Rural Health Policy Update

Update provided by Andrew Coats, NOSORH Legislative Liaison 

Race to Fund the Government Continues – with progress: 
From a government funding perspective, leaders of the appropriations committees in both chambers have agreed upon top-line allocations for each of the 12 annual appropriations bills, allowing the respective subcommittee chairman to begin negotiations over each measure. The Labor-HHS-Education spending panel faces a cut for fiscal 2024, while the subcommittee that oversees the FDA’s funding is set for a boost.  

Earlier this month, Congress averted a government shutdown by passing another “laddered” continuing resolution (CR) that funds some government agencies through March 1st and others through March 8th. Despite having promised not to pass another CR, Speaker Johnson relented and put the measure on the floor, where it passed with 106 Republicans voting against it. The measure also extends through March 8th the same healthcare provisions from the previous CR, which includes funding for community health centers, an extension of the moratorium on the ACA-related Medicaid DSH cuts, teaching health center GME, and an extension of the floor on the geographic index used to calculate provider payment rates under Medicare. Notably, the CR did not include a provision to alleviate the 3.4% cuts to Medicare physician payments that began on January 1st. Several lawmakers have expressed a commitment to at least reducing the cut and making it retroactive. 

As a reminder, below are the FY 24 funding levels for rural health programs that have been passed through the committee level in each chamber:   

Medicare Rural Hospital Flexibility program  

• House:  $74,277,000 of that amount, $25,942,000 for the Small Rural Hospital Improvement Grant Program  
• Senate: $64,277,000 of that amount, $20,942,000 for the Small Rural Hospital Improvement Grant Program 

Rural Emergency Hospital Technical Assistance  

• House: $5,000,000 
• Senate: $5,000,000 

State Offices of Rural Health grant program  

• House: $12,500,000 
• Senate: $12,500,000 

Rural Residency Programs  

• House: $12,700,000 
• Senate: $12,500,000 

Rural Communities Opioids Response Program   

• House: $0 
• Senate: $155,000,000 

Hill Meeting Summary: 
NOSORH braved the elements and was on Capitol Hill during a January meeting with congressional offices on the Rural Communities Opioid Response Program. NOSORH met with Republican and Democrat offices in both the House and Senate on the issue. Be on the lookout for legislative action soon.   

Rural Health Legislation Introduced: 

• The Equal Access to Specialty Care Everywhere Act was introduced to increase rural access to medical specialists via telehealth. The bill would use existing Center for Medicare and Medicaid Innovation funds for the specialty network, focusing on extending telehealth access to rural and underserved communities. 
• The legislation is introduced by Michelle Steel (R-CA), Andrea Salinas (D-OR), Mike Kelly (R-PA), Don Davis (D-NC), Darin LaHood (R-IL), Lori Chavez-DeRemer (R-OR), Don Bacon (R-NE), Yadira Caraveo (D-CO), Monica De La Cruz (R-TX), and Susie Lee (D-NV). 

CMS Issues Medicare Advantage RFI 
CMS issued a Request for Information seeking input on “all aspects of data related to the Medicare Advantage program.” This includes feedback on: 

• “…prior authorization and utilization management, including denials of care and beneficiary experience with appeals processes as well as use and reliance on algorithms; 
• cost and utilization of different supplemental benefits; 
• all aspects of MA marketing and consumer decision-making; care quality and outcomes, including value-based care arrangements and health equity;  
• healthy competition in the market, including the impact of mergers and acquisitions, high levels of enrollment concentration, and the effects of vertical integration, data topics related to Medicare Advantage prescription drug plans;  
• and special populations such as individuals dually eligible for Medicare and Medicaid, individuals with end-stage renal disease (ESRD), and other enrollees with complex conditions.  

From a provider perspective, CMS seeks “detailed information…on common challenges and experiences in the MA program for which limited data are currently available.” 

HHS Issues Cybersecurity Voluntary Goals 
HHS published voluntary goals for healthcare providers on cybersecurity. These goals are a voluntary subset of cybersecurity practices that healthcare organizations, particularly delivery organizations, can prioritize to strengthen cyber preparedness, improve cyber resiliency, and ultimately protect patient health information and safety.   

Maternal Health Initiatives 
HRSA announced a year-long initiative to “maximize the impact of HRSA grants and programs and foster new partnerships across the country to address maternal mortality crisis and reduce maternal health disparities.” 

CMS Announces New Model to Test Behavioral Health Approaches  
Rolling out in Fall 2024, CMS announced the “Innovation in Behavioral Health model” to provide interprofessional care teams of behavioral and physical health providers to improve conditions of adults with mental health conditions and substance use disorders. It is expected to operate for eight years in up to eight states.