April 2017

April 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.

Centers for Medicare and Medicaid Services (CMS) Delays Update to Rules for Home Health Agencies (HHAs)

CMS finalized new rules for HHAs participating in Medicare and Medicaid on January 13, 2017, to incorporate recent advances and current medical practices that focus on patient-centered, data-driven and outcome-oriented care. In this first update to home health rules since 1989, CMS revised its policy to allow licensed practical nurses acting within their state licensure and scope-of-practice requirements to receive verbal orders for home health services, which may benefit HHAs in rural areas disproportionately affected by physician shortages. On April 3, 2017, CMS delayed the effective date of these new rules from July 13, 2017, to January 13, 2018. Comments related to this delay can be submitted by June 2, 2017.

2018 Medicare Advantage and Part D Plan Payment and Policy Updates

CMS has finalized 2018 payment updates for Medicare Advantage and Part D plans, including policies that encourage safeguards when prescribing opioids. CMS specifies in this letter to plans that all Part D sponsors focus on improving the coordination of care among enrollees using high dosage of opioids, and in particular, Medicare Advantage plans that include prescription drug coverage should consider expanding the care management they provide enrollees.

Specifically applicable to rural populations, CMS reinforces in this letter that Medicare Advantage Organizations (MAOs) are expected to promote access to high-quality and culturally competent health care services to vulnerable populations including racial and ethnic minorities, people with disabilities, sexual and gender minorities and rural populations. Furthermore, this letter clarifies that regulations that prohibit discrimination do not preclude a MAO from conducting outreach that targets a portion of the population or provides targeted interventions to a specific subset of enrollees. 

Request for Information (RFI) on how to Improve Medicare Advantage and Part D

In the 2018 payment update letter, CMS also requests public input on how they can improve the Medicare Advantage and Part D programs. This RFI is an opportunity for rural providers, stakeholders and consumers to offer ideas on benefit design, network composition flexibility, supporting doctor-patient relationships, and monitoring and measuring plans. Send your ideas to PartCDcomments@cms.hhs.gov through April 24, 2017, and include “2017 Transformation Ideas” in the subject line.   

CMS Selects Accountable Health Communities (AHC)

The AHC Model is moving forward with the identification of 32 local-level organizations that will bridge the gap between clinical and social need providers to address housing instability, food insecurity, utility needs, interpersonal violence and transportation. One example of how this can work in rural areas is offered by the Oregon Health & Science University, which plans to collaborate with more than 50 clinical sites across nine counties to coordinate services for residents.