Rural Health Policy

Regulatory Review

The Federal Office of Rural Health Policy is charged in Section 1102(b) of the Social Security Act with advising the Secretary of the U.S. Department of Health and Human Services on the effect that federal health care policies and regulations may have on rural communities. Monitoring current and proposed changes, including programs established under titles XVIII and XIX (Medicare and Medicaid), FORHP analyzes their impact on the financial viability of small rural hospitals and clinics, on the ability of rural areas to attract health professionals, and on rural areas’ access to high quality care.

Data collection and analysis is essential to understanding the challenges in rural communities, how those communities are impacted by policy, and setting policy for the future. For this reason, the work of the Rural Health Research Centers informs that of FORHP’s policy team and vice versa.

Policy Announcements

October 31

Proposed Rule: SNAP Benefits   – Comment by November 28.  Last month, the USDA Food and Nutrition Service (FNS) issued a proposal to update general information and guidelines for the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program.  The proposed rule would 1) require states to issue households’ monthly SNAP benefits in one lump sum; and 2) clarify rules and timeline for clearing unused benefits (expungement) from user accounts.  Current policy allows states to delete funds only when the account has been inactive for one year.  Proposed policy would allow states to delete any funds that have not been used after 12 months, regardless of account activity.  FNS is particularly interested in receiving comments on expungement, rules for reinstating funds, and whether states should be given options on the process.

Final Rule: Consumer Protections for Long-Term Care Facility Residents.  In September, CMS issued a final rule updating the requirements for long-term care facilities to reflect current practice standards of person-centered care. CMS now requires a data-driven quality assurance and performance improvement (QAPI) program, an infection prevention and control program (IPCP), and a compliance and ethics program at all Medicare-certified skilled nursing facilities and Medicaid-certified nursing facilities. In a change from the proposed rule, CMS withdrew its requirement for a medical evaluation before all non-emergency resident transfers. Of note for rural providers, the rule updates the subset of provisions applicable to swing beds at CAHs and PPS hospitals. Changes in this rule will be phased in over three years beginning November 28.

Final Rule:  Childcare and Development Fund.  On September 30, the Administration for Children and Families (ACF) published a final rule strengthening requirements to protect the health and safety of children in child care settings. The Child Care and Development Fund (CCDF) provides funding to states and territories to help low-income parents get child care while working.  This final rule requires more robust standards for child care providers, including mandatory background checks for staff; annual monitoring of all CCDF-funded childcare providers, and workforce training on 10 key health and safety topics such as first aid and CPR, medication administration, and the prevention of sudden infant death syndrome (SIDS). The rule also requires states and territories to describe strategies for increasing the supply and improving the quality of child care services in underserved areas. Rule changes are effective November 29 and states and territories are expected to be in full compliance by the end of the fiscal year (FY) 2016-2018 CCDF plan period.

ONC Health IT Program: Enhanced Oversight and Accountability: On October 14, 2016, the Office of the National Coordinator  for Health IT displayed the final rule for the ONC Health IT Certification Program, which gives the agency more direct  oversight of the health IT testing labs. The rule highlights the importance of protecting public health and safety while strengthening transparency and accountability in the certification program.  This rule is intended to enable the ONC Health IT Certification Program to better support physicians and hospitals – the vast majority of whom use electronic health records – and the rapid pace of innovation in the health information technology market. Rural providers are encouraged to review the final rule with their electronic health records vendors in order to ensure compliance of the changes to the ONC Health IT Certification Program. Please see the fact sheet on this final rule for more information.    

Please send your questions to FORHP's Policy Team at

Last Reviewed: November 2016