From the Pittsburgh Post-Gazette

An emergency childbirth on the side of Route 219 in Elk County, four months after the closing of the maternity unit at the nearest hospital, is stoking health care worries in the sparsely populated county, 2½ hours northeast of Pittsburgh.

Ridgway Ambulance Corp. paramedic Missy Lecker, 54, and her crew delivered a healthy baby girl on the side of the road Sept. 24, when it became clear they were not going to make it to Penn Highlands Healthcare’s maternity hospital in Clearfield County, about 29 miles from where the call was received.

“She was in labor,” Ms. Lecker said about the 27-year-old mother. “Her water had broken.”

Penn Highlands, which reported an operating loss of $36.4 million for the year ending June 30, closed the maternity unit at its St. Marys hospital in May.

“Unfortunately, this is becoming way too commonplace with the closure of Penn Highlands Elk maternity,” the ambulance service posted on its Facebook page. Ms. Lecker declined further comment.

A Penn Highlands spokeswoman said the hospital system had no plans to reopen the closed unit at the St. Marys hospital or create a freestanding birthing center alternative for moms-to-be.

Operating losses for the eight-hospital, DuBois-based system for fiscal years ending June 30 in 2023 and 2024 totaled $68.7 million, spurring a Fitch Ratings bond issuer default and revenue bond ratings cut to BBB from A-minus in August.

Elk County is part of a six-county swath of the state — twice the size of Delaware — that has no hospital maternity care, which concerns Ridgway Borough Council member Zack Pontious, who has met with Penn Highlands officials to discuss its decision to end obstetrics services at the local hospital.

“A more vibrant, community-minded health care delivery system delivers high-quality care, even for the most basic medical needs,” he said. “We do not have that in Elk County today.”

In response, a group of local residents and business owners have formed the Elk County HealthCare Coalition, with the aim of creating an independent, countywide authority that would find ways of enhancing health care services. The county commissioners will conduct a public hearing on the proposal to create the Elk County Health Care Authority on Oct. 11.

“It did seem the idea had merit,” Elk County Commissioner Matthew G. Quesenberry said. “It’s an idea worth pursuing. They’ve got their facts together.”

The Penn Highlands spokeswoman said the health care system would continue consulting with county commissioners on the creation of the authority, but said it was premature to say whether the discussions would result in a partnership.

Elk County has a population of just 31,000, smaller than some Pittsburgh-area townships, which includes 4,500 women between the childbearing ages of 15 and 44, according to the U.S. Census.

Rural residents generally face poorer health outcomes from cancer, heart problems and other chronic diseases while rural hospitals often face bigger fiscal challenges than their urban counterparts, according to KFF Health News, a San Francisco nonprofit.

Rural health care providers often face bigger fiscal challenges than their urban counterparts, according to KFF, while studies have shown wide disparities in longevity and how well patients do in recovering from chronic diseases, depending on whether they live in rural or urban areas.

Between 2010 and 2019, 114 rural hospitals eliminated inpatient services or closed altogether while others cut specific service lines, such as obstetrics. In 2019, the year before the start of the COVID-19 pandemic, median operating margins at rural hospitals were 1.5%, which compared to 5.2% among other hospitals.

In addition to maternity care, Mr. Pontious said a health care authority could try to find physicians and other partners and solutions for a variety of health care issues in the county, including expanding primary care.

“We hear this mantra that rural health care doesn’t work,” Mr. Pontious said. “What’s interesting is that an independent authority could find creative ways to fill a number of health care gaps in the county.”

“Everything is on the table,” he said. “The problem is so big.”

The Commonwealth of Pennsylvania is taking action against the state’s high maternal mortality rate through the development of a statewide Maternal Health Strategic Plan. They are looking to learn more about what people experience and what needs they have before, during, and/or after a pregnancy, or when receiving maternal health care such as check-ups and preventive services. This survey takes approximately 10-15 minutes to complete and all questions are optional.

The survey closes on November 4th.

Click here to take the survey.

Funding supports the White House Blueprint for Addressing the Maternal Health Crisis by investing in innovative state-based strategies

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), announced nearly $19 million in awards to 15 states to identify and implement innovative strategies to address the maternal health crisis. HRSA Deputy Administrator Jordan Grossman, joined by Congresswoman Robin Kelly (IL-02), Chair of the Congressional Black Caucus Health Braintrust and Co-chair of the bipartisan Maternity Care Caucus, announced these awards in Chicago, IL as part of HRSA’s latest state Enhancing Maternal Health Initiative convening.

HRSA announced the availability of this funding in December 2023 at a White House roundtable on innovation in maternal health convened by the Office of the Vice President Kamala Harris and the Domestic Policy Council in support of the White House Blueprint for Addressing the Maternal Health Crisis.

“Supporting community solutions to the maternal mortality crisis means listening to moms and women with lived experience,” said HRSA Deputy Administrator Grossman. “At the Health Resources and Services Administration, we are proud to invest in our State Maternal Health Task Force initiative to create community tables across the country that are innovating and deploying community-driven solutions and strategies to advance women’s health.”

“Our nation’s crisis of maternal mortality requires urgent action. Pregnancy and birth should be one of the happiest moments for a family, but too many moms and women are suffering,” said Rep. Kelly. “I’m grateful to HRSA for elevating this conversation and for their efforts to improve maternal health outcomes in Illinois and nationwide. Together, we will ensure that every woman receives the care, support, and resources she deserves.”

State Maternal Health Innovation programs identify the key drivers of maternal mortality in their state, develop strategies and implement new interventions to address these issues tailored to their state’s needs. As part of this program, HRSA also funds State Maternal Health Task Forces that bring together health care providers, policymakers, patients, payers, and other stakeholders to develop shared solutions specific to their state’s needs and to better support pregnant women and new moms.

State Maternal Health Innovations programs have implemented a broad range of interventions to address maternal health challenges in their individual states. Examples of these interventions include early identification and treatment of hypertension to reduce preeclampsia and other risks, providing mobile simulation trainings to prepare health care providers for a range of adverse labor events, expanding access to trainings to rural and frontier hospitals that do not have a dedicated obstetrics department, and creating resources to improve first responders’ ability to respond to patients with substance use disorder during and after pregnancy.

This funding is part of the Biden-Harris Administration’s broader efforts to improve maternal health and supports HRSA’s ongoing initiative to reduce maternal mortality and health disparities. HRSA’s Enhancing Maternal Health Initiative aims to accelerate HRSA’s efforts to improve maternal health outcomes in partnership with women, grant recipients, community organizations, and state and local officials nationwide. Other key actions HRSA has taken to improve maternal health include:

• Launching the National Maternal Mental Health Hotline (833-TLC-MAMA) in 2022. The hotline provides 24/7 emotional and mental health support via call or text to expectant and new mothers and their families.
• Expanding Home Visiting services. HRSA recently awarded over $440 million in funding to expand voluntary, evidence-based home visiting services for eligible families across the country. Through the Maternal, Infant, and Early Childhood Home Visiting Program, local organizations can provide home visits from nurses, social workers, and other trained health workers who work with families to improve maternal and child health, child development and school readiness.
• Expanding Healthy Start services. HRSA recently invested $105 million in community-based organizations to improve maternal and infant health across the country through Healthy Start. Healthy Start funding will better support moms and babies to improve health in communities experiencing high disparities in maternal and infant health outcomes.
• Growing and diversifying the perinatal workforce, including doulas. HRSA has increased the number of obstetrician-gynecologists (OB/GYNs), nurses, midwives, doulas, and community health workers, especially in places without them, through grants, scholarships and loan repayment. For example, HRSA launched new programs to train more nurse midwifes who reflect the communities they serve, train and deploy more community-based doulas, and support the training of more nurse practitioners with a focus on maternal health, including in underserved and rural areas.
• Investing in new community health center efforts to address maternal health disparities. HRSA invested more than $65 million in 35 HRSA-funded health centers across the country to implement innovative approaches to improve maternal health outcomes and reduce disparities for patients at highest risk.
• Supporting maternal health care in rural communities. HRSA funds the Rural Maternity and Obstetrics Management Strategies (Rural MOMS) Program to increase access to maternal and obstetrics care in rural communities and improve health outcomes for mothers and infants. HRSA also awarded nearly $9 million over four years to five organizations to expand access to and coordinate health care services before, during, and after pregnancy in rural communities in the South.

For a complete list of State MHI awards, visit: https://mchb.hrsa.gov/programs/state-mhi/awards

See News & Announcements on HRSA.gov.

U.S. Department of Agriculture (USDA) Deputy Secretary Xochitl Torres Small announced that USDA is partnering with farmers and small businesses to expand access to clean energy and lower energy bills through the Rural Energy for America Program (REAP).

“As drivers of our economy, farmers and rural business owners deserve affordable energy,” Deputy Secretary Torres Small said. “That’s why, as part of the Biden-Harris Administration’s Investing in America Agenda, I’m proud to announce an additional $104 million in REAP loans and grants that will lower energy costs for farmers and small business and help them expand their operations, all while tackling climate change.”

USDA is investing $104 million in loans and grants that will support over 300 clean energy projects in 34 states. Many of the projects are funded by President Biden’s Inflation Reduction Act, the nation’s largest-ever investment in combating the climate crisis. The projects also advance President Biden’s Investing in America Agenda to grow the nation’s economy from the middle out and the bottom up.

You can view the complete news release on our website.

The Centers for Medicare & Medicaid Services (CMS) released guidance on state compliance with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements under Medicaid and the Children’s Health Insurance Program (CHIP).  Current law entitles eligible children under the age of 21 to Medicaid coverage of health care, diagnostic services, treatment, and other measures described that are medically necessary.  This guidance provides an overview of EPSDT requirements and discusses policies, strategies, and best practices to maximize health care access and utilization for EPSDT-eligible children.  Strategies include promoting EPSDT awareness and accessibility, expanding and using the child-focused (EPSDT) workforce in rural areas, and improving care for EPSDT-eligible children with specialized needs, including providing behavioral health services in Rural Health Clinics. Medicaid and CHIP covers about 47 percent of children in rural areas and small towns.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule addressing significant, anomalous, and highly suspect (SAHS) billing activity within Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (SSP). In 2023, CMS identified a concerning rise in urinary catheter billings, which was attributed to a small group of durable medical equipment supply companies. CMS determined that the beneficiaries did not receive catheters and were not billed directly, physicians did not order these supplies, and supplies were not needed.  This rule specifies how CMS will calculate various factors used in SSP financial calculations for 2023.  The proposed Physician Fee Schedule addresses SAHS billing activity for 2024 onwards.  As of January 2024, over 500 Critical Access Hospitals and 2,500 Rural Health Clinics participated in Medicare SSP ACOs.

– Comment by November 29. This week, the Centers for Medicare & Medicaid Services (CMS) released an interim final action with comment period (IFC) that removes the low wage index hospital policy following the appellate court decision in Bridgeport Hosp. v. Becerra. The low wage index hospital policy was implemented in FY2020 to address wage index disparities affecting low-wage index hospitals, including many rural hospitals.  The court decided that the policy and related budget neutrality adjustment must be reversed. As a result, this IFC revises the Medicare wage index values for FY 2025, establishes a transitional payment exception for low wage hospitals significantly impacted by those revisions, and makes conforming changes to the Medicare hospital Inpatient Prospective Payment System (IPPS) payment rates for FY 2025. These changes are effective September 30, 2024. To be assured consideration, comments must be received by November 29, 2024.

Among key findings in this policy brief from the University of Minnesota Rural Health Research Center:

• Health care affordability and medical debt issues differed significantly among rural residents by race and ethnicity, sexual orientation, age, income, and type of health insurance.
• Rural residents in the Western U.S. were more likely to be able to pay their medical bills than rural residents in the Northeast, North Central/Midwest, or Southern U.S.

USDA Rural Development is now accepting applications for the Rural Energy for America Program. This program provides guaranteed loan financing and grant funding to agricultural producers and rural small businesses for renewable energy systems or to make energy efficiency improvements. Agricultural producers may also apply for new energy efficient equipment and new system loans for agricultural production and processing.  The Federal Register document will be posted on the program website once it is published.

The Rural Energy for America Program helps increase American energy independence by increasing the private sector supply of renewable energy and decreasing the demand for energy through energy efficiency improvements. Over time, these investments can also help lower the cost of energy for small businesses and agricultural producers. The loan guarantee percentage is published annually in a Federal Register notice. REAP loans approved in Fiscal Year 2024 will receive an 80 percent guarantee. REAP loans approved in Fiscal Year 2025 will receive an 80 percent guarantee.

To apply for this REAP funding, please visit the Rural Energy for America Program page at Rural Development’s website. You can also find eligibility requirements, loan terms, and other frequently asked questions at this page. Also, be sure to follow USDA Rural Development’s Facebook page for updates.