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Announcements from the Federal Office of Rural Health Policy

October 31, 2016

What’s New

Health Insurance Marketplace Help for Rural Communities – TODAY, Monday, October 31 at 2:00 pm ET.  Open Enrollment for the Health Insurance Marketplace begins on Tuesday, November 1st. Rural communities can tune into this month’s “FOHRP, ACA and You” Office Hours for a one-hour webinar to hear our Community Benefit and Outreach grantees share strategies for reaching special populations such as veterans and those without internet access.  Recordings of this and all Office Hours webinars will be available on the FORHP ACA page about one week after the session.

CMS Finalizes Quality Payment ProgramOn October 19, The Centers for Medicare & Medicaid Services (CMS) released a final rule with comment period implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program (QPP) that affects over 600,000 clinicians providing Medicare Part B services. CMS also launched a new QPP website to explain the program and help clinicians identify the measures most meaningful to their practice or specialty.

What do rural providers need to know?

  • The final rule allows for flexibility in participating in the program during the first year.
  • Eligible clinicians below the low-volume threshold would be excluded from MIPS.  The final rule defines the threshold as having Medicare Part B allowed charges less than or equal to $30,000 or 100 or fewer Part B-enrolled Medicare beneficiaries
  • Rural Health Clinics and Federally Qualified Health Centers have the option to voluntarily report on applicable measures and activities with no penalty in order to remain in alignment with broader efforts under Delivery System Reform.

The provisions of this final rule with comment period are effective on January 1, 2017.

To learn more about the final rule and the Quality Payment Program, please see the executive summary, fact sheet and other resources.  CMS is also providing opportunities to better understand this historic rule and program through a call presentation open to the public on Tuesday, November 15 at 1:30pm ET.

Funding Opportunities

Multiagency Funding to Assist with Opioid Crisis in Rural Areas. A new federal funding opportunity was announced to help find solutions to the opioid use and overdose crisis in the nation’s rural regions. It includes a focus on coal-impacted counties within Appalachia, as well as rural communities in other parts of the country. This initiative will support comprehensive, integrated approaches to prevent opioid injection and its consequences, including substance use disorder, overdose, HIV and hepatitis C virus infection, along with associated conditions, such as hepatitis B virus infection and sexually transmitted diseases. These projects will work with state and local communities to develop best practice responses to opioid injection epidemics that can be implemented by public health systems in the nation’s rural communities.  Letters of Intent for both programs are due December 10, 2016 for a January 10, 2017 application deadline. 

Advanced Nursing Education Workforce (ANEW) Program – January 25, 2017. Entities providing registered nurses with training that leads to master’s and/or doctoral degrees may be eligible to apply for the ANEW Program, which supports academic-practice partnerships to prepare advanced registered nursing students for primary care practice in rural and underserved areas.  Applicants can get technical assistance at a 90-minute webinar on Wednesday, November 9 at 2:00 pm ET.  Dial-in at 888-282-1744 ; passcode 6266489.

Rural Health Research

Rural Hospitals and Delivery System Reform. The HHS Office of the Assistant Secretary for Planning and Evaluation released a report that reviews what is currently known about rural health and  health care in delivery system reform.  The report found that many rural hospitals are participating in initiatives such as the Medicare Shared Savings Program even though most are not subject to mandated payment incentives or penalties. Despite the challenges they face, rural hospitals are performing better than urban hospitals on many measures.

Policy Updates

FORHP’s Policy Team is ready to answer any questions you may have about these updates at

Changes to Farm Bill Provisions  – Comment by November 28.  Last month, the USDA Food and Nutrition Service (FNS) issued a proposal to update general information and guidelines for the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program.  In addition to making the new program name formal, the proposed rule would 1) require states to issue households’ monthly SNAP benefits in one lump sum; and 2) clarify rules and timeline for clearing unused benefits (expungement) from user accounts.  Current policy allows states to delete funds only when the account has been inactive for one year.  Proposed policy would allow states to delete any funds that have not been used after 12 months, regardless of account activity.  FNS is particularly interested in receiving comments on expungement, rules for reinstating funds, and whether states should be given options on the process.

Final Rule: Consumer Protections for Long-Term Care Facility Residents.  In September, CMS issued a final rule updating the requirements for long-term care facilities to reflect current practice standards of person-centered care, improving resident safety and quality of life.  After the first comprehensive review since 1991, CMS now requires a data-driven quality assurance and performance improvement (QAPI) program, an infection prevention and control program (IPCP), and a compliance and ethics program at all Medicare-certified skilled nursing facilities and Medicaid-certified nursing facilities. In a change from the proposed rule, CMS withdrew its requirement for a medical evaluation before all non-emergency resident transfers. Of note for rural providers, the rule updates the subset of provisions applicable to swing beds at CAHs and PPS hospitals. Changes in this rule will be phased in over three years beginning November 28.

Final Rule:  Childcare and Development Fund.  On September 30, the Administration for Children and Families (ACF) published a final rule strengthening requirements to protect the health and safety of children in child care settings. The Child Care and Development Fund (CCDF) provides funding to states and territories to help low-income parents get child care while working.  In the first major update to the CCDF since 1998, this final rule requires more robust standards for child care providers, including mandatory background checks for staff; annual monitoring of all CCDF-funded childcare providers, and workforce training on 10 key health and safety topics such as first aid and CPR, medication administration, and the prevention of sudden infant death syndrome (SIDS). The rule also requires states and territories to describe strategies for increasing the supply and improving the quality of child care services in underserved areas. Rule changes are effective November 29 and states and territories are expected to be in full compliance by the end of the fiscal year (FY) 2016-2018 CCDF plan period.

ONC Health IT Program: Enhanced Oversight and Accountability: On October 14, 2016, the Office of the National Coordinator  for Health IT displayed the final rule for the ONC Health IT Certification Program, which gives the agency more direct  oversight of the health IT testing labs. The rule highlights the importance of  protecting public health and safety while strengthening transparency and accountability in the certification program.  This rule is intended to enable the ONC Health IT Certification Program to better support physicians and hospitals – the vast majority of whom use electronic health records – and the rapid pace of innovation in the health information technology market. Rural providers are encouraged to review the final rule with their electronic health records vendors in order to ensure compliance of the changes to the ONC Health IT Certification Program. Please see the fact sheet on this final rule for more information.

Resources, Learning Events and Technical Assistance

How to Report Across Medicare Quality Programs – Tuesday, November 1 from 1:30 – 3:30 pm ET.  In this 90-minute session from the Medicare Learning Network, rural providers can learn how to report quality measures during the 2016 program year to maximize your participation in Medicare quality programs, including the Physician Quality Reporting System (PQRS), Medicare Electronic Health Record (EHR) Incentive Program, Value-Based Payment Modifier (Value Modifier), and the Medicare Shared Savings Program. Satisfactory reporters will avoid the 2018 PQRS negative payment adjustment, satisfy the clinical quality measure component of the EHR Incentive Program, and satisfy requirements for the Value Modifier to avoid the downward payment adjustment. A question and answer session will follow the presentation. Space is limited so register in advance.

Learn about the PTAC – Wednesday, November 2 at 1:00 pm ET.  The Physician-Focused Payment Model Technical Advisory Committee was established by MACRA to receive feedback from stakeholders about Alternative Payment models and make recommendations to the Secretary of HHS.  This will be the first of three webinars providing background information about the PTAC and explaining the process for submitting proposals.  The second session will take place on Wednesday, November 16 at 2:00 and a third will be scheduled for late November.

Approaching Deadlines

Accountable Health Communities Model – November 3

Healthy Places for Healthy People – November 6

Nursing Workforce Diversity Program – November 14
Nurse Faculty Loan Repayment Program – November 14
Delta Health Care Services Grant Program – November 14
RWJF Health Policy Fellowship – November 15
Rural Health Network Development Program – November 28
Comment: Changes to Farm Bill Provisions  – November 28
Community Facilities Program – Ongoing


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