Medicare Compliance & Reimbursement

Tip: CMS offers tools aplenty for rural providers.

COVID-19 numbers are on the rise again and coincide with the onset of the flu season. This double whammy is likely to hit rural areas especially hard as they are already strained due to provider and hospital shortages. Because of these worries and others, the feds have introduced a new initiative for addressing rural health inequities that includes new payment models, funding, and more.

HHS Has a New ‘Rural Action Plan’

On Sept. 3, the Department of Health and Human Services (HHS) released a Rural Action Plan, which addresses mandates outlined in an Aug. 3 executive order to improve healthcare of rural areas in the United States. As part of a collaborative effort, 18 HHS agencies coordinated together to develop the plan, “which includes 71 new or expanded activities for [fiscal year] FY 2020 and beyond,” indicates HHS in a release.

“The Rural Action Plan identifies key, tangible areas where HHS agencies can soon make a real difference in the health outcomes of millions of Americans,” says HHS Secretary Alex Azar in a release. “We cannot just tinker around the edges of a rural healthcare system that has struggled for too long, which is why the Rural Action Plan lays out a bold vision for transforming how healthcare works in rural America.”

The interagency “roadmap” utilizes a “Four-Point Strategy,” according to the plan. Take a look at the four points with some examples of what HHS and its subsidiaries hope to rollout:

1. Sustainability: As part of its “Build a Sustainable Health and Human Services Model for Rural Communities” strategy, HHS intends to boost rural communities with more tools and funding.

• Example: The agency plans to increase funding and expand the Community Health Aide Program to circumvent chronic diseases and encourage healthy living while providing quality and affordable healthcare.

2. Health IT: Technology has become a crucial tool for providers, but rural health lags behind its urban and suburban counterparts. The “Leverage Technology and Innovation” strategy aims to change that with cost-cutting programs, offering more telehealth funding and hi-tech options that promote efficiency.

• Example: Under its HHS Health Challenge program, the agency hopes to use technology to help rural mothers struggling with postpartum depression.

3. Disease prevention: Increasingly, rural Americans tend to suffer from a higher incidence of comorbidities and higher mortality rates. Under the “Focus on Preventing Disease and Mortality” category, the 18 HHS agencies want to support “rural-specific efforts to improve health outcomes” with education, technology, and investments.

• Example: The Rural Action Plan calls for a $2 million investment in 2020 for “evidence-based interventions” to “reduce health risks” in rural communities, HHS says.

4. Provider shortages: There is a dire need in rural communities for more clinicians, and the plan boasts of several new and expanded grant programs and regulatory rollbacks as part of the “Increase Rural Access to Care” strategy.

• Example: The Health Resources & Services Administration (HRSA) has already started to disburse funding to train current rural providers and coax new clinicians with financial incentives to practice in rural communities. Currently, $178 million in grant money is scheduled to be spread out across various HRSA provider enhancement programs in FY 2020, according to the plan.

Review the Rural Action Plan at www.hhs.gov/sites/default/files/hhs-rural-action-plan.pdf.

See Details on a New Rural Payment Model

In response to the executive order, the Centers for Medicare & Medicaid Services (CMS) announced a new rural-centered payment model through the CMS Innovation Center: the Community Health Access and Rural Transformation (CHART) Model.

Why? More than 130 rural hospitals have closed since 2010, and Medicare aims to do something about it — and about other hardships for rural providers and beneficiaries

CMS plans to test the CHART Model. Under the program, the agency is directly providing a pool of $75 million in upfront, seed funding, with 15 rural communities applying for up to $5 million to develop local transformation plans, the agency says in a fact sheet.

The CHART Model offers two options for participants, a Community Transformation track and an Accountable Care Organization (ACO) Transformation track.