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

November 16-20

On November 16th, the 2016 Medicare Physician Fee Schedule final rule was published in the Federal Register.  This proposed rule makes several policy changes related to Medicare Part B payment. Among changes important to rural providers, the rule seeks to

  • Authorize Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQNCs) to provide chronic care management services;
  • Require RHCs to report all services using standardized coding systems, such as level I and level II of the HCPCS beginning April 1, 2016;
  • Authorize Advance Care Planning services for providers including RHCs at the local level under the discretion of the Medicare Administrative Contractors.
  • Apply the value modifier in the CY 2018 payment adjustment period to non-physician eligible professionals (EPs) who are PAs, NPs, CNSs, and CRNAs in groups with two or more EPs, and to PAs, NPs, CNSs, and CRNAs who are solo practitioners; and
  • Extend payment add-ons for ambulance transportation services in rural areas.

Comments on the final rule are due by December 29, 2015.  

November 2-6

On November 2, 2015 the Centers for Medicare & Medicaid Services (CMS) published a final rule on Methods for Assuring Access to Covered Medicaid Services including an opportunity for public comment on whether future adjustments are needed to the requirements for ongoing State reviews of beneficiary access. In conjunction with this final rule, CMS published a request for information (RFI) that solicits feedback from States, beneficiaries, advocacy organizations, providers, managed care organizations, research and measurement communities, professional associations and other members of the public on data metrics and alternative processes for measuring access to care in the Medicaid Program. Rural health stakeholders have a chance to weigh in on whether and which core access measures, thresholds, and appeals processes would provide additional information useful to CMS and States in ensuring access to care for Medicaid beneficiaries. Comments on both the final rule and the RFI should be submitted in writing to CMS by January 4, 2016.

October 26-30

On October 29, the Centers for Medicare & Medicaid Services (CMS) announced its final rule updating Medicare payment rates for home health agencies (HHAs) for 2016. As authorized by the Affordable Care Act, the rule launches a new Home Health Value-Based Purchasing model to begin January 1, 2016 for all Medicare-certified HHAs in nine states: Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee. Of note for rural HHAs, the rule implements the extension of the 3% rural add-on payment through January 1, 2018 as authorized by the Medicare Access and CHIP Reauthorization Act of 2015.

On October 29, CMS displayed a proposed rule to revise discharge planning requirements in the Conditions of Participation under Medicare and Medicaid for hospitals and home health agencies. These providers would need to develop and implement discharge planning processes that effectively transition patients from care settings, reduce preventable readmissions, and prepare patients to be active partners in post-discharge care.  The proposed rule will be published November 3 and comments are due in 60 days.

On October 29, The Centers for Medicaid & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced rules for the third and final stage of Meaningful Use, the set of standards for using Electronic Health Records (EHRs). The new regulations aim to “ease the reporting burden for providers, support interoperability, and improve patient outcomes.” CMS provides a fact sheet on EHR Incentive Programs going forward and seeks public comment, particularly from rural providers, about quality measurements aligning with the Medicare Access and CHIP Reauthorization Act (MACRA).

On October 30, CMS released a final rule updating Medicare payment rates for calendar year 2016 under the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System. The rule finalizes several policy changes, including a payment transition for former Medicare Dependent, Small Rural Hospitals (MDH), and changes to the Two-Midnight rule for short inpatient stays.