Centers for Medicare & Medicaid Services to consider future policies through 'rural lens'

The Centers for Medicare & Medicaid Services launched its first "Rural Health Strategy" on Tuesday—an effort, officials said, to better consider the rural impact as part of the of the agency's work.

The strategy, which highlights tactics such as improving access to telemedicine, is meant to avoid unintended consequences of policy and program implementation in rural health settings, officials said.

“Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas," said CMS Administrator Seema Verma in a statement.

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CMS said it is changing access to telehealth services, particularly in rural areas, by paying for additional services and making it easier for providers to bill Medicare.

It could be a big deal for what could be resource-strapped areas. CMS estimates 60 million Americans live in rural areas and are more likely to experience disproportionately high poverty rates, having more chronic conditions, being uninsured or underinsured, as well as experiencing a fragmented healthcare delivery system.

The announcement was cheered by leaders in the rural health space who are meeting in New Orleans this week.

"Something that our organization has been promoting and pushing for quite a while is we just want CMS internally, before they promulgate any rules, to take a look at the impact on rural providers and communities," said Alan Morgan, CEO of the National Rural Health Association. "It seems so easy and so straightforward."

But in the past, he said, rules have generally been released without specific regard for the burdens they place on small rural practices.

For example, Morgan pointed to CMS' "exclusive use" rule with requirements that providers have an exclusive entrance, waiting and registration areas, permanent walls and distinct suite designations. Those rules often don't make sense for small, rural facilities and can be prohibitively expensive, creating "a chilling effect and exacerbating the specialty care shortage crisis that plagues rural America," he said.

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The NRHA doesn't have an expectation that their providers will input, he said. But if they're asking about the rural perspective of future regulations like that, it could make all the difference, Morgan said.

"It's not glamorous. But from an actual impact standpoint, it could be quite significant," he said.