In an open-access article in the New England Journal of Medicine, top officials at the U.S. Department of Health & Human Services (HHS) describe the rationale and approach for a newfound focus on climate change.  The effort began with an executive order in January 2021 that created the new Office of Climate Change and Health Equity, charged with acting on health threats caused by extreme weather and prioritizing vulnerable populations.  According to the Fourth National Climate Assessment, increasingly severe events – rising temperatures, fire, flooding, land erosion – will affect every region of the country and have an outsized impact on rural residents and economies.

HRSA has established a process that accounts for extenuating circumstances that may have prevented providers from submitting a completed Provider Relief Fund report. From Monday, April 11 to Friday, April 22, 2022, at 11:59 pm ET, providers will have the opportunity to submit a request for Reporting Period 1 reports.

Department Responds in Record Time to Meet the Growing Health Care Needs in Rural America

U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small today announced that USDA is awarding $10.5 million in Emergency Rural Health Care Grants to 18 rural health care organizations and community groups in Pennsylvania.

“No matter where you live, people deserve good health care, and the Biden-Harris Administration is committed to making that a reality throughout rural America,” Torres Small said. “Through the Emergency Rural Health Care Grants Program, USDA is improving access to the critical health care services rural people rely on every day here in rural Pennsylvania, and we are proud to have such strong partners like Representatives Cartwright and Wild.”

The Biden-Harris Administration made these funds available through its historic legislative package, the American Rescue Plan Act. Within months after the Act’s passage, USDA responded quickly by making this funding available to ensure the long-term availability of rural health care services.

The grants USDA is awarding will help rural hospitals and health care providers implement telehealth and nutrition assistance programs, increase staffing, build or renovate facilities, and purchase medical supplies.

Torres Small made the announcement at the Greater Pittston Ambulance Rescue Service Association. The association is one of 18 recipients to receive grant funds in Pennsylvania. It will use a $226,900 grant to purchase approximately 200 pieces of medical equipment for emergency and ambulatory services. The equipment includes LIFEPAK monitors, therapy cables and reusable blood pressure cuffs.

The complete news release including all 18 projects that were announced can be viewed on our website.

The Centers for Medicare & Medicaid Services (CMS) announced a series of Cross-Cutting Initiatives (CCIs) that will drive the Centers’ and Offices’ strategic vision to advance health equity, expand coverage, and improve health outcomes.  In addition to advancing the six strategic pillars that CMS announced last year, the CCI’s aim to improve behavioral and maternal health coverage, drug price affordability, and rural health care delivery along with strengthening quality improvement strategies and ensuring coverage for eligible individuals post-pandemic.  The CCIs will also identify opportunities to streamline the consumer experience of CMS’ coverage programs and expand coverage, while leveraging data to drive innovation and person-centered care.  CMS is committed to track, monitor, and refine success measures for these initiatives in partnership with stakeholders and to report on progress to the public.

For more information visit the CCI webpage: https://www.cms.gov/cms-strategic-plan

Learn more about the Cross-Cutting Initiatives Fact Sheet: Overview fact sheet (PDF)

Learn more about the CMS Quality Strategy: National Quality Strategy Fact Sheet (PDF)

Learn more about Behavioral Health:

• Fact Sheet: Behavioral Health Strategy Fact Sheet (PDF)
• Webpage: https://www.cms.gov/About-CMS/Story-Page/behaviorial-health

In January, the Senate Health, Education, Labor, and Pensions (HELP) Committee introduced their bipartisan legislation, the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics (PREVENT Pandemics) Act.

This legislation is designed to respond to the current, and prepare for future, public health emergencies (PHE). In February, NRHA provided comments on critical rural needs for Committee consideration before mark-up. NRHA is pleased that many rural provisions were included in the Committee passed version of the bill. That said, more can be done to improve the rural public health infrastructure through this bill.

NRHA needs member support to ensure successful advocacy for: 1) the creation of an Office of Rural Health within the CDC, 2) additional capital funding for rural providers to improve their infrastructure, and 3) rural representation in all new funding and grant opportunities.  

 It is now time to gain momentum on ensuring that rural friendly provisions are included in the final passage of this legislation, and we need your help! NRHA urges you to use our pre-drafted Advocacy Campaign to communicate the need for rural friendly tweaks to this important legislation. As a reminder, an Advocacy Campaign is a short message you can send to your elected officials on key issues. The Advocacy Campaign for the PREVENT Pandemics Act can be found here. NRHA has provided pre-drafted language urging your elected officials to support rural friendly tweaks to this important legislation. While the pre-drafted language is sufficient, we encourage you to tell your story in the text as well. You can edit the language to explain how the amendments to the PREVENT Pandemics Act will specifically benefit your facility and community. Elected officials rely on feedback from YOU to understand what is needed in their communities.

In the coming weeks, we will also be introducing an Advocacy Campaign on the Fiscal Year 2023 appropriations cycle. 

As always, if you have any questions or would like additional information, do not hesitate to reach out. You can email me at lcostello@ruralhealth.us. 

CMS issued its fiscal year (FY) 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS) proposed rule, which includes asking for public feedback on how staffing in nursing homes and health equity improvements could lead to better health outcomes.

The proposed rule builds upon the Biden-Harris Administration’s commitment to advance health equity, drive high-quality person-centered care, and promote sustainability of its programs. The rule is an important step in fulfilling its goal to protect Medicare skilled nursing facility (SNF) residents and staff by improving the safety and quality of care of the nation’s SNFs (commonly referred to as nursing homes). The SNF PPS provides Medicare payments to over 15,000 nursing homes, serving more than 1.5 million people. Medicare spending to nursing homes is projected to be approximately $35 billion in FY 2022. Through the SNF PPS proposed rule, CMS is continuing its work to transform the SNF payment system to a more patient-centered model by making payments based on the needs of the whole patient, rather than focusing on the volume of certain services the patient receives.

“Everyone deserves to receive safe, dignified, and high-quality care, no matter where they live,” said HHS Secretary Xavier Becerra. “Today we are starting the necessary work to ensure our loved ones living in nursing homes receive the best care at the staffing levels they need. We are working hard to deliver on President Biden’s commitment to protecting seniors and improving the quality of our nation’s nursing homes.”

The SNF PPS proposed rule aims to realize the President’s vision for the nation’s nursing homes as outlined in his State of the Union Address, with a focus on providing safe, dignified, and appropriate care for residents. As part of this vision, the Biden-Harris Administration recently set a goal to improve the quality of nursing homes so that seniors, people with disabilities, and others living in nursing homes get the reliable, high-quality care they deserve. A key part of reaching this goal is addressing staffing levels in nursing homes, which have a substantial impact on the quality of care and outcomes residents experience.

“The COVID-19 pandemic has highlighted serious problems at some of the nation’s nursing homes that have persisted for too long. And we have seen the tragic impact that inadequate staff resources can have on residents and staff,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration has promised that we will work with all stakeholders to do better for nursing home residents, and today’s proposed rule includes important steps toward our goal to promote safety and quality of care for all residents and staff.”

In the SNF PPS proposed rule, CMS is soliciting input to help the agency establish minimum staffing requirements that nursing homes will need to meet to ensure all residents are provided safe, high-quality care, and nursing home workers have the support they need. This input will be used in conjunction with a new research study being conducted by CMS to determine the optimal level and type of nursing home staffing needs. The agency intends to issue proposed rules on a minimum staffing level requirement for nursing homes within one year.

CMS is also requesting stakeholder input on a measure that would examine staff turnover levels in nursing homes for possible inclusion in CMS’ SNF Value-Based Purchasing (VBP) Program, which rewards facilities with incentive payments based on the quality of care they provide to people with Medicare. Looking at the relationship between staff turnover and quality of care, preliminary analysis by CMS has shown that as the average staff turnover decreases, a facility’s overall rating on CMS’ Nursing Home Five Star Quality Rating System increases, which suggests that lower turnover is associated with higher overall quality. CMS will use the stakeholder feedback to inform a proposal of this measure to include in the SNF VBP Program in the future.

In January, CMS began posting nursing home staff turnover rates (as well as weekend staff levels) on the Medicare.gov Care Compare website, and CMS will be including this information in the star rating system starting in July 2022. This information helps consumers better understand each nursing home facility’s staffing environment and also helps providers to improve the quality of care and services they deliver to residents.

The proposed rule also proposes the adoption of 3 new measures into the SNF VBP Program:

• The Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (SNF HAI) is an outcome measure that assesses SNF performance on infection prevention and management.
• The Total Nursing Hours per Resident Day is a structural measure that uses auditable electronic data to calculate total nursing hours per resident each day.
• The Adoption of the Discharge to Community – Post Acute Care Measure for SNFs (DTC) is an outcome measure that assesses the rate of successful discharges to community from a SNF setting.

To advance health equity and address the health disparities that underlie the U.S. health care system, CMS is requesting stakeholder feedback on the role health equity plays in improving health outcomes and the quality of care in nursing homes. Specifically, CMS is seeking comment on how to arrange or classify measures in nursing home quality reporting programs by indicators of social risk to better identify and reduce disparities.

CMS is proposing a 3.9%, or $1.4 billion, update to the payment rates for nursing homes, which is based on a 2.8% SNF market basket update plus a 1.5 percentage point market basket forecast error adjustment and less a 0.4 percentage point productivity adjustment. The proposed rule also contains a proposed adjustment to payment rates as the result of the transition to the SNF payment case-mix classification model  ̶  the Patient Driven Payment Model (PDPM) that went into effect on October 1, 2019. When finalizing the PDPM, CMS also stated that the transition to PDPM would not result in an increase or decrease in aggregate SNF spending. Since PDPM implementation, CMS’ data analysis has shown an unintended increase in payments. Therefore, CMS is proposing to adjust SNF payment rates downward by 4.6%, or $1.7 billion, in FY 2023 to achieve budget neutrality with the previous payment system. As a result, the estimated aggregate impact of the payment policies in this proposed rule would be a decrease of approximately $320 million in Medicare Part A payments to SNFs in FY 2023 compared to FY 2022.

More Information:

• Proposed rule
• Fact sheet: President Biden’s remarks during the State of the Union Address on improving nursing home safety and quality
• Fact sheet: FY 2023 SNF PPS proposed rule