- Rural Hospitals Built During Baby Boom Now Face Baby Bust
- Food Stamps Go Further in Rural Areas — Until You Add Transportation Costs
- CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Texas
- CMS Proposes New Payments for Digital Health Under CY2025 PFS Draft Rule
- Improving Public Health by Strengthening Community Infrastructure
- Biden Harris Administration Proposes Policies to Reduce Maternal Mortality, Advance Health Equity, and Support Underserved Communities
- Nearly Half of U.S. Counties Don't Have a Single Cardiologist
- Randolph County, Ill. Turns Unused Part of Nursing Home Into State-Of-The-Art Behavioral Health Center
- Rural RPM Program Is a Lifeline for Pregnant Women
- Safe and Stable Housing Is a Foundation of Successful Recovery
- Expert: Rural Hospitals Are Particularly Vulnerable to Increasing Cyberattacks Targeting Healthcare Facilities
- Biden-Harris Administration Invests Over $200 Million to Help Primary Care Doctors, Nurses, and Other Health Care Providers Improve Care for Older Adults
- AJPH Call for Papers Special Section on Intersections of Public Health And Primary Care
- NIH HEAL Initiative Turns Attention to Pragmatic Trials in Rural Communities
- Limited Continuing-Care Options in Rural Virginia Create Challenges for an Aging Population
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.
HHS Takes Actions to Promote Safety & Quality in Nursing Homes
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
Exponential Growth in U.S. Dental Spending is Expected by 2030
According to a March 28 briefing from the Office of the Actuary at the U.S. Centers for Medicare and Medicaid Services, the annual spending on dental care in the U.S. is projected to increase over the next several years, reaching $230 billion by 2030.
Study Highlights Racial and Ethnic Disparities in Pediatric Asthma Care
An NIH-funded study found that Black children with asthma accessed community health centers less than white children, while Latino children were more likely to visit health centers for acute, chronic, and preventive care overall.
Medicare Enrollees Can Get Free COVID-19 Tests at Drug Stores
Amid worries that the latest coronavirus variant could spark another rise in cases, Medicare announced Monday that millions of enrollees will finally have access to free over-the-counter COVID-19 tests at drug stores. More than 59 million people with Medicare’s “Part B” outpatient coverage will be able to get up to eight free at-home tests per month, or enough for an individual to test twice a week, as some doctors have recommended. Read more.
Some Hesitant Parents are Warming to COVID-19 Vaccine, Poll Finds
A growing segment of the wait-and-see crowd may be warming to the idea of getting a COVID-19 shot for kids 5 and under, according to a poll provided exclusively to Axios from The Harris Poll. The Harris Poll found nearly half of parents who were unvaccinated themselves said they’d get the vaccine for their little kids, up from 35% in early February. It’s also well above the low of 22% later in February after a delay in Pfizer’s FDA authorization process was announced.
U.S. Health Care is Seriously Failing Women
American women of reproductive age score worse on just about every major health metric compared to their peers in other wealthy countries according to a new report from the Commonwealth Fund. The researchers looked at women ages 18–49 in 11 developed nations and found the U.S. had the highest maternal mortality rate by far at 23.8 maternal deaths per 100,000 live births. When broken out by race, the rate was 55.3 deaths per 100,000 births for Black women or about triple the 19.1 deaths per 100,000 for white women and 18.2 deaths per 100,000 for Hispanic women. American women also were among the most likely to have two or more chronic conditions, skip necessary care due to cost and have the worst rate of avoidable deaths.
The 2022 Telehealth Billing Guide Announced
The Center for Connected Health Policy (CCHP) has released an updated billing guide for telehealth encounters. The guide takes into consideration temporary Public Health Emergency (PHE) policies as well as permanent post-PHE policies. The guide provides an overview of billing terminology and service codes, as well as topics such as chronic care management and remote patient monitoring.
HealthChoices 2022 Reassignment has been Delayed to August 1
The Pennsylvania Department of Human Services indicated that transition milestones for the new Physical HealthChoices contracts have been shifted. The new date for managed care organization (MCO) readiness reviews is April 22, 2022, dissemination of letters to patients about selecting or being assigned to a new MCO will be delayed until after the readiness review process, and the launch date for 2022 MCO assignments will move to August 1, 2022.
Medicaid and CHIP Extended Postpartum Coverage Takes Effect
In an announcement released last Friday, the Centers for Medicare and Medicaid Services (CMS) reminded states that beginning, April 1, 2022, they can provide 12 months of continuous postpartum coverage to Medicaid and CHIP enrollees as part of the American Rescue Plan Act (ARP). States must submit a state plan amendment for this option. This announcement comes at a crucial time when enrollees who have retained continuous postpartum coverage throughout the Public Health Emergency (PHE) are at risk of losing it when the PHE unwinding begins. This infographic from the Modern Medicaid Alliance provides more information about maternal health through Medicaid.