The Office of Justice Programs and the Centers for Medicare & Medicaid Services Office of Minority Health have joined together to release a new Coverage to Care (C2C) resource to support individuals upon release and re-entering the community to connect to health coverage and health services.

Click here to view: Returning to the Community: Health Care After Incarceration

This guide, Returning to the Community: Health Care After Incarceration, will assist individuals upon release and re-entering the community to better understand their health care needs, including physical and behavioral health, to learn key information, terms, people, and titles to help connect to health care services pre- and post-release, learn about insurance coverage types and how to apply, and tips to get started using health coverage to receive needed services to support a successful reentry and healthy life.

Based on community and peer feedback, OJP and CMS worked together to create this resource to help  fill a gap  and give people returning to the community information that can support their ability to advocate for needed services and coverage.  Many people returning to the community may not have health coverage right away or know how to obtain health coverage, and caring for physical or behavioral health needs may have been deferred.  While the immediate needs of  housing or employment will be a priority, it is still important to consider immediate health care needs, including prescriptions, care management, or behavioral health – needs that should not wait. Connecting people to health coverage and to services is essential. This resource is specifically tailored to consider the unique considerations, concerns, and needs of individuals that are incarcerated, soon to be released, or recently released.

Returning to the community can be overwhelming. OJP and CMS encourage family members, community partners, peer support services, and justice-related programs and other stakeholders to use this resource to help start conversations about and support individuals in seeking health care coverage, services, and how to get started. Coverage to Care (C2C) is a CMS initiative meant to assist consumers in understanding their health coverage and using it to receive needed health care services.

Returning to the Community: Health Care After Incarceration is currently available in English and Spanish. Additional languages will be made available. This resource can be used alongside other Coverage to Care resources like the Roadmap to Better Care or the Roadmap to Behavioral Health.

To learn more about Coverage to Care, sign up for our listserv, visit https://go.cms.gov/c2c or email CoveragetoCare@cms.hhs.gov.

To learn more about the Office of Justice Programs, sign up for our listserv, visit https://www.ojp.gov/subscribe.

From Becker’s Financial Management

Nearly 200 rural hospitals have closed since 2005, and some states bear the brunt of this reduction to healthcare access more than others.

Since 2005, 192 hospitals in rural America have shut down, and the COVID-19 pandemic only accelerated rural hospitals’ risk of closure. Eight rural hospitals closed in 2023, as many as in 2022 and 2021 combined, according to the report. This followed a landmark 18 rural hospital closures in 2020, more than any year in the previous decade.

The counts come from the Center for Healthcare Quality and Payment Reform’s latest report, “Rural Hospitals at Risk of Closing.” CHQPR tracks rural hospital closures on an annual basis and, using the latest hospital financial information released by CMS in April 2024, analyzes rural hospitals’ risk of closure.

Below is a listing of the states that have seen the greatest number of rural hospital closures over the past 19 years. For a forward-looking way of looking at the risks of rural hospital closures, here are 25 states ranked by the percentage of their rural hospitals at risk of closure in the next two to three years maximum. The report from CHQPR assessing each state’s rural hospital health and risks can be found in full here.

• Texas: 25
• Tennessee: 15
• North Carolina: 12
• Kansas: 10
• Missouri: 10
• California: 9
• Georgia: 9
• Florida: 8
• Oklahoma: 8
• Alabama: 7
• Minnesota: 6
• Mississippi: 6
• New York: 6
• Pennsylvania: 6
• West Virginia: 5
• Arizona: 4
• Illinois: 4
• Indiana: 4
• Kentucky: 4
• South Carolina: 4

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. By taking bold action to strengthen protections against discrimination on the basis of race, color, national origin, sex, age, and disability, this rule reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.

“Today’s rule is a giant step forward for this country toward a more equitable and inclusive health care system, and means that Americans across the country now have a clear way to act on their rights against discrimination when they go to the doctor, talk with their health plan, or engage with health programs run by HHS,” said Secretary Xavier Becerra. “I am very proud that our Office for Civil Rights is standing up against discrimination, no matter who you are, who you love, your faith or where you live.  Once again, we are reminding Americans we have your back.”

“Section 1557 is critical to making sure that people in all communities have a right to access health care free from discrimination.  Today’s rule exemplifies the Biden-Harris Administration’s ongoing commitment to health equity and patient rights,” said OCR Director Melanie Fontes Rainer. “Traveling across the country, I have heard too many stories of people facing discrimination in their health care. The robust protections of 1557 are needed now more than ever. Whether it’s standing up for LGBTQI+ Americans nationwide, making sure that care is more accessible for people with disabilities or immigrant communities, or protecting patients when using AI in health care, OCR protects Americans’ rights.”

“CMS is steadfast in our commitment to providing access to high-quality, affordable health care coverage for millions of people who represent the vibrant diversity that makes America strong,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s rule is another important step toward our goal of health equity – toward the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health.”

The rule will restore protections gutted by the prior administration and help increase meaningful access to health care for communities across the country. The 1557 final rule draws on extensive stakeholder engagement, review of over 85,000 comments from the public, the Department’s enforcement experience, and developments in civil rights law. Among other things, the rule:

• Holds HHS’ health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance.
• For the first time, the Department will consider Medicare Part B payments as a form of Federal financial assistance for purposes of triggering civil rights laws enforced by the Department, ensuring that health care providers and suppliers receiving Part B funds are prohibited from discriminating on the basis of race, color, national origin, age, sex and disability.
• Requires covered health care providers, insurers, grantees, and others, to proactively let people know that language assistance services are available at no cost to patients.
• Requires covered health care providers, insurers, grantees, and others to let people know that accessibility services are available to patients at no cost.
• Clarifies that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency, and individuals with disabilities.
• Protects against discrimination by codifying that Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients.
• Respects federal protections for religious freedom and conscience and makes clear that recipients may simply rely on those protections or seek assurance of them from HHS.
• Respects the clinical judgement of health care providers.
• Protects patients from discriminatory health insurance benefit designs made by insurers.
• Clarifies the application of Section 1557 nondiscrimination requirements to health insurance plans.

Given the increasing use of artificial intelligence (AI) in health programs and activities, the rule clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools. This clarification serves as one of the key pillars of HHS’ response to the President’s Executive Order on Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence. Specifically, the rule:

• Applies the nondiscrimination principles under Section 1557 to the use of patient care decision support tools in clinical care.
• Requires those covered by the rule to take steps to identify and mitigate discrimination when they use AI and other forms of decision support tools for care.

Through partnership and enforcement, HHS OCR helps protect access to health care, because all people deserve health care that is safe, culturally competent, and free from discrimination. Learn more about the robust protections of Section 1557 of the ACA at www.HHS.gov/1557 .

This press release provides a summary, not any independent interpretation of Section 1557.  The Final Rule may be viewed or downloaded at: https://www.federalregister.gov/public-inspection/2024-08711/nondiscrimination-in-health-programs-and-activities

A color-coded map of the U.S. provides a seven-day heat forecast that indicates where temperatures may reach levels that could harm health.  It’s a collaboration between the National Oceanic and Atmospheric Administration and the Centers for Disease Control and Prevention (CDC).  As part of this effort, the CDC also provides a HeatRisk Dashboard with resources for high-heat days, details on local air quality, and actions to stay safe in these conditions.  Finally, the CDC has a site with clinical guidance for heat health, focused initially on treating children with asthma, pregnant women, and people with cardiovascular disease.

Read more.

Also known as LIHEAP, the program provides federally funded assistance to reduce the costs of home energy bills, energy crises, weatherization, and post-disaster needs.  In fiscal year 2023, the Administration for Children and Families (ACF) invested $4 billion for grantees in each state and in five territories, with set-aside for tribal assistance.  In turn, these grantees assist households with low incomes, particularly those that have a high home energy burden and/or have members who are elderly, disabled, and/or a young child.  Any community-based organization can use ACF’s Cooling Season Outreach toolkit with fliers, videos, and social media content in several languages.  There’s also a LIHEAP search tool that individuals can use to find help.

Read more.

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This rule aims to hold nursing homes accountable for providing safe and high-quality care for nearly 1.2 million residents living in Medicare and Medicaid-certified long term care facilities. Central to the rule are comprehensive minimum nurse staffing standard requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within LTC facilities.  As the long-term care sector continues to recover from the COVID-19 pandemic, the final standards also consider the local realities in rural and underserved communities via staggered implementation and exemptions processes. Highlights of finalized policies include a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. CMS also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. Finally, CMS finalizing to define “rural” in accordance with the Office of Management and Budget (OMB) definition. OMB designates counties as Metropolitan (metro), Micropolitan (micro), or neither. “A Metro area contains a core urban area of 50,000 or more population, and a Micro area contains an urban core of at least 10,000 (but less than 50,000) population. All counties that are not part of a Metropolitan Statistical Area (MSA) are considered rural”. As of 2022 the Rural Health Research & Policy Centers Nursing Home Chartbook, 87 percent of non-core counties have dually/Medicaid certified nursing homes while 82 percent of non-core counties have dually/Medicare-certified nursing homes.

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On April 18, the Health Resources and Services Administration released a final rule establishing an Administrative Dispute Resolution (ADR) process for the 340B Drug Pricing Program that is effective on June 18.  The federal 340B program allows certain hospitals and clinics, aka ‘covered entities,’ that treat low-income and uninsured patients to buy outpatient prescription drugs from manufacturers at a discount, and it is intended to help these providers stretch scarce federal resources as far as possible.  This rule finalizes new requirements and procedures to make the resolution of disputes between covered entities and manufacturers more accessible and efficient.

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Together, these rules from the Centers for Medicare & Medicaid Services (CMS), advance access to care, access to quality of care and aim to improve health outcomes across Medicaid fee-for-service (FFS) and managed care plans. The Access Rule addresses dimensions of access across both Medicaid FFS and managed care delivery systems, including increasing transparency and accountability, standardizing data and monitoring, and creating opportunities for states to promote beneficiary engagement.  The Managed Care Rule addresses standards for timely access to care and states’ monitoring and enforcement efforts; quality and fiscal and program integrity standards for state directed payments; the scope of in lieu of services and settings; establishment of a quality rating system (QRS) for Medicaid and CHIP managed care plans.

Read more on access to medicaid services and CHIP.

There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part, this is because methods to identify RHC encounters within Medicaid claims data are outdated. This brief from the Maine Rural Health Research Center describes a methodology for identifying RHC encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Read more.

From 2019-2020, rural lesbian, gay, and bisexual adults were more likely to report poor/fair self-rated health than rural heterosexual adults.  This  Recap summarizes several policy briefs from the University of Minnesota Rural Health Research Center examining self-rated health, chronic conditions, mental health, and social and emotional support systems for LGBTQ+ populations.

Read more.