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 January 13, 2017

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CMS Issues New Guidance for Hospitals (PDF – 50 KB). Last month, the Centers for Medicare & Medicaid Services (CMS) issued preliminary guidance clarifying the 21st Century Cures Act provisions that impact hospital outpatient off-campus provider-based departments (PBD) with concrete plans for construction at the passing of the Bipartisan Budget Act of 2015. The Cures law extended the grandfather date for those facilities to qualify for payment under the outpatient prospective payment system, rather than at the lower “site-neutral” rate. On Dec. 28, CMS also issued sub- regulatory guidance (PDF – 408 KB) on how hospitals can request from their CMS Regional Office a relocation exception for an excepted off-campus provider based department due to an extraordinary circumstance. Please see the fact sheet for more information on the finalized Hospital Outpatient Prospective Final Rule and provisions related to payments for off-campus PBDs.

Report to Congress: Performance Under Value-Based Purchasing Programs. In December, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) issued the first of two reports to Congress mandated by the IMPACT Act that analyze the effect of social risk factors on Medicare quality measures and quality-based payment programs. In this first report, ASPE considered how the performance of hospitals, health plans, physicians, dialysis facilities, skilled nursing facilities, and home health agencies were affected by the following six social risk factors: (1) dual enrollment in Medicare and Medicaid, (2) residence in a low-income area, (3) Black race, (4) Hispanic ethnicity, (5) residence in a rural area, and (6) disability status. Of the risk factors considered, ASPE found that dual enrollment was the most powerful predictor of poor performance. While beneficiaries’ rural residence was not a significant predictor, rural beneficiaries are more likely to be dually enrolled (PDF – 442 KB) than their urban counterparts. In its results, ASPE finds that beneficiaries with social risk factors had poorer outcomes on many process, clinical outcome, and patient experience measures, and in every care setting examined, providers that cared for higher proportions of beneficiaries with social risk factors tended to perform worse than their peers, even after adjusting for beneficiary characteristics, leading to financial penalties across all five Medicare quality-based payment programs.

CMS Unveils New Compare Websites and Data Updates. In December, CMS also announced two new websites providing quality data on inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs): IRF Compare and LTCH Compare. The new Compare sites report performance measures from the IRF and LTCH quality reporting programs, such as the percentage of patients with new or worsened pressure ulcers and the rate of unplanned readmissions within 30 days after discharge. Of note for rural residents, the IRF Compare site includes information on inpatient rehabilitation units at both critical access hospitals and other rural hospitals. LTCH Compare also includes rural providers, though these make up only about 5% of all LTCHs. CMS has also provided data updates for the Hospice Quality, Hospital Compare, and Physician Compare websites.

Participate in TOH Quality Measures Pilot – Deadline to submit has already passed. Rural-based Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), Long Term Care Hospitals (LTCHs), and Home Health Agencies (HHAs) that have been Medicare-certified for at least one year are eligible to participate in a pilot that allows CMS to test two new efforts to standardize quality measure reporting under the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act) of 2014 (PDF – 1.2 MB). Participation in the Transfer of Health Information and Care Preferences (TOH) pilot allows rural agencies and facilities to provide input for the ongoing development of quality measures and to provides a greater understanding of how TOH data collection might impact patient care in rural areas. To participate, one needed to submit the Interest Form found in the Transfer of Health Pilot zip file by January 17.

Health Workforce Connector – Comment by February 3. To expand the function of the National Health Service Corps Jobs Center, HRSA seeks comments on the information collected to develop a Health Workforce Connector. The Connector would provide a central platform where users can create a profile, search for NHSC and NURSE Corps sites and find job opportunities in underserved communities with facilities in need of providers.

Request for Information: PACE Innovation Act – Comment by February 10. CMS is seeking public input on potential adaptations to the Programs of All-Inclusive Care for the Elderly (PACE), which provides medical and social services to certain frail, community-dwelling elderly individuals most of whom are eligible for Medicare and Medicaid benefits. The changes would implement a new five-year test model for additional beneficiaries, age 21 and older, with disabilities that impair their mobility and who require a nursing home level of care. This is an opportunity for rural providers to provide CMS with input on rural considerations for expanding the program.

CMS Seeks Nominations for Advisory Panel on Hospital Outpatient Payment – Submit by February 21. CMS seeks nominations for the Advisory Panel on Hospital Outpatient Payment. The purpose of the Panel is to advise the Secretary of the Department of Health and Human Services and CMS on the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, and supervision of hospital outpatient therapeutic services. For supervision deliberations, the Panel is interested in members that represent the interests of critical access hospitals.

Last Reviewed: January 2017