Rural Health Information Hub Latest News

CMS Seeking Public Input on Updates to Medicare Advantage and Part D Prescription Drug Coverage – Comment by March 1

The Centers for Medicare & Medicaid Services (CMS) is required to update Medicare Advantage (MA) payment rates and other policies for calendar year 2025.  The full Advance Notice may be viewed on the CMS website by selecting “2025 Advance Notice.”  For Medicare Advantage, CMS proposes to continue phasing in previously finalized adjustments to plan pay rates as well as make new adjustments for MA plans in Puerto Rico.  They also request input on future quality measures.  For the Part D Prescription Drug program, CMS invites comment on draft guidance implementing parts of the Inflation Reduction Act of 2022 (IRA) that take effect in 2025.  Specifically, the IRA creates a newly defined standard Part D benefit design; lowers the annual out-of-pocket threshold; establishes the Manufacturer Discount Program, under which manufacturers provide discounts on applicable drugs in the initial coverage phase and catastrophic phase of the defined standard drug benefit; and changes the liability of enrollees, sponsors, manufacturers, and CMS.  In recent years, non-metro areas have seen slightly higher growth in the number of MA plans and enrollment than metropolitan counties.

Read the full article here.

CMS Hosting Webinar on AHEAD Model Hospital Global Budgets – February 14 at 3:00 pm Eastern

In this hour-long webinar, the Centers for Medicare & Medicaid Services (CMS) will provide an overview of the hospital global budget methodology for the new States Advancing All-Payer Health Equity and Development (AHEAD) Model and answer audience questions. AHEAD is a state total-cost-of-care model, and global budgets are a key feature to control the growth of health care costs and improve care. A hospital global budget pays a pre-determined, fixed annual budget for hospital inpatient and outpatient facility services, rather than paying a fee for each service provided.  This webinar will describe the method CMS will use to calculate the Medicare hospital payment amount for the AHEAD model as well as operational considerations for hospitals.  States interested in participating in the model should submit their applications by Monday, March 18, 2024, at 3:00 p.m. ET (for Cohorts 1 and 2) & Monday, August 12, 2024, at 3:00 p.m. ET (Cohort 3). To get notified about model events and resources, sign up for email updates about the AHEAD Model on the CMS website.

Register here.

NIH Study Shows Higher Mortality Rates for Patients on Respiratory Support in Rural Care

The National Institutes of Health (NIH) published a study finding rural patients receiving ventilator life support in intermediate care units had significantly higher death rates than patients in the same type of unit at urban hospitals.  Data was collected from 2010 to 2019 on 2.75 million hospitalizations of Medicare patients who were on respiratory support at rural and urban hospitals across the country.

Read the full report here.

New Medicaid Model for Treatment of Rare Diseases Introduced

The Centers for Medicare & Medicaid Services (CMS) announced the Cell and Gene Therapy (CGT) Access Model, an initiative that aims to improve the lives of people with Medicaid living with rare and severe diseases by increasing access to potentially transformative treatments. Initially the model will focus on increasing access to gene therapy treatment for sickle cell disease, a genetic blood disorder that disproportionately impacts Black Americans. CGT is a multi-year payment model with state Medicaid agencies and pharmaceutical companies acting as participants, with optional grant funding available for states to provide an increased level of support for patients receiving gene therapy. CMS expects to release a Request for Application (RFA) to manufacturers in early spring 2024 and an RFA and Notice of Funding Opportunity (NOFO) to states in summer 2024.

Read the full article here.

AHRQ Requesting Public Input: Severe Maternal Morbidity Measurement – Comment by March 4

The Agency for Healthcare Research and Quality (AHRQ) needs assistance with data on state-level rates of severe maternal morbidity, that help inform HRSA’s Maternal and Child Health Bureau Title V Block Grant.  Among the questions AHRQ has for stakeholders representing consumers – including but not limited to state and local health departments, accountable care organizations, and providers such as Critical Access Hospitals and Rural Health Clinics – is what quantitative data would you need to make maternal health service improvements.  The comment period closes on March 4th and comments should be sent to askahrq@ahrq.hhs.gov.  Recently, the Government Accountability Office cited several factors that pose additional risks and challenges for pregnant women in rural areas.

Read the full report here.

SAMHSA Finalizes Rule on Medications for the Treatment of Opioid Use Disorder

On January 31, the Substance Abuse and Mental Health Services Administration (SAMHSA) published final revisions to federal regulations surrounding opioid use disorder treatment standards, including accreditation and certification standards for opioid treatment programs (OTP). The final rule addresses several longstanding barriers to broader use of medications to treat opioid use disorder.    Among other changes, the revised policy formalizes various methadone treatment protocols at OTPs that were put in place during the pandemic, and expands access to take-home methadone.  The finalized rule also adds to the workforce and their capabilities, expanding the definition of OTP practitioner to include Nurse Practitioners and Physician Assistants, among other types of clinician, and allowing for MOUD prescribing via telehealth.  The effective date of this final rule is April 2, 2024 and the compliance date is October 2, 2024.

Read the full report here.

An Update Released on the Federal Overdose Prevention Strategy

FORHP’s Rural Communities Opioid Response Program figures prominently among ongoing federal grant programs that are part of the strategy that is now entering its third year.  The effort involves every one of the 12 operating divisions of the U.S. Department of Health & Human Services and, in 2023 alone, featured groundbreaking changes to policy that include:

  • Eliminated the Drug Enforcement Agency waiver for prescribing medications for opioid use disorder (MOUD) and made temporary rules for prescribing via telemedicine permanent; (See more details about SAMHSA policy changes for MOUD in the next item.)
  • Increased Medicare payment rates for opioid treatment programs (OTPs), including services provided by mobile units;
  • Expanded the clinical workforce that may bill Medicare by including marriage and family therapists, licensed professional counselors, and others to provide behavioral health services;
  • Established Medicare payment for Intensive Outpatient Program services, which can be furnished in hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers, Rural Health Clinics, and OTPs.

The latest initiative in the overdose prevention strategy was announced earlier this week.  The Substance Abuse and Mental Health Services Administration will invest more than $20 million to advance health information technology in behavioral health care and practice settings.

Read the full article here.