On July 1, 2019, the Federal Office of Rural Health Policy (FORHP) announced that it will award approximately $2.2 million to 25 awardees for the 2019 Rural Health Network Development Planning Program (Network Planning). This is a one-year, community-driven program designed to assist in the planning and development of an integrated health care network at the local level. By emphasizing the role of networks, the program creates a platform for medical care providers, social service providers, and community organizations to coalesce key elements of a rural health care delivery system for the purpose of improving local capacity and coordination of care.

The Network Planning program will aid providers as they move from focusing on the volume of services to focusing on the value of services. For grantees, the award (of up to $100,000) provides an opportunity to implement new and innovative approaches towards a dynamic health care environment that may in turn serve as a model for other rural communities. The incoming cohort of Network Planning grantees have projects that focus on building, strengthening, and formalizing integrated health care networks and systems, developing training cooperatives, conducting community health needs assessments, increasing service capacity, addressing behavioral and mental health conditions, and addressing the rural opioid epidemic.

Historically, previously awarded grantees have been successful in leveraging finances by using FORHP grants to sustain their efforts; they have been able to combine federal funds with local and foundation dollars to support the continuation and development of health care services in rural areas. Organizations have also demonstrated the ability to achieve innovative expansion and replication of their funded projects to successfully serve additional populations and regions, providing support to other rural communities with similar healthcare needs.

As FORHP continues to focus on showcasing program outcomes, the identification and dissemination of rural evidence-based models maintains as a priority. The Rural Community Health Gateway, located on The Rural Health Information Hub (RHIhub) consists of a number of resources, including successful program models and evidence-based toolkits.

If you have any questions about the program, please contact Jillian Causey:  JCausey@hrsa.gov or 301-443-1493.

The Federal Office of Rural Health Policy is pleased to announce approximately $6.3 million in grant awards to 32 rural communities across 19 states for the Small Health Care Provider Quality Improvement (Rural Quality) Program.  Each award recipient will receive up to $200,000 per year for a three-year project period to improve to patient health outcomes through implementation of activities designed to address improvements to the quality and delivery of rural health care services in primary care settings.  Organizations participating in the Rural Quality Program are required to utilize an evidence-based or promising practice quality improvement model, perform tests of change focused on improvement, and use health information technology (HIT) to collect and report data.  The Incoming cohort of Rural Quality grantees include projects that focus on substance use disorders and chronic disease conditions, such as diabetes and cardiovascular disease, and propose goals to integrate metal/behavioral health and primary care, enhance chronic disease management, improve transitions of care, reduce preventable hospital and emergency department utilization and better engage patients and their caregivers.  Several projects also align with national quality improvement initiatives such as value-based care and the accreditation and application of the patient centered medical home model. Historically, grantees have demonstrated success in leveraging finances by using FORHP grants to sustain their efforts; they have been able to combine federal funds with local and foundation dollars to support the continuation and development of health care services in rural areas.  Organizations have innovatively expanded their programs to serve different populations and regions while ensuring alignment with the current health care landscape.

As FORHP continues to focus on showcasing program outcomes, the identification and dissemination of rural evidence-based models maintains as a priority.  The Rural Community Health Gateway, located on The Rural Health Information Hub (RHIhub) consists of a number of resources, including successful program models and evidence-based toolkits.  If you have any questions about the program, please contact Katherine Lloyd:  Klloyd@hrsa.gov or 301-443-2933.  Thank you for your continued support and dedication to rural health!

On July 29, 2019, the Centers for Medicare and Medicaid Services (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, 2020. 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
• Proposes changes to the ESRD Quality Incentive Program
• Includes requests for information on data collection resulting from the ESRD PPS technical expert panel, on possible updates and improvements to the ESRD PPS wage index, and on new rules for the competitive bidding of diabetic testing strips.

In addition, this rule proposes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services and making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts. This rule would also:

• Make amendments to revise existing policies related to the competitive bidding program for DMEPOS
• Streamline the requirements for ordering DMEPOS items, and create one Master List of DMEPOS items that could potentially be subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements

The proposed CY 2020 ESRD PPS base rate is $240.27, an increase of $5.00 to the current base rate of $235.27.  This proposed amount reflects a reduced market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.7 percent) and application of the wage index budget-neutrality adjustment factor (1.004180).

The proposed rule also includes:

• Annual update to the wage index
• Update to the outlier policy
• Eligibility criteria for the Transitional Drug Add-on Payment Adjustment (TDAPA)
• Basis of Payment for the TDAPA for calcimimetics
• Average sales price conditional policy for the application of the TDAPA:
• New and innovative renal dialysis equipment and supplies
• Discontinuing the application of the erythropoiesis-stimulating agent monitoring policy
• Impact analysis:

For more information see:

• Proposed Rule: Public comments due by September 27, 2019
• Press Release

See the full text of this excerpted CMS Fact Sheet (issued July 29, 2019).

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) proposed policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Health Care to Put Patients First,” that lay the foundation for a patient-driven health care system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.

The proposed changes also encourage site-neutral payment between certain Medicare sites of services.  Finally, the proposed rule proposes updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed polices in the CY 2020 OPPS/ASC Payment System proposed rule would further advance the agency’s commitment to increasing price transparency, (including proposals for requirements that would apply to each hospital operating in the United States), strengthening Medicare, rethinking rural health, unleashing innovation, reducing provider burden, and strengthening program integrity so that hospitals and ambulatory surgical centers can operate with better flexibility and patients have what they need to become active health care consumers.

In accordance with Medicare law, CMS is proposing to update OPPS payment rates by 2.7 percent. This update is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for Multi-Factor Productivity (MFP).

In the CY 2019 OPPS/ASC final rule with comment period, we finalized our proposal to apply the hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023). CMS is not proposing any changes to its policy to use the hospital market basket update for ASC payment rates for CY 2020-2023. Using the hospital market basket, CMS proposes to update ASC rates for CY 2020 by 2.7 percent for ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for MFP. This change will also help to promote site neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ASC setting.

The proposed rule also includes:

• Proposed definition of ‘hospital,’ ‘standard charges,’ and ‘items and services’
• Proposed requirements for making public all standard charges for all items and services
• Proposed requirements for making public consumer-friendly standard charges for a limited set of ‘shoppable services’
• Proposals for monitoring and enforcement
• Method to control for unnecessary increases in utilization of outpatient services
• Changes to the Inpatient Only list
• ASC covered procedures list
• High-cost/low-cost threshold for packaged skin substitutes
• Device pass-through applications
• Addressing wage index disparities
• Changes in the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals
• Hospital Outpatient Quality Reporting Program
• Ambulatory Surgical Center Quality Reporting Program
• CY 2020 OPPS payment methodology for 340B purchased drugs
• Partial Hospitalization Program rate setting and update to per diem rates
• Revision to the organ procurement organization conditions for certification
• Potential changes to the organ procurement organization and transplant center regulations: Request for Information

For more information see:

• Proposed Rule: Public comments due by September 27, 2019
• Press Release

See the full text of this excerpted CMS Fact Sheet (issued July 29, 2019).

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. This proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation. It also includes proposals to streamline the Quality Payment Program with the goal of reducing clinician burden. This includes a new, simple way for clinicians to participate in our pay-for-performance program, the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways.

The proposed rule also includes:

• CY 2020 PFS rate setting and conversion factor
• Medicare telehealth services
• Payment for evaluation and management services
• Physician supervision requirements for physician assistants
• Review and verification of medical record documentation
• Care management services
• Comment solicitation on opportunities for bundled payments
• Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
• Bundled payments for substance use disorders
• Therapy services
• Ambulance services
• Ground ambulance data collection system
• Open Payments Program
• Medicare Shared Savings Program
• Stark advisory opinion process

For More information see:

• Proposed Rule: Public comments due by September 27, 2019
• Press Release
• PFS Proposed Rule Fact Sheet
• Quality Payment Program Proposed Rule Fact Sheet

See the full text of this excerpted Fact Sheet (Issued July 29, 2019).

Earlier this year, the Rural Health Information Hub (RHIhub) launched a toolkit that provides steps and resources for connecting with philanthropic organizations focused on rural health.  The RHIhub recently released two videos featuring participants and highlights of the seventh annual Public-Private Collaborations in Rural Health Meeting that took place in May. The agenda this year included topics related to housing and the opioid epidemic, and featured a discussion of the Surgeon General’s Health and Prosperity Initiative.  Click here to access the toolkit.

Last year, the Centers for Medicare & Medicaid Services (CMS) created a scorecard to improve public transparency and accountability of two state-based programs, Medicaid and the Children’s Health Insurance Program (CHIP), and recently added new data.  The Scorecard reports measures on State Health System Performance (i.e. postpartum care and follow-up after hospitalization for mental illness), State Administrative Accountability (i.e., days to get information on State Plan Amendments), and Federal Administrative Accountability (i.e., time to approve waiver requests) with the intent of driving improvement in beneficiary outcomes and administration of the programs.  Medicaid is an important source of health coverage for rural populations covering about a quarter of nonelderly rural individuals.   The scorecard can be accessed here.

Harrisburg, PA – (July 25, 2019)  Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller and Pennsylvania Department of Community and Economic Development (DCED) Secretary Dennis Davin have submitted comments to the United States Department of Housing and Urban Development (HUD) indicating the Wolf Administration’s strong opposition to a federal proposal that would withhold housing assistance from some immigrant families.

In a letter to HUD Secretary Ben Carson, secretaries Miller and Davin advocate for the continuation of the current prorating system, which provides a method for public housing authorities (PHAs) to support the housing needs of low-income children and adults who are U.S. citizens or have an eligible immigration status who live with someone who is ineligible. These are considered mixed status families.

Under the proposed rule, a household would no longer receive any housing assistance unless every member residing in the home is of eligible immigration status, eliminating the current policy of prorating assistance according to the number of eligible persons in the home.

“Children are the largest group benefitting from the current policy, and they would be the most harmed by a rule change to exclude mixed-eligibility families from access to affordable housing,” Secretary Miller said. “We are speaking up on behalf of those children and urging the Department of Housing and Urban Development to reconsider this discriminatory proposal.”

At the very least, the secretaries argue, a grandfathering provision should be included to allow families that are currently receiving a prorated subsidy to remain until they choose to no longer participate in a Section 214 program.

“Rather than stripping away housing assistance from the families and children who need it most, the federal government should be focusing on strengthening our communities and empowering individuals to break the cycle of poverty,” Secretary Davin said. “This policy would place undue burden on our public housing authorities that are providing crucial housing services. We urge HUD to rethink this approach.”

If implemented, this new policy would add unnecessary stress to an already overburdened system of Pennsylvania Public Housing Authorities. Instead of working with low-income families to secure stable housing, the PHAs would be forced to spend valuable time and money to exclude mixed-eligibility families from access to affordable housing.

“The departments of Human Services and Community and Economic Development exist to strengthen Pennsylvania communities, but this federal proposal undermines that mission,” Secretary Miller said. “We call on the Trump Administration to reverse course and abandon its effort to implement a policy that will discriminate against the most vulnerable families and ultimately harm children.”

For more information about housing assistance in Pennsylvania, visit https://dced.pa.gov/housing-and-development/ and http://www.dhs.pa.gov/citizens/housing/.

MEDIA CONTACT: Erin James, DHS – 717-425-7606; Michael Gerber, DCED – 717-783-1132

The Pennsylvania State Data Center recently updated their Detailed Population Estimates Dashboard. Now powered by Tableau, users can access state and county level data on the total population, the change in population since 2010, and detailed characteristics like sex, age, race, and Hispanic origin.  Click here to visit the dashboard.

Did you know?

Pennsylvania’s number of self-employed drivers more than doubled from 2015 to 2017, according to the latest Nonemployer Statistics (NES) from the U.S. Census Bureau, adding over 18,000 drivers (+142%).  Click here to view the percent change by county.  Click here for more information on self-employed drivers from the U.S. Census Bureau.

Other Highlights from the Data Center

     2018 Detailed Population Estimates Report

This brief uses data from the U.S. Census Bureau’s 2018 Detailed Population Estimates to report changes in Pennsylvania’s Population by age, sex, race, and Hispanic origin. Click here to read the full brief.

     Neighboring Municipalities and Commuting Flows Visualization

This interactive visualization shows patterns in the place of residence and place of work for Pennsylvanians. It includes four categories which expand our understanding of commuter flows by considering those who work (or do not work) in a municipality that neighbors the municipality in which they live. Click here to view.