Facing ongoing concerns about rural hospital closures, Capitol Hill lawmakers have introduced a spate of proposals to fix a federal program created to keep lifesaving services in small towns nationwide.

In Anamosa, Iowa — a town of fewer than 6,000 residents located more than 900 miles from the nation’s capital — rural hospital leader Eric Briesemeister is watching for Congress’ next move. The 22-bed hospital Briesemeister runs averages about seven inpatients each night, and its most recent federal filings show it earned just $95,445 in annual net income from serving patients.

Yet Briesemeister isn’t interested in converting the facility into a rural emergency hospital, which would mean getting millions of extra dollars each year from federal payments. In exchange for that financial support, hospitals that join the program keep their emergency departments open and give up inpatient beds.

“It wasn’t for us,” said Briesemeister, chief executive of UnityPoint Health-Jones Regional Medical Center. “I think that program is a little bit more designed for hospitals that might not be around without it.”

Nationwide, only about two dozen of the more than 1,500 eligible hospitals have become rural emergency hospitals since the program launched last year. At the same time, rural hospitals continue to close — 10 since the fix became available.

Federal lawmakers have introduced a handful of legislative solutions since March. In one bill, senators from Kansas and Minnesota list a myriad of tactics, including allowing older closed facilities to reopen.

Another proposal introduced in the House by two Michigan lawmakers is the Rural 340B Access Act. It would allow rural emergency hospitals to use the 340B federal drug discount program, which Congress created in 1992.

The 340B program, named after its federal statute, lets eligible hospitals and clinics buy drugs at a discount and then bill insurance companies, Medicare, or Medicaid at market rates. Hospitals get to keep the money they make from the difference.

Congress approved 340B as an indirect aid package to help struggling hospitals stay afloat. Many larger hospitals say the cash is used for community benefits and charity care, while many small hospitals depend on the drug discounts to help cover staffing and operational shortfalls.

Currently, emergency hospitals are not eligible for 340B discounts. According to a release from U.S. Rep. Jack Bergman (R-Mich.), the House proposal would “correct this oversight.” Backers of the House bill include the American Hospital Association and the National Rural Health Association.

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On June 3, 2024, the Federal Communications Commission (FCC) will is pay out the dregs of a fund that Congress established in 2021 to help lower-income families connect to the internet.

The Affordable Connectivity Program, part of the landmark 2021 Infrastructure Investment and Jobs Act, is out of money as of May 31, 2024.

This month, the FCC sent final payments to some 23 million households that participated in the program. About 14% of participants (3.2 million households) were rural, according to a Daily Yonder analysis of FCC data.

The White House laid blame for closure of the program at the feet of Republican lawmakers who have not advanced pending legislation to continue funding.

“Republicans have failed to act,” said Stephen Benjamin, a senior adviser to the president, in an online White House press conference. “Millions of Americans will see prices increase for the necessary connectivity to do their homework, access telehealth, hold a remote job, or run a small business from their home.”

Benjamin called ACP “the largest and most successful internet affordability program in our nation’s history.”

ACP provided $30 to eligible families to pay for low-cost broadband connections. Participants on tribal lands were eligible for $75 a month. As part of the effort, the White House persuaded internet service providers to offer ACP participants a lower monthly subscription rate, resulting in no net cost to users.

The White House announced Friday that 14 internet service providers have agreed to continue offering the low-cost subscriptions to ACP participants for the rest of 2024, despite the end of federal funding for the program. But more than half of ACP participants get their broadband from an internet service provider that has not agreed to offer the lower rate. (See below for a list.)

“In the absence of funding for the Affordable Connectivity Program, President (Joe) Biden remains committed to doing everything possible to ensure families continue to access affordable high-speed internet,” Benjamin said.

ISPs That Will Continue Low-Cost Program

According to a White House fact sheet, the following companies (which range from national telecommunications giants to small, local companies) have agreed to continuing offering the $30 internet subscription with no data cap or fees through the rest of 2024:

• Allo Fiber
• altafiber (and Hawaiian Telcom)
• Astound Broadband
• AT&T
• Comcast
• Cox
• IdeaTek
• Mediacom
• MLGC
• Optimum
• Spectrum (Charter Communications)*
• Starry
• Verizon
• Vermont Telephone Company

*Offer available to new subscribers and eligible existing customers.

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HHS’ Administration for Community Living (ACL), the Office of the Assistant Secretary for Health, and the Administration for Children and Families (ACF) issued an informational memo about sexual violence against persons with intellectual and developmental disabilities. The letter, available on ACL’s website, raises awareness of the disparities that can put people with these disabilities at greater risk for sexual assault. It provides guidance and resources that help advocates and others recognize sexual violence and improve services for survivors.

HRSA’s National Policy Telehealth Resource Center released a fact sheet to help Federally Qualified Health Centers (FQHCs) navigate Medicaid telehealth reimbursement. Find updated information and policies for Spring 2024. Read more.

Are you passionate about helping those with substance use disorders? If you are a behavioral health clinician or support worker, clinical support staff, or are trained in substance use disorders, you can apply to the Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) and receive up to $250,000 in loan repayment. In exchange, you must work full-time for six years in a STAR LRP-approved facility. Make sure your health center is an approved STAR LRP site. The application is open now through June 27 at 7:30 pm ET.

CVS, Walmart, and Walgreens are all scaling back or shuttering retail health clinics. Walgreens’ VillageMD recorded a $6 billion loss, an example of just how difficult it has become to generate profits from a healthcare model that retailers over the past decade bet would be a big win. Read more.

PACHC is facilitating this two-part webinar series with guest speaker Alexander Lipovtsev from Feldesman Leifer (formerly Feldesman Tucker Leifer Fidell). The first session is on June 5 from 1:00 – 2:00 pm. Alex will review the CMS EP Final Rule, discuss all its current requirements for FQHCs, how they may connect with the Joint Commission accreditation requirements, as well as provide some practical tips to ensure ongoing compliance. The second session will take place on July 2 from 1:00 – 2:00 pm and will explore best practices for developing an emergency operations plan (EOP) document for your organization, which is a required element by CMS. Registration cost is $50 for both webinars and you will receive the recording after the sessions. Register here. 

In a recent conversation with the Office of Mental Health and Substance Abuse Services (OMHSAS) it was stated that audio-only services for telehealth should only be used when the individual does not have access to technology such as a smart phone, tablet, or computer that would allow real time audio-visual communication. Additional requirements for audio-only services include the following: payers are allowed to require a signature after each encounter, providers are still required to fill out service verification (encounter forms), and providers can send a form in the mail to patients with a pre-paid return envelope or utilize a HIPAA compliant system that captures an electronic signature in a manner that is auditable. If you have questions about obtaining a signature from your patients, please contact your payer.

From April 2023 to Feb. 2024, Pennie engaged 412,070 Medicaid unwinding applicants through transfers from Medicaid and direct enrollments. Of the applicants, 61,567 enrolled in a plan for an average total conversion rate of 15% as of April 30. Philadelphia, Allegheny, Delaware, Berks, and Lehigh counties saw the largest number of unwind applicants. Unwinding consumers tend to pay less for coverage than other consumers due to the additional tax credits and cost-sharing reductions based on household size and income: 23% of enrollees paid less than $1 and 55% of enrollees paid $50 or less for a plan. The majority of the unwinding population, totaling 81% of enrollees, fell below 250% of the Federal Poverty Level and chose Gold or Silver plans. The data shows unwind consumers tend to be younger than the average consumer, more likely to be female, and more likely to be non-Hispanic/Latino. To view additional data, go to the May Pennie Board Meeting Deck.