Congressman Greg Pence (R-IN), along with Rep. Brett Guthrie (R-KY), Rep. Vern Buchanan (R-FL), Rep. Michelle Fischbach (R-MN), Rep. Jared Golden (D-ME), and Rep. Chris Pappas (D-NH), led 91 of their colleagues on a bipartisan letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra.

In the letter, the lawmakers expressed their concerns with the Centers for Medicare and Medicaid Services’ (CMS) proposed rule that was issued on September 1, 2023, at the direction of the Biden White House. This rule would establish minimum staffing requirements and standards for nursing homes, which would inevitably result in limited access to care for seniors, mandatory increases in state Medicaid budgets, and most consequentially lead to widespread nursing home closures.

“At a time when nursing homes are already experiencing healthcare worker shortages and financial hardships, CMS and the Biden Administration should not be implementing a regulation that would only exacerbate this issue. If implemented, facilities throughout the country will have no choice but to deny access to our nation’s seniors who need nursing home care, especially in rural communities, like many of the ones I represent in Indiana’s sixth congressional district,” said Congressman Pence. “This one-size-fits-all regulatory requirement will result in many negative consequences, and I strongly urge Secretary Becerra to reconsider this proposal.”

“I am pleased join with Representatives Pence, Fischbach, Golden, and Pappas to express our serious concern about the Centers for Medicare and Medicaid’s (CMS) proposed rule, which would lead to significant reductions in care for long-term care residents, especially in rural communities. We must ensure that we have a strong pipeline of long-term care, but instead of working with Congress to address long-standing health care workforce issues; CMS’ one-size-fits-all unfunded mandate makes it more challenging to find qualified workers further restricting access to these essential health care services. On the contrary, my bipartisan Building America’s Health Care Workforce Act would help bolster America’s nursing home workforce by extending a pathway for temporary nurse aides to become Certified Nursing Assistants. With the workforce shortages already affecting nursing homes across the country, seniors cannot afford yet another top-down mandate from the Biden administration,” said Congressman Guthrie.

“I am again encouraging the administration to reconsider its rule that could force nursing homes in rural Minnesota to close their doors,” said Congresswoman Fischbach. “Further closures of facilities in rural areas would leave seniors with little to no options for care. That is unacceptable. Instead, this letter outlines specific ways CMS can work with stakeholders to improve care and encourage recruitment and retention of qualified staff.”

“I remain committed to supporting access to high quality care for individuals residing in nursing home facilities. However, these proposed requirements could devastate access to long-term care for New Hampshire’s seniors,” said Congressman Pappas. “Instead of burdening nursing homes with new regulations during an ongoing workforce shortage, we should be focused on providing long-term care facilities with the resources and funding to stay open, recruit and retain a strong workforce, and provide residents with the best care possible. Granite Staters, especially those in rural areas, deserve access to long-term care in their communities, and I urge CMS to re-evaluate these regulations to prevent the closure of nursing homes across the country.”

“There are workforce shortages all across rural America and healthcare workers are no exception. I’m committed to working with my colleagues to find ways to prevent otherwise avoidable closures of nursing homes in Maine,” said Congressman Golden.

Background:

In September, CMS issued a proposed rule establishing minimum staffing requirements and standards for nursing homes. Highlighted in the proposed rule is that, according to the Bureau of Labor Statistics, “there are roughly 235,900 fewer health care staff working in nursing homes and other long-term care facilities compared to March of 2020.” Nursing homes around the country would need to hire nearly 13,000 registered nurses and 76,000 nursing assistants. Safety thresholds could increase a modest 1% while costing between $1.5 to $6.8 billion to fully implement. Noncompliance with CMS’ proposed minimum staffing requirements would lead to citations for noncompliance with Medicare Conditions of Participation, potentially resulting in a variety of enforcement actions, including imposition of Civil Monetary Penalties, denial of payments for new admissions, and even termination from the Medicare program.

Many organizations, including the American Health Care Association, National Rural Health Association, National Association of State Veterans Homes, Lutheran Services in America, Council for Health and Human Services Ministries, and LeadingAge, are supportive of this letter.

To read the letter, click here.

In addition to the letter, Reps. Pence and Fischbach have introduced H.R. 5796, the Protecting Rural Seniors Access to Care Act, to prevent CMS from implementing this rule until it can prove it will not result in the closure of skilled nursing facilities, will not harm patient access, and will not make workforce shortage issues worse.

The Pennsylvania Broadband Development Authority (PBDA) has drafted its Volume II of the Broadband Equity, Access, and Deployment (BEAD) Proposal, as required through the National Telecommunication and Information Administration’s BEAD Notice of Funding Opportunity and supplemental guidance. Volume II includes critical components of PBDA’s plans for implementing BEAD grant funding, to ensure that all Pennsylvanians have access to high-speed internet. To draft the document, PBDA complied with NTIA requirements and guidance on elements such as the application process, scoring criteria, labor standards, and other requirements, as well as Commonwealth policies.

Volume II will be available for public review and comment for the required 30 days, from October 16, 2023 through November 14, 2023. Upon receipt and consideration of comments and Board approval, PBDA will submit the Volume for consideration to the NTIA prior to the submission deadline of December 27, 2023.

The public is asked to share comments by 11:59PM on November 14, 2023.

Access the website at Broadband Equity, Access, and Deployment (BEAD) – PA Department of Community & Economic Development and scroll to the “SUBMIT FEEDBACK” button to provide input.

Questions on Volume II of the BEAD Initial Proposal can be directed to PABroadbandAuthority@pa.gov

From Healthcare Dive

HRSA is once again requiring hospitals to register outpatient clinics and list them on Medicare cost reports, setting a higher bar for eligibility in the drug discount program.

Dive Brief

• Hospitals are up in arms over new guidance issued by the Health Resources and Services Administration on Thursday that could restrict the eligibility of their outpatient clinics for drug discounts in the 340B program.
• During the thick of the COVID-19 pandemic in 2020, regulators waived longstanding 340B eligibility requirements for participating hospitals’ offsite locations to help streamline hospital operations. Now, HRSA is once again requiring hospitals to register outpatient clinics and list them on Medicare cost reports, according to a Thursday notice in the Federal Register.
• Many hospitals had expected the 2020 waiver to become permanent, so a number have yet to register their offsite clinics. Hospital association America’s Essential Hospitals said the change will “significantly harm essential hospitals” and their ability to care for patients.

Dive Insight

The 340B drug discount program requires pharmaceutical companies to give discounts on outpatient drugs for providers serving low-income communities. The discounts, which can range from 25% to 50% of the cost of the drugs, can be a big financial aid to those providers, which generally operate under very thin margins.

Yet under the new guidance, even if a hospital is eligible for 340B, its care sites may no longer qualify for the drug discount program.

Hospitals with large outpatient networks could pay more for prescription drugs as a result of the change, said Maureen Testoni, CEO of 340B Health, a trade group representing providers in the program, in emailed comments.

Many hospitals relied on HRSA’s prior language to invest in developing new offsite locations that have yet to start using 340B, according to Testoni.

“This change could require those hospitals to forego months of 340B discounts, pending the filing of the Medicare cost report,” Testoni said. “This would have significant financial consequence, potentially millions in 340B savings.”

But the change is just returning to standards that regulators have used to determine 340B eligibility for decades, HRSA said in the notice.

Regulators said hospitals have largely returned to business as usual coming out of the pandemic, and the waiver has made it harder for HRSA to oversee 340B compliance — a hot-button issue for pharmaceutical companies and lawmakers critical of how hospitals use 340B discounts.

In the notice, HRSA said recent audits of hospital-covered entities found more than one-third of hospitals were using 340B drugs in unregistered sites. Though those hospitals said they would register those locations in a future Medicare cost report, they had not done so as of May.

Now, in order to continue buying 340B drugs, hospitals’ outpatient sites need to either comply with registration requirements or notify HRSA that they’ve started the registration process within three months.

Hospitals that don’t comply could face “audit and compliance action,” HRSA said.

The 340B program has existed since the 1990s, but faces recent upheaval on multiple fronts. A number of major drugmakers are feuding with hospitals and the government, refusing to pay 340B discounts and sparking multiple lawsuits.

Drugmakers say the program doesn’t require hospitals to account for their savings or ensure they’re reinvested in patient care, a complaint shared by some legislators.

Hospitals are also not pleased with recent decisions from the Biden administration regarding 340B, with many airing concerns about regulators’ solution to repay 340B hospitals for years of alleged underpayments.

Click here for the 340B program guidance.

From Becker’s

Only 16 hospitals have converted to rural emergency hospitals since the CMS designation was made available Jan. 1, but more may follow suit in the coming quarters as rural hospitals continue to be challenged by staffing shortages and rising costs, which are stifling recovery efforts and leaving some on the brink of bankruptcy or closure.

Since 2005, 100 rural hospitals have completely shut down, with another 95 facilities no longer providing inpatient services, according to data compiled by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. Thirty-seven of those rural hospital closures have occurred since 2020.

To address concerns that rural and critical access hospital closures are reducing access to care for people in rural areas, CMS established the rural emergency hospital designation, a new Medicare provider type.

The designation aims to curb rural hospital closures by offering them a chance to close infrequently used inpatient beds and focus on outpatient and emergency department services.

In exchange for giving up their expensive inpatient beds and focusing solely on emergency and outpatient care, rural emergency hospitals receive a 5 percent increase in Medicare payments as well as an average facility fee payment of about $3.2 million a year.

While the designation has helped some hospitals survive under a new provider type, others are still weighing the benefits and drawbacks of implementing such a drastic change to their services and business model.

The hospitals that have made the switch are predominantly in the South and in states that have not expanded Medicaid coverage. Here are the 16 facilities that have converted to rural emergency hospitals, beginning with the most recent:

• Harper Community Hospital (Buffalo, Okla.)
• South Central Kansas Medical Center (Arkansas City)
• St. Bernards Five Rivers Medical Center (Pocahontas, Ark.)
• Assumption Community Hospital (Napoleonville, La.)
• Sturgis (Mich.) Hospital
• TriStar Ashland City (Tenn.) Medical Center
• Stillwater Medical-Blackwell (Okla.)
• Blue Ridge (Ga.) Medical Center
• St. Luke’s Health-Memorial San Augustine (Texas)
• Jefferson County Hospital (Fayette, Miss.)
• Stillwater Medical-Perry (Okla.)
• Anson (Texas) General Hospital
• Alliance Healthcare System (Holly Springs, Miss.)
• Falls Community Hospital and Clinic (Marlin, Texas)
• Irwin County Hospital (Ocilla, Ga.)
• Crosbyton (Texas) Clinic Hospital

St. Bernards Healthcare’s Five Rivers transitioned to a rural emergency hospital on Sept. 1, the first hospital in Arkansas to do so.

With inpatient extended care accounting for only about 5 percent of the hospital’s business, the decision was a relatively easy one for the facility, Randy Barymon, the hospital’s administrator, told local news outlet KAIT8.

“Cost of care has certainly gone up, and reimbursement has gone up. It’s actually harder to get reimbursed for the care that we provide here at Five Rivers,” Mr. Barymon told KAIT8. “I think a lot of rural facilities are seeing a trend down inpatient extended-stay care. This was really just a natural progression for us.”

For Anson General Hospital, the decision to convert to a rural emergency hospital came down to survivability.

The Texas hospital reported three consecutive years of financial losses and patient volumes declined to about 1.7 inpatients a week, on average, partially due to factors related to the COVID-19 pandemic.

“Our numbers drastically declined, and we knew that this was our only hope to stay open,” Chief Nursing Officer Anna Doan, BSN, RN, told Becker’s.

The hospital filed its application in early January and, effective March 27, has been operating as a rural emergency hospital. CEO Ted Matthews retired from the hospital more than a decade ago and returned to helm the facility in February.

“We have embraced this new identity,” Mr. Matthews told Becker’s. “What it allowed us to do is continue to provide access to care. We were the only hospital at one time. Jones County had three hospitals, and we are the lone surviving hospital. And if we had to close, there would have been no hospitals in the county.”

Short-term health insurance plans are exempt from key Affordable Care Act protections — consumers with preexisting medical conditions who purchase these plans can be denied coverage and anyone who buys one may lack coverage for key services. The Trump administration loosened regulation of short-term plans, with a stated goal of increasing coverage and reducing the uninsured rate. A new analysis indicates that it did not accomplish this: coverage did not increase and the uninsured rate did not drop.

The Pennsylvania Department of Human Services (DHS) announced on October 1, due to changes made by the USDA’s Food and Nutrition Services, that it was raising its income and benefit limits for the Supplemental Nutrition Assistance Program (SNAP), meaning some people who previously weren’t eligible to receive assistance through the SNAP Program may now qualify. Factors that could contribute to a household’s higher SNAP allowances and income limits include household size, monthly income, and if a member of the household is 60 years of age or older or has a disability. Benefits were also expanded for college students enrolled in some employment and training programs. The SNAP income limit changes run through September 30, 2024.

All nine managed care organizations offering health insurance coverage through Pennie, PA’s Health Insurance Marketplace, presented their individual markets and plan designs during this a Pennie Insurer Marketplace Plan Review. Jefferson Health Plans, a new competitor in Bucks, Montgomery, and Philadelphia counties, presented their new plans for potential customers along with hospital and provider networks. Highmark and Geisinger have added plans in several new counties as they expand their footprint from 2023. According to the PA Insurance Department, all insurers currently offering individual market coverage in Pennsylvania’s 67 counties will continue to provide plans in 2024 with a statewide average premium increase of 3.9%, which is lower than what insurers initially filed and what was reported this summer. The individual health insurance market rate increases are lower than last year’s increases and are trending lower than current national averages for 2024 health plans. Open Enrollment begins November 1, 2023, and ends January 19, 2024.

There have been some confusing reports around Pennsylvania’s Medicaid unwinding process and the Department of Human Services (DHS) requests your help in correcting misunderstandings, particularly that DHS is pausing its Medicaid unwinding process. Pennsylvania is not pausing redeterminations. DHS is operating under an approved mitigation strategy to manually address a known issue with the ex parte review process which is the highest priority right now.