On May 8, 2018, the Centers for Medicare and Medicaid Services (CMS) announced the agency’s first Rural Health Strategy (RH Strategy), which is designed to promote CMS policies that help make rural healthcare more accessible, affordable, and accountable.
CMS describes the RH Strategy as a proactive approach to address the unique healthcare issues facing rural communities with the goal of ensuring all individuals have access to high-quality healthcare. Presently, the RH Strategy is centered on 5 distinct objectives:
1. Applying a rural lens to CMS programs and policies:
CMS will apply a rural lens to policymaking, program design, and stretch planning to promote health equity by addressing the unique implications of CMS policies and procedures to rural communities. Specifically, CMS will: (a) review policies and procedures using a newly developed checklist for optimizing CMS policies and programs for health equity and identify possible impacts on rural health insurance plans, providers, and communities, (b) identify and accelerate practices that improve access to services and providers in rural communities, and (c) incorporate a rural lens into quality improvement and innovation activities.
In 2017, CMS engaged in listening sessions with rural providers across the country. Concerns expressed in those sessions included payment rates, the administrative burden in quality reporting, transportation issues affecting access to specialty care and difficulty navigating varied coverage requirements. CMS intends to continue its rural listening sessions in 2018 and is focused on reducing the administrative burden on rural providers. Providers should be prepared to submit their comments and ideas on reducing the burden to CMS or other agencies who are seeking to address the plight of rural providers.
Along these same lines, the Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy (FORHP) tracks health care policies and proposed regulations that may impact rural providers. A list of current opportunities to comment can be found here: https://www.hrsa.gov/rural-health/policy/index.html.
2. Improving access to care through provider engagement and support:
CMS hopes to improve access to rural healthcare by maximizing provider scope of practice to increase the number of health professionals in rural areas, implementing quality measurements that focus on value instead of volume, providing technical assistance to rural health providers to help them comply with CMS policies and foster quality improvement, and overcoming barriers to access such as lack of transportation.
Providers may expect to see loosened policies (at least at the federal level) regarding who can perform certain tasks and receive Medicare payment. That said, in many cases, the scope of practice for physician extenders is governed by state law, rather than federal billing requirements. With respect to improving access to information relevant to rural providers, CMS launched a website in 2017 at go.cms.gov/ruralhealth. CMS will likely utilize this website to announce new efforts to address the needs of rural health care providers.
3. Advancing telehealth and telemedicine:
Telehealth offers a possible solution for many of the problems facing rural healthcare communities by improving access to care, increasing quality of care, and reducing costs. CMS will work to reduce some of the barriers to rural telehealth use, including issues relating to reimbursement, cross-state licensure, and the administrative and financial burdens of implementing telehealth capabilities. Using medical innovation models and demonstrations, CMS will explore options to modernize and expand telehealth in rural communities.
To help improve access to care and support innovation in rural communities, CMS expanded access to telehealth, adding new services for both 2017 and 2018, including behavioral health integration services that help to expand access to mental health services in rural areas. As part of its RH Strategy, CMS will continue to encourage the use of telehealth. Currently, the FORHP has an open funding opportunity (HRSA-18-032) for Evidence-Based Tele-Behavioral Health Network Program. The Program seeks to increase access to behavioral health care services in rural and frontier communities (closing 6/25/2018). Notably, the efforts to increase telehealth in rural communities are also supported by President Trump’s 2019 Budget, which allots $50 billion to rural infrastructure growth, including broadband internet service.
4. Empowering patients in rural communities to make decisions about their healthcare:
To address rural populations’ specific challenges such as limited specialty providers and longer travel distances, CMS wants to collaborate with rural communication networks and foster outreach efforts to help individuals living in rural areas to be more engaged with their providers and have the knowledge to effectively navigate their health care choices.
5. Leveraging partnerships to achieve the goals of the CMS RH Strategy:
In addition to bolstering existing CMS initiatives such as reducing the burden on providers, improving quality care, and addressing the opioid epidemic, the RH Strategy will also leverage federal, state, and local partnerships. For example, CMS looks to collaborate with other agencies and partners, such as the Federal Office of Rural Health Policy at the Health Resources and Services Administration and the Centers for Disease Control and Prevention.
It should be noted however, that President Trump’s Fiscal Year 2019 Budget reduces funding for HRSA by $953 million dollars (as compared to the FY 2018 Continuing Resolution). HRSA therefore is making shifts in its funding, which could impact its ability to provide additional grant funding for programs for the rural health community. That is, unless CMS’s partnership could provide additional funding to HRSA and the FORHP.
The CMS Rural Health Council (RH Council) was instrumental in developing the RH Strategy and will hold a central role in the continued implementation of the RH Strategy. The RH Council was founded in 2016 and makes recommendations on CMS regulations and policies that are designed to positively impact rural health consumers, providers, and markets. When developing the RH Strategy, the RH Council analyzed how CMS presently addresses rural health issues and surveyed rural providers and communities to identify the unique challenges to providing high-quality healthcare in rural communities. Going forward, the RH Council will continue to engage rural healthcare stakeholders for feedback regarding rural healthcare issues and solutions not addressed the RH Strategy.
Through the RH Strategy, CMS appears to re-commit to the traditionally under-represented but significant rural healthcare community with a more unified approach than in previous years. It remains to be seen whether and in what amounts additional funding will be freed up for rural health care providers, but providers can expect the RH Strategy to bring some new resources and attention to many of the unique challenges facing rural healthcare providers and communities, including fragmented health care delivery systems, stretched rural health workforces, and lack of access to specialty services and providers.
To read the complete CMS Rural Health Strategy, click here. For more information on currently available resources and programs for providers and professionals serving rural communities, please contact Jenny E. Tyler or Charmaine Mech.