Rural Health Information Hub Latest News

Trump Administration Proposes Policies to Provide Seniors with More Choices and Lower Costs for Surgeries

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule advances CMS’ commitment to increasing competition

As directed by President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors, CMS is proposing several policies that would give Medicare beneficiaries more choices in where they seek care and lower their out-of-pocket costs for surgeries. The proposed rule takes steps that would allow hospitals and ambulatory surgical centers to operate with better flexibility and patients to have what they need to make informed decisions on where they receive care.

“President Trump’s mandate is to put patients and doctors back in charge of health care,” said CMS Administrator Seema Verma. “Following through on that mandate entails loosening the stranglehold of government control that has accumulated over decades. Surgeries can be expensive. Patients should have as many options as possible for lowering their costs while getting quality care. These proposed changes, if finalized, would do exactly that, help put patients and doctors back in the driver’s seat and in a position to make decisions about their own care.”

For patients having surgery, hospital outpatient departments are subject to the same quality and safety standards as inpatient settings under Medicare rules. With this in mind, for 2021, CMS proposes to expand the number of procedures that Medicare would pay for in the hospital outpatient setting by eliminating the “Inpatient Only list,” which includes procedures for which Medicare will only make payment when performed in the hospital inpatient setting. This proposed change would remove regulatory barriers to give beneficiaries the choice to receive these services in a lower cost setting and convenience to go home as early as the same day after a procedure, when their clinician decides such a setting is appropriate. CMS would phase-in this proposal over three years and would gradually allow over 1,700 additional services to be paid when furnished in the hospital outpatient setting. In 2021, approximately 300 musculoskeletal services (such as certain joint replacement procedures) would be newly payable in the hospital outpatient setting. The proposed change would be the largest one-time reduction to the Inpatient Only list by far; from 2017 through 2020, approximately 30 services total were removed from the Inpatient Only list.

Medicare pays for most services furnished in ASCs at a lower rate than hospital outpatient departments. As a result, when receiving care in an ASC rather than a hospital outpatient department, patients can potentially lower their out-of-pocket costs for certain services. For example, for one of the most common cataract surgeries, currently, on average, a Medicare beneficiary pays $101 if the procedure is done in a hospital outpatient department compared to $51 if done in a surgery center.

CMS proposes to expand the number of procedures that Medicare would pay for when performed in an ASC, which would give patients more choices in where they receive care and ensure CMS does not favor one type of care setting over another. For CY 2021, we propose to add eleven procedures that Medicare would pay for when provided in an ASC, including total hip arthroplasty. Since 2018, CMS has added 28 procedures to the list of surgical services that can be paid under Medicare when performed in ASCs.

Additionally, we propose two alternatives that would further expand our goals of increasing access to care at a lower cost. Under the first alternative, CMS would establish a process where the public could nominate additional services that could be performed in ASCs based on certain quality and safety parameters. Under the other proposed alternative, we would revise the criteria used to determine the procedures that Medicare would pay for in an ASC, potentially adding approximately 270 procedures that are already payable when performed in the hospital outpatient setting to the ASC list. Under this alternative, we solicit comment on whether the ASC conditions for coverage (the baseline health and safety requirements for Medicare-participating ASCs) should be revised given the potential for a significant expansion in the nature of services that would be added under this alternative proposal.

As part of the Trump Administration’s commitment to lowering drug prices, CMS is proposing a change that would lower beneficiaries’ out-of-pocket drug costs for certain hospital outpatient drugs. In 2018 and 2019, CMS implemented a payment policy to help beneficiaries save on coinsurance for drugs that were administered at hospital outpatient departments and acquired through the 340B program, which allows certain hospitals to buy outpatient drugs at lower costs. Due to CMS’ policy change, which was recently upheld by the United States Court of Appeals for the D.C Circuit, Medicare beneficiaries now benefit from the steep discounts that 340B-enrolled hospitals receive when they purchase drugs through the 340B program.

For 2021, CMS would provide even larger discounts for beneficiaries by proposing to further reduce the payment rate for drugs purchased through the 340B Program based on hospital survey data on drug acquisition costs. CMS is proposing to pay for 340B acquired drugs at average sales price minus 28.7 percent. With this proposed change, CMS estimates that, in 2021, Medicare beneficiaries would save an additional $85 million on out-of-pocket payments for these drugs and that OPPS payments for 340B drugs would be reduced by approximately $427 million. The savings from this change would be reallocated on an equal percentage basis to all hospitals paid under the OPPS. We propose that children’s hospitals, certain cancer hospitals, and rural sole community hospitals would continue be excepted from these drug payment reductions. In the alternative, and in light of the court’s recent decision, we propose to continue our current policy of paying ASP minus 22.5% for 340B drugs.

In continuing the agency’s Patients Over Paperwork Initiative to reduce burden for health care providers, CMS is proposing to establish, update, and simplify the methodology to calculate the Overall Hospital Quality Star Rating (Overall Star Rating) beginning with CY 2021. The Overall Star Rating summarizes a variety of quality measures published on the Medicare.gov Hospital Compare tool for common conditions that hospitals treat, such as heart attacks or pneumonia. Along with publicly reported data on Hospital Compare, the Overall Star Rating helps patients make better informed health care decisions.

Responding to stakeholder feedback about the current methodology used to calculate the Overall Star Rating, CMS is proposing revisions on how to calculate the ratings and grouping hospitals in the Readmission measure group by the hospital’s percentage of patients who are dually enrolled in Medicare and Medicaid, which would help provide better insight on health disparities. These and other proposed changes are intended to reduce provider burden, improve the predictability of the star ratings, and make it easier to compare ratings between similar hospitals.

As part of the agency’s Rethinking Rural Health Initiative, in the FY 2020 Inpatient Prospective Payment System (IPPS) final rule, CMS increased the wage index for certain low wage index hospitals for at least four years, beginning in FY 2020. In the CY 2020 OPPS/ASC Payment System final rule, CMS adopted changes to the wage index for outpatient hospitals as were finalized in the FY 2020 IPPS final rule, including the increase in wage index for certain low wage index hospitals. The OPPS wage index adjusts hospital outpatient payment rates to account for local differences in wages that hospitals face in their respective labor markets. For 2021, under the OPPS, CMS proposes to continue to adopt the IPPS post-reclassified wage index, including the wage index increase for certain low wage index hospitals. The increase would address a common concern that the current wage index system contributes to disparities between high and low wage index hospitals. Overall, CMS estimates that payment for outpatient services in rural hospitals across the country would increase by 3 percent, which is 0.5 percent higher than the national average increase of 2.5 percent.

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2020 Assister Certification Training on the Marketplace Learning Management System (MLMS) “Go-Dark”

As we prepare to release the 2021 Assister Certification Training, the 2020 Assister Certification Training that is hosted on the Marketplace Learning Management System (MLMS), will be taken offline at 6:00 p.m. (ET) on August 28, 2020.  During this “go-dark” period, assisters will not be able to access the certification training.  We anticipate that the 2021 Assister Certification Training will be available later this summer.

Assisters who need to take the current training before the 2021 training is available should complete the 2020 Assister Certification training prior to its removal on August 28.

Please note: this is training for assisters in the Federally-facilitated Marketplace, and assisters in State-based Marketplace  or State-based Marketplace using the Federal platform should follow their state’s training and certification requirements.

 

Appeals Court Upholds Nearly 30% Payment Cut to 340B Hospitals

Fierce Healthcare

A federal appeals court has ruled the Trump administration can install nearly 30% cuts to the 340B drug discount program.

The ruling Friday is the latest legal setback for hospitals that have been vociferously fighting cuts the Department of Health and Human Services (HHS) announced back in 2017.

340B requires pharmaceutical manufacturers to deliver discounts to safety net hospitals in exchange for participation in Medicaid. A hospital will pay typically between 20% and 50% below the average sales price for the covered drugs.

HHS sought to address a payment gap between 340B and Medicare Part B, which reimburses providers for drugs administered in a physician’s office such as chemotherapy. There was a 25% and 55% gap between the price for a 340B drug and on Medicare Part B.

So HHS administered a 28.5% cut in the 2018 hospital payment rule. The agency also included the cuts in the 2019 payment rule.

Three hospital groups sued to stop the cut, arguing that HHS exceeded its federal authority to adjust the rates to the program.

A lower court agreed with the hospitals and called for the agency to come up with a remedy for the cuts that already went into effect.

But HHS argued that when it sets 340B payment amounts, it has the authority to adjust the amounts to ensure they don’t reimburse hospitals at higher levels than the actual costs to acquire the drugs.

If the hospital acquisition cost data are not available, HHS could determine the amount of payment equal to the average drug price. HHS argued that hospital cost acquisition data was not available and so HHS needed to determine the payment rates based on the average drug price.

The court agreed with the agency’s interpretation.

“At a minimum, the statute does not clearly preclude HHS from adjusting the [340B] rate in a focused manner to address problems with reimbursement rates applicable only to certain types of hospitals,” the ruling said.

The court added that the $1.6 billion gleaned from the cuts would go to all providers as additional reimbursements for other services.

340B groups were disappointed with the decision.

“These cuts of nearly 30% have caused real and lasting pain to safety-net hospitals and the patients they serve,” said Maureen Testoni, president and CEO of advocacy group 340B Health, which represents more than 1,400 hospitals that participate in the program. “Keeping these cuts in place will only deepen the damage of forced cutbacks in patient services and cancellations of planned care expansions.”

This is the latest legal defeat for the hospital industry. A few weeks ago, the same appeals court ruled that HHS had the legal authority to institute cuts to off-campus clinics to bring Medicare payments in line with physician offices, reversing a lower court’s ruling.

The groups behind the lawsuit — American Hospital Association, American Association of Medical Colleges and America’s Essential Hospitals — slammed the decision as hurtful to hospitals fighting the COVID-19 pandemic. But the groups didn’t say if it would appeal the decision.

“Hospitals that rely on the savings from the 340B drug pricing program are also on the front-lines of the COVID-19 pandemic, and today’s decision will result in the continued loss of resources at the worst possible time,” the groups said in a statement Friday.

Pennsylvania Dashboard Data Shows Weekly COVID Case Increases Statewide, Multiple Counties with High Percent-Positives

Pennsylvania Governor Tom Wolf released a weekly status update detailing the state’s mitigation efforts based on the COVID-19 Early Warning Monitoring System Dashboard comparing the seven-day period of July 24 – July 30 to the previous seven days, July 17 – July 23.

The dashboard is designed to provide early warning signs of factors that affect the state’s mitigation efforts. The data available on the dashboard includes week-over-week case differences, incidence rates, test percent-positivity, and rates of hospitalizations, ventilations and emergency room visits tied to COVID-19.

“The mitigation efforts we took on July 15 were a proactive step to get in front of the rise of cases that we continue to see,” Gov. Wolf said. “Our percent positivity decreased this week, which is a positive sign, but in order to continue to see numbers decrease, we must continue to wear masks and practice social distancing.

“Going out without a mask and congregating at a bar or in a crowded backyard party where social distancing isn’t being practiced continues to lead to spikes in cases. We need to recommit to these simple measures to stop the spread and go back to more freedoms.”

As of Thursday, July 30, the state has seen a seven-day case increase of 6,228, the previous seven-day increase was 6,010, alerting that cases are continuing to rise throughout the state.

The statewide percent-positivity went down to 4.6% from 4.7% last week. Counties with concerning percent-positivity include Lawrence (7.4%), Franklin (7.2%), Indiana (7.2%), Fayette (7.1%), Armstrong (7.0%), Beaver (6.5%), Delaware (6.5%), Allegheny (6.4%), Lancaster (5.8%), Berks (5.6%), Philadelphia (5.4%) and Chester (5.3%). Each of these counties bear watching as the state continues to monitor all available data.

The Department of Health updated its travel recommendations, originally announced on July 2, to remove Wyoming to the list of states recommended for domestic travelers returning from to quarantine for 14 days upon return to Pennsylvania.

It is important that people understand that this recommendation is in place to prevent the spread of COVID-19 in Pennsylvania. A significant number of recent cases have been linked to travel, and if people are going to travel, we need them to take steps to protect themselves, their loved ones and their community, and that involves quarantining.

Gov. Wolf continues to prioritize the health and safety of Pennsylvanians through the COVID-19 pandemic. Pennsylvanians should continue to take actions to prevent the spread of COVID-19, regardless of the status of their county. This includes wearing a mask or face covering anytime they are in public. COVID-19 has been shown to spread easily in the air and contagious carriers can be asymptomatic.

Pennsylvania Department of Health Continues to Increase Testing in Several Regions

The Pennsylvania Department of Health announced that beginning Wednesday, August 5, various Walmart locations across the state will begin providing drive-thru testing for residents living in areas where there is a need for testing sites.

“We appreciate the hard work done by health systems, pharmacies, Federally Qualified Health Centers (FQHCs), medical clinics and other entities that are providing testing for COVID-19 across Pennsylvania,” Secretary of Health Dr. Rachel Levine said. “When we established our testing strategy, we wanted testing to be accessible, available and adaptable and we are working to meet that challenge. Anyone who believes they are in need of a COVID-19 test and meet testing criteria can get tested today in Pennsylvania.”

Nine new drive-thru testing sites will launch on August 5. There is no testing in stores. These sites will be open weekly to test up to 50 registered patients. Registration is required one day in advance. The following drive-thru testing sites will be open Monday-Friday from 9:00 AM to 4:00 PM starting Wednesday, August 5th:

  • Walmart Supercenter pharmacy drive-thru, 355 Walmart Drive, Uniontown, PA
  • Walmart Supercenter pharmacy drive-thru, 2601 Macarthur Rd Relocation, Whitehall, PA
  • Walmart Supercenter pharmacy drive-thru, 2010 Village Center Dr, Tarentum, PA
  • Walmart Supercenter pharmacy drive-thru, 134 Daniel Kendall, West Brownsville, PA

The following drive-thru testing sites will be open Monday, Wednesday, Friday from 7:00 AM to 9:00 AM starting Wednesday, August 5th:

  • Walmart Supercenter parking lot, 20245 Route 19, Cranberry Township, PA
  • Walmart Supercenter parking lot, 200 Kocher Lane, Elizabethville, PA
  • Walmart Supercenter parking lot, 50 Newberry Parkway, Etters, PA
  • Walmart Supercenter parking lot, 1355 East Lehman St, Lebanon, PA
  • Walmart Supercenter parking lot, 100 Chippewa Town Center, Beaver Falls, PA

These nine new sites are in addition to existing Walmart drive-thru sites in Clarion, State College, New Castle and Edinboro. The most updated testing sites and information is available on the Department of Health’s website.

Pennsylvania Governors’s Administration, Local Law Enforcement Stress Important Roles Education and Understanding Play in Enforcement of COVID-19 Orders

Pennsylvania Governor Tom Wolf visited the Susquehanna Township Police headquarters to discuss the important roles education and understanding play in the enforcement of the various COVID-19 mitigation orders in place across the state.

“We have to do everything we can to keep our communities safe and healthy, including wearing a mask and following mitigation orders so our business operate safely,” Gov. Wolf said. “We have the ability to enforce these rules, and we are going to continue to work closely with commonwealth agencies and local officials to enforce public safety orders.”

The governor was joined by representatives of commonwealth agencies and local law enforcement involved in mitigation order enforcement, including Secretary of Heath Dr. Rachel Levine, Secretary of Agriculture Russell Redding, Pennsylvania State Police Lt. Col. Scott Price, and Susquehanna Township Chief of Police Rob Martin.

Each representative focused on the role their agency plays in education and enforcement of the various orders in place to keep Pennsylvanians safe and stop the spread of COVID-19.

“Wearing a mask is so important to protecting each other. I implore all Pennsylvanians to do right thing,” Dr. Levine said. “When you wear a mask you are not only telling that person you pass on the street that you care about their safety, you are telling police and other first responders that you care about their safety, too.”

“Pennsylvania’s restaurant owners and staff and have delivered for us, putting safe, healthy food on our tables,” Redding said. “We can all deliver for them by wearing a mask and following the COVID-19 measures to keep them safe and healthy.”

“As some of the most visible public servants in the commonwealth, the state police will continue working collaboratively with the Department of Health and local police departments to remain at the forefront of law enforcement pandemic response efforts,” said Lieutenant Colonel Price.  “We are grateful to the majority of Pennsylvanians who have stepped up to follow mitigation requirements and for all the support our troopers and liquor control enforcement officers have received during the past several months.”

Local law enforcement’s role is a collaborative one with state agencies and local officials, and Chief Martin stressed his department’s work to educate businesses and residents, and to refer any suspected violations of the governor and Dr. Levine’s orders to the proper state agency if necessary.

“Our citizens in Susquehanna Township have been inspiring. On many occasions they have contacted our police department and our government center for advice, guidance, and our assistance. We wish to meet our citizens where they are and be an educational voice of gentle persuasion,” Martin said. “Of the times that we have had to make referrals to our commonwealth partners, we have been met with cooperation and understanding. I want to thank the commonwealth for being a valued partner, and thank Governor Wolf for his always civil mannered discourse, as what our country needs right now is civility.”

The governor also asked local elected officials and business owners to work with local law enforcement to protect their communities and constituents.

“I’m calling upon every Pennsylvanian to do their part to help us get as close as we can to 100 percent compliance on masking,” Gov. Wolf said. “We need the help of our business owners to get workers masking. We need the help of our local elected officials to emphasize the importance of masking on keeping the community safe.”

According to a recent poll by Franklin & Marshall College, two-thirds of registered voters in Pennsylvania believe it is “extremely important” to wear a mask whenever they leave home.

“We need to come together, unified, against COVID-19,” Gov. Wolf said. “I’m calling upon every Pennsylvanian to do their part to help us get as close as we can to 100 percent compliance on masking.”

New! NOSORH Issue Brief Defining Rural Population Health and Health Equity

New NOSORH issue brief examines the definitions of population health and health equity for rural stakeholders, and offers examples of successful rural strategies.

In recent years, the terms “population health” and “health equity” have often been used interchangeably by some rural stakeholders. This issue brief aims to examine the differences between the two terms, and offers successful examples of rural population health and health equity activities by State Offices of Rural Health (SORH) and their partners. The brief also offers suggestions on how rural health stakeholders can get started in population health and health equity efforts at the state and local levels.

With support from the Federal Office of Rural Health Policy, NOSORH developed this issue brief for SORH and other rural health stakeholders as a means of ensuring unified definitions and approaches to population health and health equity by rural stakeholders.

Looking for more?

Check out the Resources by Topic and Position Statements sections of the NOSORH website.

High-Quality Pre-K Across Pennsylvania

Access to high-quality pre-k is a fundamental building block of our state’s education system. In PPC’s role as a principal partner of the Pre-K for PA campaign, they annually update this mapping feature to help all Pennsylvanians learn more about this vital early learning experience in their local area.

View the map

Use it to search by House or Senate district, by school district or county, and this year a school district map showing the percentage of capacity that is high-quality is now available. After completing your search, you can also print a fact sheet that includes the number of children served, unmet need, the number of high-quality providers and current capacity.

ARC Annual Summit Goes Virtual With Summer Showcase

This year, ARC’s annual summit is going virtual with a four week seminar series discussing major themes and best practices guiding the Region’s economic future. Register now for Economic Innovation + Ingenuity During COVID: An Appalachian Perspective, a free seminar produced in partnership with the state of Ohio. Join a session every Wednesday, 11 am (ET) August 19- September 9:

  • August 19: Lessons Learned in Leadership During the COVID-19 Crisis with Ohio Governor Mike DeWine; ARC Federal Co-Chairman Tim Thomas; and Coshocton Port Authority Executive Director Tiffany Swigert; moderated by Ohio Development Services Agency Director Lydia Mihalik.
  • August 26: Appalachia’s dual pandemics: Substance Abuse and COVID 19 with Deputy Secretary of Health Preparedness and Community Protection in Pennsylvania Ray Barishansky; Executive Director of Ross County Community Action Commission in Ohio Julie Bolen; and Executive Director of Southern Tier East Regional Planning Development Board in New York Jennifer Gregory; moderated by RecoveryOhio Director Alisha Nelson.
  • September 2: Highways to Cyberways: Innovations in Infrastructure with Natural Resources Business Specialist in Garrett County, Maryland Cheryl DeBerry; Executive Director of LENOWISCO Planning District Commission in Virginia Duane Miller; and Executive Director of DriveOhio Patrick Smith; moderated by Chief of the Office of BroadbandOhio Peter Voderberg.
  • September 9: Attracting the Socially Distant Tourist with Executive Director of the Hatfield McCoy Regional Recreation Jeff Lusk; Director of TourismOhio Matthew MacLaren; and Producing Artistic Director of Barter Theatre in Virginia Katy Brown; moderated by Ohio Development Services Agency Director Lydia Mihalik.

More information about the series is available at www.arc.gov/summit.

All Appalachian Counties Report Confirmed Cases of COVID-19

Appalachia’s first COVID-19 cases were confirmed in early March. 143 days later, on July 26, Doddridge County, West Virginia became the final of Appalachia’s 420 counties to report a confirmed COVID-19 case. Drawing on data from the Johns Hopkins University, COVID-19 Cases in Appalachia maps COVID-19’s spread in the region in relation to the rests of the country.  

More county-level information regarding COVID-19 cases can be found using the searchable database offering demographic data snapshots of confirmed cases and deaths in relation to hospital bed counts, population and businesses, and categories of people at risk for COVID-19. By hovering over each statistical icon, users can learn more about the supporting data. COVID-19 related data is updated daily.