March 2017

March 2017

The Federal Office of Rural Health Policy (FORHP) Policy Team is ready to answer any questions you may have about these updates at RuralPolicy@hrsa.gov.

Chronic Care Management Payment Correction for Rural Health Clinics and Federally Qualified Health Centers

The Centers for Medicare and Medicaid Services (CMS) recently sent the following notice to rural health clinics (RHCs) and federally qualified health centers (FQHCs) regarding Chronic Care Management (CCM) billing: Effective January 1, 2016, RHCs and FQHCs received payment for CCM services based on the Medicare Physician Fee Schedule national average non-facility payment rate. However, for claims with dates of service on or after January 1, 2017, RHCs and FQHCs have been receiving a locality adjusted payment rate for these services. Your Medicare administrative contractor (MAC) will adjust any claim processed incorrectly. No provider action is required.

New Broadband Advisory Committee 

The Federal Communications Commission (FCC) recently published its intent to establish the new federal Broadband Deployment Advisory Committee (BDAC). Studies have shown that nearly 20 percent of primary care practices in small rural areas face challenges in accessing the internet. The new BDAC will provide advice and recommendations to the FCC on how to accelerate the deployment of high-speed internet access across the country by removing regulatory barriers to infrastructure investment. The Commission expects to hold its first meeting of the new Committee during the spring of 2017.

Secretary Price Highlights State Innovation Waivers

On March 13, 2017, the Department of Health and Human Services (HHS) and the Department of the Treasury highlighted State Innovation Waivers as an opportunity for states to foster health care innovation. Section 1332 of the Affordable Care Act (ACA) permits states to apply for a waiver to pursue strategies for providing its residents with access to high quality, affordable health insurance, including high-risk pool/state-operated reinsurance programs. Rural stakeholders should learn more about this opportunity in the event your state decides to move forward with such waiver. Alaska has a waiver under review creating a reinsurance program that would stabilize premiums and make insurance more affordable. For more information, visit the Section 1332 State Innovation Waivers website.

New Bundled Payment Programs Delayed

CMS has delayed the effective date of the Comprehensive Care for Joint Replacement (CJR) expansion and episode payment models (EPMs) to improve cardiac care from March 21, 2017 to May 20, 2017. CMS also delayed the date when hospitals would be responsible for implementing these programs from July 1, 2017 to October 1, 2017. Most rural hospitals are unable to participate in the CJR or EPM models as the primary site of orthopedic surgery or heart attack care and bypass surgery, but are able to collaborate as post-acute care providers. CMS seeks public comments on the “appropriateness of this delay,” as well as its consideration to delay these implementation dates even further, perhaps until January 1, 2018. Comments must be submitted by April 19, 2017.

CMS Issues Emergency Information Collection for Home Health Beneficiaries 

CMS has issued an emergency information collection request to enforce rules and standards designed to ensure home health agencies (HHAs) protect the health and safety of beneficiaries, such as providing a notice of rights to all patients and assuring the proper training of home health aides prior to their providing hands-on care. State surveyors and MACs will use this information to ensure compliance with the Medicare conditions of participation and to ensure the quality of home health care. For rural-serving HHAs, which often struggle to meet federal requirements, CMS estimates its information collection will require roughly 473 hours of information collection per HHA per year, on average. Comments must be submitted by April 3, 2017.

Government Accountability Office Issues Preliminary Observations on Veterans' Access to Choice Program Care

The Choice Program allows veterans to obtain health care services outside the Veterans Health Administration (VHA) if those services are not available or readily accessible within VHA.

The Government Accountability Office (GAO) found that if VHA staff and the Choice Program contractors take the maximum amount of time allowed for appointment scheduling, veterans could potentially wait up to 81 calendar days to attend their first appointments. However, they were not able to determine how often veterans have actually experienced such lengthy wait times because VHA lacks complete and reliable data about the timeliness with which its staff and contractors schedule Choice Program appointments. Published March 7, 2017, on the GAO website: