In 2015, the National Center for Transgender Equality conducted the largest survey examining the lives of transgender people.  More than 27,000 respondents from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and overseas military bases answered questions about their experiences with social determinants of health such as education, employment, family life, health care, housing, and interactions with the criminal justice system.  Information from the survey fills in some of the large gaps in research and provides critical tools for researchers, policymakers, and advocates seeking to eliminate disparities.  Though it’s estimated that at least three million LGBT people live in rural America, there remains a need for data from rural areas.  To that end, the National Center for Transgender Equality asks for volunteers living in rural areas to take the 2022 US Transgender Survey.

Deadline November 21

On September 6, 2022, the Pennsylvania Rural Health Association held a webinar on training, recruiting, and retaining a strong rural health workforce in Pennsylvania, as part of its Special Topics in Rural Health 2022 Webinar Series hosted by Rep. Kathy Rapp (R-PA 65th District) and Sen. Michele Brooks (R-PA 50th District).  Ben Fredrick, MD, Professor of Family & Community Medicine at the Penn State College of Medicine and Program Director of the Pennsylvania Area Health Education Center (PA AHEC), gave a compelling presentation on strategies for cultivating rural health professionals in our hometowns.

See below for the links to the presentation, recording, and handout.

Presentation: Cultivating A Rural Health Workforce in Pennsylvania

Recording: Cultivating a Rural Health Workforce in Pennsylvania

Handout:  Need for Rural Workforce One Pager_References

The Pennsylvania Department of Education, Health, Human Services, and Insurance are reminding families to ensure their children’s immunizations are up to date as part of back-to-school preparations. Vaccine-preventable diseases, such as chicken pox, meningitis, measles, whooping cough, and others are still seen across the commonwealth. Keeping children up to date on vaccinations is the best way to keep them healthy and reduce unnecessary absences from school. Staying up to date with immunizations provides the best protection against disease and is essential to individual and population health. The Centers for Disease Control and Prevention recognizes August as National Immunization Awareness Month (NIAM). This annual observance highlights the importance of getting recommended vaccines. Whether children are homeschooled or attend a public, private, charter, or religious school, state laws require they stay up to date for certain vaccinations based on their age, as recommended by the CDC. Additional information on immunizations can be found on the Pennsylvania Department of Health website.

CMS issued a final rule for inpatient and long-term care hospitals that builds on the Biden-Harris Administration’s key priorities to advance health equity and improve maternal health outcomes. As required by statute, the fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule updates Medicare payments and policies for hospitals, drives high-quality, person-centered care, and promotes fiscal stewardship of the Medicare program. In addition, the rule finalizes new measures to encourage hospitals to build health equity into their core functions. These actions will improve care for people and communities who are disadvantaged or underserved by the health care system.

The rule includes three health equity-focused measures in hospital quality programs and establishes a “Birthing-Friendly” hospital designation. CMS will award this new designation to hospitals that participate in a statewide or national perinatal quality improvement collaborative program and have implemented the recommended quality interventions.

For acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record users, the final rule will result in an increase in operating payment rates of 4.3%. This reflects a FY 2023 projected hospital market basket update of 4.1%, reduced by a statutorily required productivity adjustment of a 0.3 percentage point and plus a 0.5 percentage point adjustment required by statute. This is the highest market basket update in the last 25 years and is primarily due to higher expected growth in compensation prices for hospital workers. Under the LTCH PPS, CMS expects payments in FY 2023 to increase by approximately 2.4% or $71 million.

“CMS is taking action to support hospitals, including updating payments to hospitals by a significantly higher rate than in the proposed IPPS rule. This final rule aligns hospital payments with CMS’ vision of ensuring access to health care for all people with Medicare and maintaining incentives for our hospital partners to operate efficiently,” said CMS Administrator Chiquita Brooks-LaSure. “It also takes important steps to advance health equity by encouraging hospitals to implement practices that reduce maternal morbidity and mortality.”

Advancing Health Equity:

Consistent with the agency’s definition of health equity, CMS is working to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all the people served by our programs, eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved, and providing the care and support that our enrollees need to thrive.

To address health care disparities in hospital inpatient care and beyond, CMS is adopting three health equity-focused measures in the IQR Program. The first measure assesses a hospital’s commitment to establishing a culture of equity and delivering more equitable health care by capturing concrete activities across five key domains, including strategic planning, data collection, data analysis, quality improvement, and leadership engagement. The second and third measures capture screening and identification of patient-level, health-related social needs — such as food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. By screening for and identifying such unmet needs, hospitals will be in a better position to serve patients holistically by addressing and monitoring what are often key contributors to poor physical and mental health outcomes.

In the near future, CMS is also interested in using measures focused on connecting patients with identified social needs to community resources or services. CMS sought comment on the proposed rule. In the final rule, CMS acknowledges the robust comments received on key considerations that inform our approach to improving data collection, to better measure and analyze disparities across programs and policies, and approaches for updating the Hospital Readmissions Reduction Program (HRRP) that encourage providers to improve performance for socially at-risk populations.

CMS is also discontinuing the use of proxy data for uncompensated care costs in determining uncompensated care payments for Indian Health Service and Tribal hospitals, and hospitals in Puerto Rico, and we are establishing a new supplemental payment to prevent undue long-term financial disruption for these hospitals and to promote long-term payment stability. CMS is also finalizing new flexibilities for graduate medical education for rural hospitals participating in rural track programs, which will help promote workforce development in rural areas.

Improving Maternal Health Outcomes:

CMS is creating a new hospital designation to identify “Birthing-Friendly” hospitals and additional quality measure reporting to drive improvements in maternal health outcomes. CMS is finalizing this designation following the release of the comprehensive CMS Maternity Care Action Plan.

The Biden-Harris Administration has championed policies to improve maternal health and equity since taking office. Earlier this year, Vice President Harris convened a first-ever White House meeting with Cabinet Secretaries and agency leaders, including Secretary Becerra and CMS Administrator Chiquita Brooks-LaSure, to discuss the Administration’s whole-of-government approach to reducing maternal mortality and morbidity. In December 2021, Vice President Harris announced a historic call to action to improve health outcomes for parents and their young children in the United States. Implementing this new hospital designation is part of the Biden-Harris Administration’s continued response to that call to action, as noted in the CMS Maternity Care Action Plan.

The “Birthing-Friendly” hospital designation will provide important information to consumers about hospitals with a demonstrated commitment to reducing maternal morbidity and mortality by implementing best practices that advance health care quality and safety for pregnant and postpartum patients.

Conditions of Participation Pandemic Reporting for Hospital and Critical Access Hospitals (CAH):

CMS proposed to continue the current COVID-19 reporting requirements for hospitals and CAHs as well as establish new reporting requirements for future public health emergencies (PHE). Based on public feedback, CMS is finalizing the proposed requirements for continued COVID-19-related reporting for hospitals and CAHs with a reduced number of data categories as an off ramp to the current PHE. CMS is not finalizing the proposed reporting requirements for future PHEs.

Continued Public Reporting of Patient Safety Metrics:

CMS uses quality measures to ensure safety and quality within the health care system and to pay providers through value-based programs. For the FY 2023 Hospital-Acquired Condition (HAC) Reduction Program, CMS proposed to pause — meaning not calculate and subsequently not publicly report — the data for the PSI-90 measure, which is a composite measure that covers multiple patient safety indicators, such as pressure sores, falls, and sepsis. CMS’ proposal reflected concerns about the impact COVID-19 would have on the ability to interpret data and was also sensitive to the risks of financially penalizing hospitals for factors potentially out of their control. CMS recognizes the importance of this measure for patients and providers and is finalizing the calculation and public reporting of the CMS PSI-90 measure results. CMS will include the measure in Star Ratings in alignment with the feedback we received. Although this measure will be publicly reported, it will not be used in payment calculations in the HAC to avoid unintentional penalties related to the uneven impacts of COVID-19 across the country.

More Information:

• Final Rule fact sheet
• Maternal Health fact sheet
• Final Rule

The Food and Drug Administration (FDA) has released a free toolkit about vaping and e-cigarettes for professionals working with youth. The toolkit contains fast facts about youth vaping as well as tips for how adults can help teens quit vaping.  It is available to order, download, or print through the FDA.

Click here to access the toolkit.

On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care — particularly in rural and underserved areas. These proposed changes play a key role in the Biden-Harris Administration’s Unity Agenda — especially its priorities to tackle our nation’s mental health crisis, beat the overdose and opioid epidemic, and end cancer as we know it through the Cancer Moonshot — and ensure CMS continues to deliver on its goals of advancing health equity, driving high-quality, whole-person care, and ensuring the sustainability of the Medicare program for future generations.

“At CMS, we are constantly striving to expand access to high quality, comprehensive health care for people served by the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s proposals expand access to vital medical services like behavioral health care, dental care, and cancer treatment options, all while promoting access, innovation, and cost savings in the Medicare program.”

“Integrated coordinated, whole-person care — which addresses physical health, behavioral health, and social determinants of health — is crucial for people with Medicare, especially those with complex needs,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.

The proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 to the CY 2022 PFS conversion factor of $34.61. This conversion factor accounts for the statutorily required update to the conversion factor for CY 2023 of 0%, the expiration of the 3% increase in PFS payments for CY 2022 as required by the Protecting Medicare and American Farmers From Sequester Cuts Act, and the statutorily required budget neutrality adjustment to account for changes in Relative Value Units.

Modernizing Coverage for Behavioral Health Services

In the 2022 CMS Behavioral Health Strategy, CMS set goals to remove barriers to care and improve access to, and the quality of, mental health and substance use care. To help address the acute shortage of behavioral health practitioners, the agency is proposing to allow licensed professional counselors, marriage and family therapists, and other types of behavioral health practitioners to provide behavioral health services under general (rather than direct) supervision. Additionally, CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient’s primary care team.

CMS is also proposing to bundle certain chronic pain management and treatment services into new monthly payments, improving patient access to team-based comprehensive chronic pain treatment. Lastly, CMS is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.

Expanding Access to Accountable Care Organizations

ACOs are groups of health care providers who come together to give coordinated, high-quality care to their Medicare patients. The Medicare Shared Savings Program covers more than 11 million people with Medicare and includes more than 500,000 providers.

CMS is proposing changes to the Medicare Shared Savings Program that, if finalized, represent some of the most significant reforms since the final rule that established the program was finalized in November 2011 and ACOs began participating in 2012. Building on the CMS Innovation Center’s successful ACO Investment Model, CMS is proposing to incorporate advance shared savings payments to certain new Medicare Shared Savings Program ACOs that could be used to address Medicare beneficiaries’ social needs. This is one of the first times Traditional Medicare payments would be permitted for such uses and is expected to be an opportunity for providers in rural and other underserved areas to make the investments needed to become an ACO and succeed in the program. CMS is also proposing that smaller ACOs have more time to transition to downside risk, further helping to grow participation in rural and underserved communities. CMS is also proposing a health equity adjustment to an ACO’s quality performance category score to reward excellent care delivered to underserved populations. Finally, CMS is proposing benchmark adjustments to encourage more ACOs to participate and succeed, which would help achieve the goal of having all people with Traditional Medicare in an accountable care relationship with a healthcare provider by 2030.

Improving Access to Colon Cancer Screening

Colon and rectal cancer were the second-leading cause of cancer deaths in the United States in 2020, with higher colorectal cancer death rates for Black Americans, American Indians, and Alaska Natives. To reduce barriers to getting a colonoscopy, CMS is proposing that a follow-up colonoscopy to an at-home test be considered a preventive service, which means that cost sharing would be waived for people with Medicare. Additionally, Medicare is proposing to cover the service for individuals 45 years of age and above, in line with the newly lowered age recommendation (down from 50) from the United States Preventive Services Task Force.

Proposing Payment for Dental Services that are Integral to Covered Medical Services

Medicare Part B currently pays for dental services when that service is integral to medically necessary services required to treat a beneficiary’s primary medical condition. Some examples include reconstruction of the jaw following accidental injury or tooth extractions done in preparation for radiation treatment for jaw cancer. CMS is proposing to pay for dental services, such as dental examination and treatment preceding an organ transplant. In addition, CMS is seeking comment on other medical conditions where Medicare should pay for dental services, such as for cancer treatment or joint replacement surgeries, as well as on a process to get public input when additional dental services may be integral to the clinical success of other medical services.

More Information:

• PFS fact sheet
• Quality Payment Program fact sheet
• Medicare Shared Savings Program Proposals fact sheet
• Blog
• Proposed rule

The Biden administration rolled out free at-home COVID-19 tests that are designed to be more accessible for people who are blind or visually impaired. Read more.

The pandemic led to an “unprecedented” increase in Hispanic pregnant women dying in 2020 compared to previous years, according to a study in JAMA. There was also an increase in existing disparities for Black pregnant women, who die at higher rates than white women. COVID itself, along with the way the pandemic delayed care for other conditions, likely contributed to the higher death toll during 2020. There were large increases in the rate of maternal deaths from viral and respiratory diseases in 2020 as well as from diabetes and hypertensive disorders. Regardless of the cause, the pandemic “created a new disparity and exacerbated existing ones,” according to one of the study’s co-authors.

The U.S. Department of Health & Human Services recently posted the guide on Telehealth.HHS.Gov. The strategy for developing a rural telehealth program includes how to get started, developing a telehealth workflow, billing, preparing patients for a new way to get health care, and gaining access to the internet.

Researchers from the Center for Rural Health Research at East Tennessee State University report that higher rates of infection and lagging vaccinations mean that the lingering effects, now called long COVID, are likely to have a disproportionate effect on rural communities.  While symptoms and severity of long COVID can range from mild to severe, the potential impact on mental health, social function, and the ability to keep working can be substantial.  Watch a presentation from the Centers for Disease Control and Prevention on evaluating and supporting patients with cognitive symptoms following COVID.