The US Administration is taking a comprehensive approach to improve healthcare in rural communities, addressing challenges such as higher poverty rates, limited access to healthcare providers, and reduced insurance coverage.

These actions build upon the Affordable Care Act and the Inflation Reduction Act and look to address these disparities and enhance healthcare access for rural Americans.

Key actions of the initiative include increasing health coverage through outreach in the ACA Marketplace, Medicaid, and Medicare, with a focus on Medicaid expansion states.

To address the issue of rural hospital closures, the administration is providing funding to small rural hospitals and Medicare-certified Rural Health Clinics, especially in response to the Covid-19 pandemic.

Additionally, the establishment of Rural Emergency Hospitals (REHs) offers rural hospitals an option to continue providing emergency and outpatient care, thus preventing closures.

Centers for Medicare & Medicaid Services (CMS) has finalised changes to REH payment methodology for Tribal and Indian Health Services (IHS)-operated REHs.

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This is aimed at addressing hurdles, which could have dissuaded the conversions of Tribal and IHS-run hospitals to REHs.

The administration is also working to support rural providers in adopting value-based care initiatives and addressing network adequacy for behavioural health services.

Initiatives include upfront payments to certain accountable care organisations (ACOs) to facilitate their participation in value-based care programmes and strengthen network adequacy requirements for Medicare Advantage organisations.

CMS is extending these telehealth flexibilities until 31 December 2024, owing to the increase in Medicare telehealth visits during the Covid-19 pandemic.

The government is looking to provide high-speed internet access to rural communities, recognising its importance for telehealth services.

Furthermore, it is taking various measures, such as expanding access to behavioural health providers, supporting the treatment of opioid use disorders, and addressing network adequacy for behavioural health services under Medicare Advantage and the ACA Marketplace.

The government is also working on expanding access to maternal care in rural areas, where challenges are particularly acute.

Initiatives include the Rural Maternity and Obstetrics Management Strategies Program, training for rural hospitals to be obstetrics-ready, and innovative payment and service delivery models aimed at improving maternal health outcomes in rural America.