Federal Senators Introduce Bipartisan Bill to Support Critical Access Hospitals

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U.S. Senators Catherine Cortez Masto (D-Nev.) Maggie Hassan (D-N.H.), John Barrasso (R-Wyo.), and Marsha Blackburn (R-Tenn.) introduced the Rural Hospital Flexibility Act, which would permanently reauthorize and modernize the Medicare Rural Hospital Flexibility Program. This program provides states with funding to support rural hospitals through training, technical support, and equipment for improving health care for patients, including emergency medical care.

The Rural Hospital Flexibility Program supports Critical Access Hospitals – small, rural hospitals that have 25 beds or less and are located either more than 35 miles from the nearest hospital or more than 15 miles in areas with mountainous terrain or only secondary roads. Nevada has 13 Critical Access Hospitals located throughout the state, which serve nearly 300,000 people, approximately 10% of the state’s population.

“Every Nevadan needs access to quality health care, no matter where they live. That’s why we must reauthorize the Rural Hospital Flex Program, which delivers vital funding and technical resources to help critical access hospitals improve the rural health care system,” said Senator Cortez Masto. “I’ll never stop fighting to keep communities in every corner of the Silver State healthy.”

“For the past 25 years, the Medicare Rural Hospital Flexibility Program or “Flex Program” has supported a wide-range of financial and operational assistance to Nevada’s thirteen Critical Access Hospitals, said Dr. John Packham, Associate Dean for Statewide Initiatives at UNR School of Medicine. “The Rural Hospital Flexibility Act of 2024 will allow the Nevada State Office of Rural Health and its partners to continue to provide vital technical assistance and support to our state’s rural hospitals and clinics, and thus ensure the economic viability of health care facilities serving the 300,000 rural and frontier residents in Nevada.”

“It is crucial that we continue to support our rural hospitals so that all Granite Staters can have access to high-quality, affordable health care,” said Senator Hassan. “The Medicare Rural Hospital Flexibility Program has helped hospitals in New Hampshire improve the health care that patients receive, and I will work with my colleagues to pass this bipartisan, commonsense legislation to renew and modernize these grants so that New Hampshire’s rural hospitals have the support, training, and equipment to provide the best possible care.

“Wyoming’s rural hospitals understand best what their patients and communities need. The Rural Flex program gives them the flexibility they need to keep their doors open,” said Senator Barrasso. “Rural hospitals use this vital program to provide specialized staff training, update technological equipment, and improve the quality of care for patients. Our legislation will help free America’s rural hospitals from one-size-fits-all Washington regulations.”

“For over 25 years, the FLEX program has been instrumental in supporting rural hospitals and healthcare providers, ensuring access to quality care for millions of Americans,” said Senator Blackburn. “The Medicare Rural Hospital Flexibility Program Reauthorization Act would build on this legacy by modernizing the program to support quality improvement, behavioral health services, telehealth, and innovative care models. This reauthorization reflects our commitment to ensuring that rural hospitals and clinics can continue to serve as lifelines for their communities, providing high-quality, sustainable care well into the future.”

“The National Rural Health Association (NRHA) thanks Senators Hassan, Barrasso, Cortez Masto, and Blackburn for their efforts to reauthorize the Medicare Rural Hospital Flexibility program. Flex is instrumental in serving critical access hospitals across the country and ensuring they are able to support the health needs of their communities. We appreciate the Senators’ continued dedication to supporting rural health care,” said Alan Morgan, CEO of The National Rural Health Association.

Senator Cortez Masto has consistently fought to ensure that Nevadans can access quality, affordable health care — including in rural communities. She’s pushed bipartisan legislation to guarantee lifesaving emergency services in rural communities and extend and increase Medicare payments for emergency ambulances everywhere. She’s passed a law to make sure ambulance providers are adequately reimbursed for providing critical services, fought to protect the Medicare Advantage program for millions of seniors and Americans with disabilities, and introduced legislation to keep labor and delivery units open in rural and underserved hospitals. She has also championed the Inflation Reduction Act, which gives Medicare the power to negotiate drug prices, caps drug costs and limits egregious price hikes by drug manufacturers.

Penn Highlands Huntingdon Addresses, Reduces Diabetes through Patient Engagement

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To highlight the wide range of issues affecting rural health, Pennsylvania Governor Josh Shapiro declared November 18-22, 2024 as Rural Health Week in Pennsylvania. This declaration comes at the request of the Pennsylvania Rural Health Association (PRHA) and the Pennsylvania Office of Rural Health (PORH).

Governor Shapiro aims to raise awareness about the various issues impacting rural health care and the health status of rural Pennsylvanians. Pennsylvania ranks among the states with the highest number of rural residents, with 26 percent of its population living in rural areas. To address the diverse needs of rural communities, the Commonwealth has supported the establishment of the Center for Rural Pennsylvania, the Pennsylvania Office of Rural Health, and other initiatives focused on improving rural health.

The week also includes November 21, which is National Rural Health Day. Established in 2011 by the National Organization of State Offices of Rural Health (NOSORH), National Rural Health Day aims to showcase rural America, raise awareness of rural health issues, and promote the efforts of NOSORH, State Offices of Rural Health (SORHs), and other organizations addressing these issues.

“Nearly 59.5 million Americans, including 3.4 million Pennsylvanians, live in rural communities,” said Lisa Davis, director of PORH and an outreach associate professor of health policy and administration at Penn State. “These small towns and communities are driven by the creative energy of citizens who step forward to provide a wealth of products, resources, and services.”

Penn Highlands Huntingdon is a small rural hospital located in the mountainous region of Huntingdon, PA. In addition to serving Huntingdon County, the hospital provides services to the surrounding counties of Bedford, Blair, Centre, Franklin, Fulton, Juniata, and Mifflin.

The population of Huntingdon County is approximately 6,927, an increase of 1.7 percent since the 2020 U.S. Census. Penn Highlands Huntingdon is continuously expanding its medical services and is committed to improving the quality of inpatient and outpatient care for the community.

According to 2024 U.S. News data and the Huntingdon County Community Health Needs Assessment, the prevalence of diabetes in Huntingdon County is 9.4 percent, which is slightly lower than the national rate of 10.6 percent. The percentage of individuals facing food and nutrition challenges in the county is 6.8 percent, higher than the national rate of 5.9 percent. The obesity rate in Huntingdon County stands at 38.4 percent, compared to the national rate of 37.4 percent. Notable nutrition-related issues include poor food options that are high in sugar and fat but low in nutritional value.

Bethany Stough, Doctor of Nursing Practice (DNP) and a leading health care provider in Huntingdon County, has observed trends in diabetes care and has taken a crucial role in developing effective solutions. Her goal is to improve health outcomes for her patients—especially those who must travel more than sixty minutes to see an endocrinologist—and to provide comprehensive education on diabetes and nutrition.

In her treatment of diabetes patients, Dr. Stough emphasizes identifying the appropriate treatment for each patient, acknowledging their current situation, and collaborating towards a shared goal. More than 90 percent of Stough’s patient population has achieved an appropriate diabetic hemoglobin A1C result, demonstrating that her patients are compliant with dietary and medication recommendations.

“Engaging patients in making lifestyle changes is crucial for effective treatment,” noted Stough. “This process requires time and a personalized approach and is critical to providing effective care for every individual.”

Lannette Fetzer, quality improvement coordinator at the Pennsylvania Office of Rural Health added, “Recognizing the importance of providing excellent quality care is crucial for achieving optimal patient outcomes, particularly for diabetic patients. The work that Dr. Stough is doing is having a profound impact on the patients she serves.”

CMS Opportunity to Help People Get Connected to Health Care Coverage

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The Centers for Medicare & Medicaid Services (CMS) thanks you for your partnership in helping to share information about Medicaid and Children’s Health Insurance Program (CHIP) renewals with people in your community. Your support as a trusted voice in your community has been key to helping people keep health coverage as states return to regular operations after the COVID-19 pandemic. The Medicaid and CHIP Renewals Outreach and Educational Resources webpage includes evergreen language that partners can use to share information about regular Medicaid and CHIP renewals. We encourage partners to continue to explore the refreshed resources and share information with people in your community.

Pennsylvania Oral Health Coalition Strongly Affirms Support for Fluoride in Water at Optimal Levels

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PCOH strongly affirms our support of adjusting fluoride in water to optimal levels. Community water fluoridation (CWF) remains the single most effective public health measure to prevent tooth decay and protect oral health. 

For nearly 80 years, communities across the United States have been adjusting the naturally occurring amount of fluoride in water to the amount recommended by the Centers for Disease Control and Prevention (CDC) for optimal oral health, and this practice has improved the oral health of tens of millions of Americans. As with most things, the amount you consume matters and too much of anything can be harmful. This is why the amount of fluoride in water is heavily regulated, tested, and ensured to be safe. Studies and court cases are often cited that indicate that fluoride causes negative health effects, when in reality, these studies are based on fluoride amounts that are far higher than we allow in the United States.

In Pennsylvania, each community water system makes its own decision on whether or not they will adjust the natural levels of fluoride in the water they provide to their customers. Adjusting the amount of fluoride in water reaches entire communities and addresses oral health needs for everyone in the community in a way that no other oral health tool can; it’s an accessible resource for all, regardless of insurance status, socioeconomic status, or access to dental care.  As we continue to face growing dental workforce shortages, adjusting fluoride levels in water is a preventive measure that will help benefit even those who are now waiting months for a dental appointment.

In the upcoming holiday season, you may find yourself having difficult conversations with family members, friends, and community members. It is important for all of us to emphasize the evidence-based science and effectiveness of water fluoridation in preventing cavities and improving oral health. We wanted to make sure that you have the tools and resources to have these difficult conversations and have created a new resource that can be used and shared when addressing fluoride levels in water.

The Pennsylvania Coalition for Oral Health (PCOH) needs support in being able to connect at the community level on this issue, and continues to offer resources to assist individuals and communities in protecting this effective public health measure. Please consider joining the Statewide Water Action Team (SWAT) by emailing nicole@paoralhealth.org.

Pennsylvania Launches Mixed-Use Housing Development Pilot Program

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Department of Community and Economic Development (DCED) Secretary Rick Siger today announced the launch of the new $10 million PA Mixed-Use Housing Development pilot program to develop mixed-use projects with a residential housing component. DCED is accepting applications for the grant funding starting today, October 23, through December 6, 2024.

Governor Josh Shapiro recently signed an Executive Order mandating Pennsylvania’s first comprehensive Housing Action Plan to address the state’s housing shortage, homelessness, and expand affordable housing options — ensuring Pennsylvanians have access to safe, affordable housing and attracting more people to live in the Commonwealth. DCED was tasked with leading the plan’s development and working with stakeholders across Pennsylvania to identify housing needs and devise a strategic response.

“The PA Mixed-Use Housing Development pilot program is a strong first step towards boosting the availability of affordable housing, increasing housing for our growing workforce, and providing crucial support for Pennsylvanians struggling to obtain housing,” said Secretary Siger. “This program and others developed under Governor Shapiro’s Housing Action Plan will improve access to safe, affordable housing which is essential for Pennsylvania’s economic growth and critical to the well-being of families and individuals throughout the Commonwealth.”

The pilot program will provide grant funding to eligible applicants for site development for a multi-use building as well as conversion or rehabilitation of existing structures for mixed-use development. A portion of the project must be devoted to development of both rental and owner-occupied residential units. The $10 million in funding for the PA Mixed-Use Housing Development pilot program is from dedicated PA SITES funding.

Eligible applicants include municipalities; economic development organizations; redevelopment authorities; municipal authorities; industrial development agencies; and for-profit organizations.

Expanding the availability of housing across Pennsylvania was a key element of Governor Shapiro’s Economic Development Strategy, the first plan of its kind in the Commonwealth in almost 20 years. Unveiled by Governor Shapiro and Secretary Siger earlier this year, the strategy will capitalize on the Commonwealth’s strengths and will reignite our economy by focusing on the Agriculture, Energy, Life Sciences, Manufacturing, and Robotics and Technology sectors.

Since day one, Governor Shapiro has worked to create real opportunities for Pennsylvanians and build an economy where everyone can chart their own course — working together with a divided legislature to deliver major investments that will help families afford to stay in their homes, address homelessness, and support our local communities by:

  • Expanding the Property Tax/Rent Rebate and the Child and Dependent Care Enhancement Tax Credit
  • Nearly doubling the funding cap for the Pennsylvania Housing Affordability and Rehabilitation Enhancement (PHARE) Fund to expand affordable housing
  • Increasing the Homelessness Assistance Program to make sure we are protecting our most vulnerable residents
  • Doubling state investments for the Neighborhood Assistance Program to encourage businesses to invest in affordable housing and community development.

For more information about the PA Mixed-Use Housing Development pilot program and DCED, visit the DCED website, and be sure to stay up-to-date with all of our agency news on Facebook, X, and LinkedIn.

CMS Announces 2025 final rules for Physician Fee Schedule, OPPS, and ASC

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CMS announced the final rules for the 2025 physician fee schedule, the hospital outpatient prospective payment system (OPPS) and the Ambulatory Surgical Centers.  Within these rules, CMS is finalizing new coding and payment policies for advanced primary care management services, advancing maternal safety standards, removing barriers to expand access to care for those formerly incarcerated and others in underserved communities, and setting policies to reduce the use of opioids and to increase access to high-cost drugs in tribal communities.

Physicians will see finalized average payment rates reduced by 2.93% in CY 2025 compared to the average payment rates for most of CY 2024, while payment rates for hospital outpatient and ASC services will increase by 2.9% in CY2025.

You can find more at the links below.  Please contact me at (insert) with questions or if you’d like to learn more.

FINAL FULL PACKAGE: Calendar Year (CY) 2025 Physician Fee Schedule (PFS) Final Rule CMS-1807-F

Web links:

New Report: 2024 State of Children’s Health Finds Uninsured Rates for Pennsylvania Children Stable, Yet Remains Too High

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The number of uninsured children in Pennsylvania remains stable following last year’s unwinding of the Medicaid continuous coverage provision, but no progress has been made, according to our 2024 State of Children’s Health report. The report provides the first look at the impact of resuming Medicaid renewals following a three-year federal hiatus during the COVID-19 public health emergency.

Between 2022 and 2023, the rate of Pennsylvania children without health insurance remained steady at 5.2%. However, steady rates do not mean progress. Too many children live in Pennsylvania without access to health insurance. The number of Pennsylvania children under age 19 without health insurance increased slightly from 145,000 to 147,000 from one year ago.

According to the report, factors such as age, race and ethnicity, and poverty level impact children’s access to health insurance. Demographic highlights include:

  • Children under 6 are more likely to be uninsured (5.6%) than school age children (5.1%).
  • Uninsured rates improved for American Indian and Alaska Native children and White children. Uninsured rates worsened for Asian children, Black children, Hispanic children, and children of multiple races.
  • Children in lower-income families are more likely to be uninsured, and approximately 6.8% of PA children are financially eligible for Medicaid but not enrolled.

Accompanying fact sheets for each of the 67 counties show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.

The report finds that Medicaid, CHIP and Pennie™ remain significant sources of coverage with approximately 47% of Pennsylvania children relying on those programs’ health plans to meet their health care needs. A growing concern is that the Pennie™ “no wrong door” policy may not be working as intended since more than half of children enrolled through Pennie™ appear financially eligible for Medicaid or subsidized CHIP programs.

While the Medicaid unwinding process did not cause significant disruptions to children’s coverage in 2023, we will know next year if there were disruptions in 2024 as the process wrapped up in June.

Approximately 8 out of 10 children with renewals completed within Medicaid unwinding maintained public coverage. However, procedural disenrollments occurred too often with 42% of children disenrolled due to administrative reasons, not eligibility. To counter this trend, the report recommends that the state improve its poor track record of using automated “ex parte” renewals instead of enrollees submitting renewal applications.

The report also recommends strengthening the state’s continuous eligibility (CE) policy and supports DHS’ plan to provide continuous eligibility to children from birth until age 6. In a big win for kids, DHS has received federal approval last week of its plan to provide Medicaid continuous coverage for Pennsylvania’s youngest children, which is expected to start in January.

To help ensure no child is disconnected from care and to keep down costs for families and the state, the report recommends that Pennsylvania:

  • Strengthen automated renewals
  • Provide continuous coverage to young children
  • Improve PA’s ‘no wrong door’ policy

CMS Releases New Provider Toolkit for Sickle Cell Disease

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The U.S. Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) has released a new resource: CMS Sickle Cell Disease (SCD) Health Care Provider Toolkit: Resources for Health Care Professionals to Support Individuals with SCD .

This new toolkit builds on the CMS Sickle Cell Disease Action Plan (released in September 2023) to strengthen the infrastructure for primary care and other care settings to care for people with SCD, improve care management, and assist providers with supporting the needs of people with SCD and other chronic conditions. The SCD Toolkit consists of 6 sections that equip healthcare providers in delivering quality care to individuals with sickle cell disease. This toolkit is designed to assist the care team in supporting people by introducing SCD, including the common barriers to care, and summarizing CMS program coverage for services around social determinants and drivers of health as well as and new sickle cell disease treatments.

Culturally Responsive Approaches to Anti-Human Trafficking Programming in Native Communities

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This policy brief from the Administration for Children and Families (ACF) examines the results of a demonstration project created by ACF’s Office on Trafficking in Persons for Native Communities.  Analysts describe how six communities chosen for the project used culture as a resource to integrate values, beliefs, traditions, and activities into various project strategies and services offered.