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The $50 billion Rural Health Transformation Program, managed by the Centers for Medicare & Medicaid Services, requires states that apply to describe how they will use technology for improved healthcare delivery across 11 categories, architected by CMS.
Over the past several weeks, applicants must have assessed how they will improve provider efficiency and long-term sustainability for their rural healthcare programs.
But rural healthcare stakeholders who have been hard at work on engaging regional and local partners to understand their needs, crafting their proposals and figuring out how to align them with what CMS is looking for have concerns that the ongoing government shutdown will slow their application process and are naturally worried about the impact of potential funding delays.
"The critical question is how potential delays or funding limitations will affect the already precarious financial stability of many rural hospitals," said Valerie Rogers, senior government relations director at HIMSS, the parent company of Healthcare IT News.
'Limited time frame'
The RHTP funding was earmarked in the Working Families Tax Cuts Act as part of the Big Beautiful Bill as a strategy to establish stable and sustainable rural healthcare through a robust workforce supported by innovation in care delivery and payment models, even amid steep Medicaid cuts.
The RHTP offers a significant opportunity to enhance states' rural health initiatives and face their inherent challenges in providing quality with advanced technologies and digital health strategies, according to Rogers.
But the "limited time frame for developing comprehensive plans, coupled with the recent government shutdown, has generated anxiety among potential applicants regarding their applications' viability," said Rogers on Wednesday.
"Our understanding from CMS is there will be no delays in the application deadline," added Krista Drobac, cofounder of the Health Policy Futures Lab, a national research group focused on healthcare transformation.
While CMS is working on the RHTP and processing applications during the government shutdown, as Drobac confirmed, reduced availability has disrupted the flow of information coming out of the agency.
HIMSS has held a series of "office hours" to help address states' technology innovation questions related to the RHTP over the past several weeks.
"While the RHTP deadline remains Nov. 5, with funding decisions expected by Dec. 31, many participants expressed concerns about the limited access to CMS officials for clarifying complex aspects of the application process and tech innovation priorities," said Rogers.
The RHTP allocations are equally divided between baseline and workload funding directly tied to a state's technical score. That means the role of technical innovation in alignment with federal priorities will help to determine the level of funding each state receives, she said.
"This lack of technical guidance leaves many states uncertain about their chances of securing funding," Rogers said.
"The key concern is whether the government shutdown has jeopardized the program or will delay the distribution of these crucial funds, especially given that this $50 billion initiative is intended to offset other federal funding cuts," she explained. "While the shutdown limited application feedback, the most immediate impact may be delays in awarding funds within the original timeline."
As announced on Wednesday, the U.S. Department of Health and Human Services is recalling some furloughed staffers to process the RHTP applications due next week.
Confronting rural challenges
The RHTP is an opportunity to expand healthcare access for rural Americans and address long-standing barriers endemic to rural healthcare, according to Abe Sutton, CMS deputy administrator and director.
"These are not new challenges," he said last month at a one-day summit in Washington, D.C., hosted by the Health Policy Futures Lab to aid RHTP applicants.
"They're challenges that we've known, but we've lacked the chance to confront them and take them on and really think about, in a strategic manner, how can we change? How can we move beyond this?"
Sutton then acknowledged the growing unaffordability of healthcare in his keynote address.
"Across the country, and in rural America in particular, employer family premiums average around $25,000 for a family now," he told the state healthcare leaders preparing their RHTP funding applications. "That's up 7% over last year; it's 24% growth from 2019 – 36% of adults in this country skipped or delayed care because of cost.
"People living in rural areas have higher rates of mortality when compared to their urban counterparts," he added. "In addition, rural communities, on average, are older than the rest of the country, and live with more chronic disease. The burden we're going to see in a rural community is going to be more extreme. And there are going to be fewer providers there to care for them."
Primary care, broadband, transportation
The Health Policy Futures Lab's D.C. summit on Sept. 30 was attended in person by 43 states and two by livestream broadcast, to exchange information, network on shared goals and more.
"States are adhering to the requirements of the application, and every state I have talked to has done [a request for information] or extensive community in-person outreach to get feedback from providers and other stakeholders on what to include in their applications," said Drobac.
A main theme in Virginia is access to basic primary care, according to Janet Kelly, the state's secretary of health and human resources. There are also broadband, transportation, and health and lifestyle challenges in the state's rural regions, she noted.
To address the RHTP application, "we've got 12 different agencies; we're treating them as if this is one big effort," Kelly said. "It's also giving us a lot of confidence."
Kate Sappra, acting deputy director of the Office of Rural Health Transformation at the Centers for Medicare & Medicaid Services, then asked panelists how they were "getting local input from the local communities and providers to make sure that as you're designing this plan, it's really responsive to the needs of the community?"
Elizabeth Hertel, the director of the Michigan Department of Health and Human Services, said her agency hosted extensive listening sessions throughout the state, inviting hundreds of guests over several weeks following the federal rural health funding program's announcement.
In some areas of Michigan, such as the Upper Peninsula, "we have difficulty sometimes getting food supply up there or other things," she said. "You can go around, through Wisconsin, but obviously it takes significantly longer."
After soliciting written public comments through Sept. 9 on an RFI, Cecile Erwin Young, the executive commissioner of the Texas Health and Human Services, said her agency had planned a series of community engagements with local officials, rural hospital stakeholders and the public across the state this month to learn more about specific health needs in each region.
Young noted that proximity to healthcare is a "huge" issue in rural areas of Texas, which has about 700,000 lane miles traversing the state. The challenge is not only in transporting patients on long roads far away from the nearest hospitals, but also with the area's active industries and dangersous professions – agriculture, oil and gas – nearby services are critical to maintain.
"We're trying to think strategically about luring [workforce] to those areas to provide the services that we need," she said.
On Monday, Nov. 3, in the second installment, we'll explore the RHTP's funding sufficiency and investments rural healthcare providers may be required to make in the future absence of federal incentives.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
