Rural Health Information Hub Latest News

Read About Telephone vs Video Virtual Visits Among Medicare Beneficiaries

In this survey study of 4,691 Medicare beneficiaries, 17 percent receiving care from practices offering both video and telephone visits reported that they were personally offered telephone visits only; 43 percent of those who were personally offered both video and telephone visits chose telephone visits. Being offered and choosing telephone visits were associated with less technology access and lack of video experience; those with Hispanic ethnicity or limited English proficiency were more likely to be offered telephone visits but not more likely to choose them.

The County Health Rankings for 2023 Have Been Released

The annual ranking of health for nearly every county in the nation takes a closer look at the way health relates to opportunities people have to participate in their communities.  The analysts examined two elements of civic health: 1) civic infrastructure, which includes the spaces such as schools, parks, and libraries; and 2) civic participation, which includes the ways people engage in community life. While their research found examples of rural towns with a strong sense of community, there was more evidence that policies and practices that disconnect people from each other, from opportunity, and from the land – for example, racial segregation and legal action to terminate Tribal rights – were more often happening in rural areas.  The report devotes a lot to voting, volunteering, and responding to the Census as important examples of civic participation and provides the data to show a direct link between civic health and population health.  See Policy Updates below for recent changes brought by the 2020 Census.

President Biden Ends COVID National Emergency After Congress Acts

The U.S. national emergency to respond to the COVID-19 pandemic ended Monday as President Joe Biden signed a bipartisan congressional resolution to bring it to a close after three years — weeks before it was set to expire alongside a separate public health emergency.

The national emergency allowed the government to take sweeping steps to respond to the virus and support the country’s economic, health and welfare systems. Some of the emergency measures have already been successfully wound-down, while others are still being phased out. The public health emergency — it underpins tough immigration restrictions at the U.S.-Mexico border — is set to expire on May 11.

The White House issued a one-line statement Monday saying Biden had signed the measure behind closed doors, after having publicly opposed the resolution though not to the point of issuing a veto. More than 197 Democrats in the House voted against it when the GOP-controlled chamber passed it in February. Last month, as the measure passed the Senate by a 68-23 vote, Biden let lawmakers know he would sign it.

The administration said once it became clear that Congress was moving to speed up the end of the national emergency it worked to expedite agency preparations for a return to normal procedures. Among the changes: The Department of Housing and Urban Development’s COVID-19 mortgage forbearance program is set to end at the end of May, and the Department of Veterans Affairs is now returning to a requirement for in-home visits to determine eligibility for caregiver assistance.

Legislators last year did extend for another two years telehealth flexibilities that were introduced as COVID-19 hit, leading health care systems around the country to regularly deliver care by smartphone or computer.

More than 1.13 million people in the U.S. have died from COVID-19 over the last three years, according to the Centers for Disease Control and Prevention, including 1,773 people in the week ending April 5.

Then-President Donald Trump’s Health and Human Services Secretary Alex Azar first declared a public health emergency on Jan. 31, 2020, and Trump declared the COVID-19 pandemic a national emergency that March. The emergencies have been repeatedly extended by Biden since he took office in January 2021, and he broadened the use of emergency powers after entering the White House.

CMS Proposes Policies to Improve Patient Safety and Promote Health Equity

Proposed Rule Would Reward Hospitals that Deliver High-Quality Care to Underserved Populations

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration’s key priorities to advance health equity and support underserved communities. As required by statute, the fiscal year (FY) 2024 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) rule updates Medicare payments and policies for hospitals. The rule would also adopt hospital quality measures to foster safety, equity, and reduce preventable harm in the hospital setting. CMS is proposing to recognize homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting, which may result in higher payment for certain hospital stays. This action aligns with the Administration’s goal of providing support to historically underserved and under-resourced communities.

“CMS is helping to build a resilient health care system that promotes good outcomes, patient safety, equity, and accessibility for everyone,” said CMS Administrator Chiquita Brooks-LaSure. “This proposed rule reflects our person-centric approach to better measure health care quality and safety in hospitals to reduce preventable harm and our commitment to ensure that people with Medicare in rural and underserved areas have improved access to high-quality health care.”

For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting program and are meaningful electronic health record users, the proposed increase in operating payment rates for FY 2024 is projected to be 2.8%. This reflects an FY 2024 projected hospital market basket update of 3.0%, reduced by a projected 0.2 percentage point productivity adjustment. For FY 2024, CMS expects the proposed increase in operating and capital IPPS payment rates would generally increase hospital payments by $3.3 billion. For LTCHs, CMS proposes to increase the LTCH PPS standard Federal payment rate by 2.9%.  Overall, CMS expects LTCH payments under the dual-rate payment system to decrease by 0.9%, or $24 million, primarily due to a projected decrease in high-cost outlier payments in FY 2024 compared to FY 2023.

“With this proposed rule, CMS is more accurately paying hospitals and recognizing for the first time that homelessness, as a social determinant of health, also impacts resource utilization,” said CMS Deputy Administrator Dr. Meena Seshamani. “Creating incentives for hospitals to provide excellent care for underserved populations lays the foundation for a health system that delivers higher-quality, more equitable, and safer care for everyone.”

Advancing Health Equity

CMS is proposing to make health equity adjustments in the Hospital Value-Based Purchasing Program by providing incentives to hospitals to perform well on existing measures and to those who care for high proportions of underserved individuals, as defined by dual eligibility status.  This builds on previous efforts to advance health equity through the finalized health equity adjustment in the Medicare Shared Savings Program and finalized policies in Medicare Advantage and Part D Star Ratings Program. CMS also proposes to recognize the higher costs that hospitals incur when treating people experiencing homelessness, when hospitals report social determinants of health codes on claims. In addition, CMS is requesting comment on how to further support safety-net hospitals.

CMS is also proposing that rural emergency hospitals could be designated as graduate medical education training sites. As a result, more medical residents would be able to train in rural settings, which can help address workforce shortages in these communities. This proposal builds on other policies to support access to care in rural and other underserved communities.

Promoting Patient Safety

Consistent with the CMS National Quality Strategy and the HHS National Healthcare System Action Alliance to Advance Patient Safety goals to promote the highest quality outcomes and safest care for all individuals, the proposed set of quality measures aims to foster safety and equity, and to reduce preventable harm in hospital settings. Among this set is a proposal to measure the rate of patients and residents in long-term care hospitals who are up to date on their COVID-19 vaccinations and new, additional measures for screenings for cancer and social drivers of health.

For a fact sheet on the proposed payment rule, visit: https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective

The FY 2024 IPPS/LTCH PPS proposed rule has a 60-day comment period. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-07389/medicare-program-proposed-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals

Pennsylvania Broadband Development Authority Approves Guidelines for $200 Million Broadband Infrastructure Grant Program, Will Begin Accepting Applications in May

The federal funding will help Pennsylvania expand broadband in unserved/underserved areas.

Pennsylvania Broadband Development Authority (Authority) Executive Director Brandon Carson announced the approval of grant guidelines for the Pennsylvania Broadband Infrastructure Program, which will provide $200 million in funding to businesses, non-profits, local government, and economic development organizations. The guidelines will be posted on the Authority’s website on Monday, April 10, 2023 and the application process for this program will open on May 10, 2023.

Too many communities lack access to high-speed internet, and many more cannot afford it. This creates a divide between those who have internet access and those who do not. From day one, Governor Josh Shapiro has said extending and expanding access to broadband across the commonwealth and making connection more reliable and affordable is a top priority of the Shapiro Administration.

The Pennsylvania Broadband Infrastructure Program, funded through the Capital Projects Fund, will fund line extension and development projects, as well as large-scale regional infrastructure projects. Upon completion, projects must deliver service that meets or exceeds symmetrical download and upload speeds of 100 Megabits per second, with prioritization being given to fiber-optic deployment. Projects must include a viable sustainability strategy to maintain, repair, and upgrade networks to ensure their continued operation.

“The Authority is pleased to provide this funding to achieve last-mile connections and increase speed for underserved and unserved regions in Pennsylvania,” said Executive Director Carson. “This is the first grant program the Authority is offering, and we look forward to seeing the impact it makes as we work to close the Commonwealth’s digital divide.”

Key Program requirements include:

  • 25-percent match: Federal, state, or local funding received by the applicant is eligible towards the match requirement.
  • Grant amounts: The minimum request considered will be $500,000 and the maximum may not exceed $10 million.
  • Universal coverage: Applicants are required to ensure that all projects either achieve or are part of a plan to achieve universal broadband for the locality or region.
  • Affordability: Applicants must participate in the Affordable Connectivity Program and will be asked to describe and document their digital equity efforts to ensure low- to moderate-income households in the proposed project area will have sustained and affordable access.
  • Labor: The Pennsylvania Prevailing Wage Act may apply to projects funded under this program. Prevailing Wage requirements are generally applicable to grants for construction, demolition, reconstruction, alteration, repair work, renovations, build-out and installation of machinery and equipment more than $25,000.

The application period will begin May 10, 2023, and will close July 10, 2023, at 11:59 PM. The Authority expects to award grants prior to the end of 2023. Funded projects must reach substantial completion―defined as services being delivered to end users―by December 31, 2026. The program will be administered in accordance with U.S. Treasury guidelines and Act 96 of 2021.

For more information about the Pennsylvania Broadband Development Authority, visit the Authority’s website.

HHS Finalizes Rule to Strengthen Medicare, Improve Access to Affordable Prescription Drug Coverage, and Hold Private Insurance Companies Accountable to Delivering Quality Health Care for America’s Seniors and People with Disabilities

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is finalizing a rule to put people with Medicare first and put strong protections in place so that Medicare Advantage (MA) works for them. This final rule will strengthen Medicare Advantage and hold health insurance companies to higher standards for America’s seniors and people with disabilities by cracking down on misleading marketing schemes by Medicare Advantage plans, Part D plans and their downstream entities; removing barriers to care created by complex coverage criteria and utilization management; and expanding access to behavioral health care. The new rule will also promote health equity, and implement a key provision of the Inflation Reduction Act—President Biden’s new law to lower prescription drug costs—that will improve access to affordable prescription drug coverage for an estimated 300,000 low-income individuals.

The Biden-Harris Administration is committed to protecting and strengthening Medicare for the 65 million people with Medicare today and for future generations. In the past few months, the Department has taken a series of actions to ensure the Medicare Advantage program works for people with Medicare and that private insurance companies are held accountable for providing quality coverage and care:

  • In February, CMS finalized a rule to start recovering improper payments made to Medicare Advantage plans through audits for the first time since 2007. Recovering these improper payments and returning this money to the Medicare Trust Funds will protect the fiscal sustainability of Medicare and allow the program to better serve seniors and people with disabilities, today and in the future.
  • Last week, CMS finalized policies in the 2024 Medicare Advantage and Part D Rate Announcement to improve payment accuracy and ensure taxpayer dollars are appropriately safeguarded and well-spent.

Cracking Down on Misleading Marketing Schemes

The final rule includes changes to protect people exploring Medicare Advantage and Part D coverage from confusing and potentially misleading marketing practices. Ads will be prohibited if they do not mention a specific plan name, or if they use the Medicare name, CMS logo, and products or information issued by the Federal Government, including the Medicare card, in a misleading way. Further, the final rule strengthens accountability for plans to monitor agent and broker activity.

Removing Barriers to Care Created by Complex Prior Authorization and Utilization Management

CMS is also providing important protections regarding utilization management policies and coverage criteria that ensure that Medicare Advantage enrollees receive the same access to medically necessary care that they would receive in Traditional Medicare. The rule streamlines prior authorization requirements and reduces disruption for enrollees by requiring that a granted prior authorization approval remains valid for as long as medically necessary to avoid disruptions in care, requiring Medicare Advantage plans to annually review utilization management policies, and requiring denials of coverage based on medical necessity be reviewed by health care professionals with relevant expertise before a denial can be issued. These policies complement proposals in CMS’ Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P).

Expanding Access to Behavioral Health Care

CMS remains committed to emphasizing the critical role that access to behavioral health plays in whole person care. In line with CMS’ Behavioral Health Strategy and the Administration’s strategy to address the national mental health crisis, CMS is strengthening behavioral health network adequacy in Medicare Advantage by adding clinical psychologists and licensed clinical social workers to the list of evaluated specialties. CMS is also finalizing wait time standards for behavioral health and primary care services and more specific notice requirements from plans to patients when these providers are dropped from their networks. In addition, CMS is requiring most types of Medicare Advantage plans to include behavioral health services in care coordination programs, ensuring that behavioral health care is a core part of person-centered care planning.

Promoting More Equitable Care

Additionally, CMS is advancing health equity and driving quality in health coverage by establishing a health equity index in the Star Ratings program that will reward Medicare Advantage and Medicare Part D plans that provide excellent care for underserved populations. Plans will also be required to provide culturally competent care to an expanded list of populations and to improve equitable access to care for those with limited English proficiency, through newly expanded requirements for providing materials in alternate formats and languages. The final rule balances patient experience/complaints measures, access measures, and health outcomes measures in the Star Ratings program to more effectively focus both on patient-centric care and on improving clinical outcomes.

Implementing President Biden’s New Prescription Drug Law

The final rule also implements a key provision of the Inflation Reduction Act that improves access to affordable prescription drug coverage for approximately 300,000 low-income individuals. As outlined in President Biden’s new prescription drug law, CMS is expanding eligibility for the full low-income subsidy benefit (also known as “Extra Help”) to individuals with incomes up to 150% of the federal poverty level who meet eligibility criteria. Beginning January 1, 2024, this change will provide the full low-income subsidy to those who would currently qualify for the partial low-income subsidy. As a result of this change, eligible enrollees will have no deductible, no premiums (if enrolled in a “benchmark” plan), and fixed, lowered copayments for certain medications under Medicare Part D.

View a fact sheet on the final rule.

The final rule can be accessed from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-07115/medicare-program-contract-year-2024-policy-and-technical-changes-to-the-medicare-advantage-program.

Medicare Advantage Value-Based Insurance Design Model Extension

Additionally, today CMS is also releasing more information about the extension of the Center for Medicare and Medicaid Innovation’s Medicare Advantage Value-Based Insurance Design (VBID) Model from 2025 through 2030. This extension will introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness. View the fact sheet, and more information, on the model webpage.

QuickStats Article from the National Center for Health Statistics Assesses Unintentional Death Rates

The latest QuickStats article published by the National Center for Health Statistics investigates Rates of Death Due to Unintentional Injury from Fire or Flames, by Sex and Urbanization Level — National Vital Statistics System, United States, 2021.

In 2021, the rates of death due to unintentional injury from fire or flames were 1.3 per 100,000 population among males and 0.8 among females and were higher for males than for females at each level of urbanization. Rates among males were lowest in large fringe (0.8) and large central (0.9) metropolitan areas and then increased with decreasing urbanization to 3.0 in noncore areas. Rates among females were lowest in large central metropolitan areas (0.5) and increased with decreasing urbanization to 1.8 in noncore areas.

County Health Rankings Released for 2023

The University of Wisconsin Population Health Institute County Health Rankings has released their annual ranking of health for nearly every county in the nation.

The ranking takes a closer look at the way health relates to opportunities people have to participate in their communities. The ranking considers civic infrastructure (schools, parks, libraries, etc.) and civic participation (ways people engage in community life).

For rural communities, the research found a strong sense of community, but policies and practices disconnect people from each other.  The report also found that in areas with long-standing disinvestment, such as rural economies, there are fewer social and economic opportunities, leading to lower healthy measures of life and quality of life.

Pennsylvania Health Care Career Events Announced

The Pennsylvania Association of Community Health Centers (PACHC) is hosting several career events this spring. Click on the event name for more information and to register.

For more information, contact Judd Mellinger-Blouch at Judd@pachc.org.

PA State Data Center Releases Census, Other Updates

New Brief Highlights Newly Released Vintage 2022 Population Estimates

The U.S. Census Bureau released the vintage 2022 population estimates for U.S counties and Puerto Rico. We’ve created a brief focused on the changes to Pennsylvania’s population. Read more on our Research Briefs page.

New Legislative Resources Available

New resources including maps and data profiles for Congressional and Legislative Districts are available on our site at: https://pasdc.hbg.psu.edu/Data/Legislative. The Census Bureau released new social, economic, housing, and demographic statistics for the 2022 state legislative districts. The four Data Profiles are available for all Pennsylvania Legislative Districts in the upper and lower chambers.

Register now for 2023 PA Data User Conference

This year will feature keynote and plenary sessions related to state and regional efforts to make data open and accessible. Concurrent sessions will feature two tracks: 1) U.S. Census Bureau staff providing updates on Census data products and tools as well as data analysts and 2) researchers across the state sharing applied uses of demographic data to better improve decision-making. Register at: https://pasdcconference.org/.

Census Bureau Updates

  • New Work-From-Home Data by Race and Ethnicity Now Available

This month, the U.S. Census Bureau released preliminary data from the Annual Business Survey (ABS) showing the impact of the coronavirus pandemic on businesses. The tables explore work from home status and business characteristics such as impact of the pandemic, financial health, outstanding debt, and expectations for continued operations. Click here to explore options for utilizing the latest data. 

  • ACCESS BROADBAND Dashboard

The U.S. Census Bureau and the National Telecommunications and Information Administration (NTIA) unveiled the first release of their joint interactive dashboard that allows users to compare U.S. state, county and census tract-level maps displaying broadband availability and adoption statistics to maps of select social and economic indicators. Click here to learn more and explore this interactive dashboard.

  • New Report: Women and Men Both Experienced Changes in Occupations During COVID-19

Click here to read this recently released report that focuses on differences in occupational employment shifts for women and men during the COVID pandemic.