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 Updates

June 22

Comments Requested: Payment Changes for Medicare Clinicians – August 21.  On June 20th, CMS released a proposed rule for the second year of the Medicare Quality Payment Program (QPP) and seeks feedback from the public on changes to the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).  Major proposals of interest to rural stakeholders include exempting additional clinicians from MIPS by increasing the low-volume threshold for small practices, adding a bonus to the MIPS score for small practices and another for complex patients, allowing FQHCs and RHCs that voluntarily report to opt-out of sharing their data on Physician Compare, clarifying policies for participation in MIPS virtual groups, modifying the MIPS scoring criteria and payment adjustment, proposing policies for “topped-out” quality measures, updating Advanced APM scoring and risk standards, and giving more detail about how CMS will implement the All-Payer Combination Option for Advanced APM participation. Once the rule is officially published on June 30th, comments can be submitted online, by mail or delivered by hand/courier until August 21.  See events section below for information about an upcoming webinar hosted by CMS on Monday, June 26 to discuss these proposed changes.

June 15

Comments Requested: Developing Measures for Telehealth – June 30.  The National Quality Forum has posted a draft document aiming to develop a telehealth framework for ensuring that clinical measures are applied to telehealth encounters.  The project, contracted to NQF by the Centers for Medicare & Medicaid Services and sponsored by the Federal Office of Rural Health Policy, is intended to identify existing and potential metrics for care delivered via telehealth, and develop a framework with guiding principles for future telehealth measurement.  NQF invites comments on the body of the report as well as suggestions on measurement concepts.  For questions, contact the NQF project team at

Comments Requested:  HUD Healthy Homes survey – July 3. The Department of Housing and Urban Development (HUD) administers the American Healthy Homes Survey, a nationally representative survey of key environmental contaminants in the nation’s housing, including lead, mold, pesticides, and for the first time, formaldehyde. The Centers for Disease Control and Prevention find that rural areas generally experience lower levels of airborne formaldehyde, a potential carcinogen, but face other infrastructural deficits that jeopardize housing conditions. In response to HUD’s invitation, commenters may suggest ways to enhance the quality, utility, and clarity of the information collected for the survey in relation to housing in rural communities.

Comments Requested: Improving the ACA Insurance Market – July 12.  CMS has published a request for information seeking recommendations from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group health insurance markets.  As rural consumers face fewer plan choices and issuers are leaving the Marketplace, CMS would like feedback on how it could change existing regulations or guidance to put patients first, promote greater consumer choice, enhance affordability, and return more control over healthcare to the states. Rural stakeholders may be able to provide feedback explaining challenges particular to rural areas. 

May 24

Rural Health Experts Wanted – July 3.  The Centers for Disease Control and Prevention (CDC) seeks new members for the Community Preventive Services Task Force (CPSTF), an independent, nonpartisan panel that identifies and recommends population health interventions scientifically proven to save lives, increase lifespans, and improve quality of life. CPSTF reports its recommendations in The Community Guide to help states, communities, and organizations select relevant, evidence-based interventions. In this round of nominations, CDC announces its strong consideration of nominees with expertise and experience in systematic review methods, economic analysis, substance abuse and violence prevention, aging, and rural health. 

May 17

Comments Requested: Interoperability Standards – July 31. Rural providers with experience using electronic health records can provide feedback to the Office of the National Coordinator for Health Information Technology (ONC) on a proposed framework for measuring and assessing healthcare interoperability standards. This framework would help health IT developers, health information exchange (HIE) organizations, and health care providers move towards a set of uniform measures to assess interoperability progress. 

Participating in MIPS? CMS has released an interactive tool on the CMS Quality Payment Program website for clinicians to determine if they should participate in the Merit-based Incentive Payment System for 2017.  Rural clinicians that bill Medicare Part B more than $30,000 a year AND see more than 100 Medicare patients a year qualify for participation in 2017.  To learn more about participation criteria, review the MIPS Participation Fact Sheet or email questions to

Criteria for Home and Community-Based SettingsCMS released an informational bulletin that extends the transition period for states to demonstrate compliance with the home and community-based settings criteria until March 17, 2022 for settings that were operating before March 17, 2014.  States should continue progress in assessing existing operations and identifying milestones for compliance that result in final Statewide Transition Plan approval by March 17, 2019. Rural providers, State Offices of Rural Health, and other key stakeholders are encouraged to continue to work with states to ensure HCBS compliance activities are collaborative, transparent, and timely.

May 10

Comments Requested: Hospice Payment Rates and Policy – June 26. CMS has issued a proposed rule to update 2018 Medicare payment and polices. The proposal includes a 1.0% or $180 million increase in payments (rural areas would experience an average 1.1% increase compared to FY 2017); outlines requirements for the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey; and solicits comments on a clarifying change to regulation for certifying a life expectancy of six months or less.  A fact sheet regarding this proposed rule is available on the CMS website for more information.

Comments Requested: Skilled Nursing Facility (SNF) Payment Rates - June 26. CMS has issued a proposed rule to update 2018 Medicare payment rates and polices for skilled nursing facilities (SNFs). Changes include a payment rate increase of 1.0% ($390 million), proposals for the SNF Value-Based Purchasing Program, revisions to the SNF Quality Reporting Program, and clarification of the regulatory requirements for team composition for complaint investigation surveys. The proposed rule also includes a Request for Information to encourage continued feedback on improvements to the Medicare program including ideas for regulatory, sub-regulatory, policy, practice and procedural changes. A fact sheet is available on the CMS website for more information.

Comments Requested: Inpatient Rehabilitation Facility (IRF) payment rates –June 27. CMS has issued a proposed rule to update 2018 Medicare payment and polices for IRFs. Changes include an overall update of 1.0% (or $80 million), removal of the voluntary swallowing status item (Item 27) from the IRF-PAI, removal of the 25 percent payment penalty for late transmissions of the IRF-patient assessment instrument (IRF-PAI), changes to the IRF Quality Reporting Program (QRP), and changes to the 60 percent rule presumptive methodology. The proposed rule also includes a specific request for comments on the 60 percent rule regarding the criteria used to classify facilities for payment under the IRF PPS and announces that FY 2018 is the third and final year of the phase-out of the 14.9 percent rural adjustment for the 20 IRF providers that were designated as rural in FY 2015 and changed to urban under the new Office of Management and Budget (OMB) delineations in FY 2016: therefore CMS will no longer apply a rural adjustment for these IRFs. Additionally, the proposed rule includes a Request for Information to encourage continued feedback on improvements to the Medicare program including ideas for regulatory, sub-regulatory, policy, practice and procedural changes. A fact sheet is available on the CMS website for more information. 

May 2

Comment requested: universal education for opioid prescribers – July 10. The Food and Drug Administration (FDA) announced a public workshop to obtain input on issues and challenges associated with Federal efforts to support training for health care providers on pain management and the safe prescribing, dispensing, and patient use of opioids. The Centers for Disease Control and Prevention has reported that rural areas are affected by higher rates of opioid misuse and overdose.  FDA will host the workshop May 9-10 at the Sheraton Hotel in Silver Spring, Md. Participants must register online before May 1. FDA welcomes public comment and suggestions on promising approaches in prescriber education and training programs. 

Last Reviewed: June 2017

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