March 2023 Newsletter

Message from the IARHC Board President

IARHC members, 

We have an exciting newsletter for you as we head into a busy spring for IARHC!

We are pleased to announce the launch of the new IARHC website! You may have noticed a few changes to the design of the website as we work to provide more information and resources for our members.

In February, the IARHC board met for a strategic planning session to discuss the future of the organization and how IARHC can better support RHCs across the state. The board spent the day establishing the priorities that IARHC will focus on over the next two years. Key takeaways and plans will be shared with all IARHC members in the coming months.

IARHC is excited to hold a Spring Workshop on May 3, 2023 in collaboration with IMGMA's spring conference May 4-5, 2023. The workshop sessions will cover changes in RHC billing, behavioral health and preventative services. IARHC members will receive a discount when they register for the workshop and are invited to register under the IMGMA member rate for the IMGMA conference. More information about the workshop and discount for members is included in this newsletter and on our website.

We will launch our annual membership drive in next month. Be on the lookout for the announcement in your inbox as we will provide more information in our weekly listserv communications.

In this newsletter, you will find information about our new website, the Spring Workshop, funding opportunities, policy updates in Iowa and nationally, and resources for your RHC.

Thank you – for all you do for your colleagues, patients, and rural communities. We hope to see you at the workshop this spring! 


Ann Wise

Board President

Clinic Director

UnityPoint Clinic Buena Vista, Sac City, and Lake View

IARHC Launches New Website

We are excited to announce the launch of a new IARHC website! The new site includes updated information on our resource page, membership information, trainings, and more! Check out the new site here.

IARHC Resources and Webinars

IARHC's new website contains updated resources for all RHCs as well as exclusive resources for IARHC members. Resources for IARHC members only will be announced in our weekly listserv communications and newsletters. Two resources available to members only are Transitions of Care Process Flow Checklist and a RHC Evidence Binder which includes an evidence binder description and content that should be included in your clinics evidence binder.

Did you miss the Community Health Worker in RHCs Webinar? Watch the recording and other IARHC webinars here.

IARHC Spring Workshop

Join us for the IARHC Spring Workshop Wednesday, May 3rd from 10:00am-3:30pm. Sessions provided in this workshop include RHC Billing Overview, Behavioral Health and Telehealth Changes, and RHC Preventive Services Billing. The workshop sessions will be presented by Charles James Jr., President and CEO of North American HMS and current President of the National Association of Rural Health Clinics. Continuing education credits are available for the IARHC Spring Workshop through AAPC. Participants will receive 4 CEUs for attending the workshop. IARHC members are invited to register using the code IARHCMEMBER to receive a discounted rate to attend the workshop. For more information about the sessions, hotel accommodations, and how to register for the conference, visit our website here.

The IARHC Spring Workshop is in collaboration with the IMGMA Spring Conference held May 4-5, 2023. IARHC and IMGMA are offering member and non-member rates for the workshop and conference. If you are a member of IARHC and would also like to attend IMGMA’s conference in addition to the IARHC workshop, IARHC members are able to register under the IMGMA member rate. Use the discount code IARHC when registering for the IMGMA conference. More information about the events can be found here.

IARHC State Capital Report

View the latest State Capitol Report from the Advocacy Cooperative. This update includes the week's highlights, post-funnel week updates, and what to is to come. The IARHC bill tracker is the best place to find updates on where bills are in the legislative process. Bills are added daily, and bill status is in real-time, so you can always know where a bill is in the legislative process. Recent highlights:

  • The House passed a bill ending physician supervision of PAs (HF 424).
  • Senate and House differ on CON for rural emergency hospitals (SF 75).
  • The Senate passed the reorganization bill without significant changes.
  • House committee advances bill that eliminates Tobacco Commission (HF 566).
  • House subcommittee approved a new nicotine solution tax.
  • Ban on gender-affirming medication and surgeries sent to Governor (SF 538).
  • House introduces 12-month postpartum Medicaid expansion bill (HSB 226).

The second funnel week occurs in legislative week 12 (March 27-31). By the end of next week, any policy bill will need to have been passed out of committee in the second chamber in order to stay alive for the year. House bills have to be voted out of Senate committees, and Senate bills out of House committees to stay alive. Exceptions from the funnel deadlines exist for bills from three committees: Appropriations, Ways & Means, and Government Oversight.  


This week, the focus is shifting away from floor debate and back to subcommittee and committee meetings as legislators try to move bills out of committee prior to the funnel deadline. View the latest State Capitol Report here.

FORHP FY 2024 Budget: Rural Health Clinic Behavioral Health Initiative

The U.S. Department of Health & Human Service’s budget request for FY 2024, Building a Healthy America, was released on March 9, 2023, and HRSA’s FY 2024 Congressional Budget Justification was released on March 13, 2023. The total request for the Federal Office of Rural Health Policy (FORHP) was a budget of $416 million, an increase of $63 million from the FY 2023 enacted budget. This budget request would enable FORHP to continue funding to our technical assistance partners, expand our reach to additional rural communities, and develop three new programs.

Notable increases would include:

  • Rural Outreach Grants - $2 million increase
  • Rural Communities Opioids Response Program - $20 million increase

The budget proposes three new programs targeting the unique and emerging needs of rural communities.

  • Rural Health Clinic Behavioral Health Initiative: Rural areas represent nearly 60 percent of Mental Health Professional Shortage Areas, encompassing more than 25 million people who do not have adequate access to mental healthcare providers. $10 million would support an initiative to expand access to mental health services in rural communities where Rural Health Clinics serve as a key access point.

With 143 hospital closures since 2010, including 19 closures in 2020, the FY 2024 budget requests an investment of $30 million towards helping rural communities sustain their hospital (including Critical Access Hospitals and Rural Emergency Hospitals) healthcare infrastructure.

  • Financial and Community Sustainability for At-Risk Rural Hospitals Program: $10 million would support rural hospitals at-risk for imminent closure through targeted technical assistance, and
  • Rural Hospital Stabilization Pilot Program, $20 million would go toward new pilot program supporting to at-risk rural hospitals to enhance and or expand needed service lines.

The request also proposes significant investments in the health workforce. HRSA’s Bureau of Health Workforce would see an overall increase of $892 million from the FY 2023 budget, of which National Health Service Corps would receive a $548 million increase to ensure even more providers are incentivized to practice in underserved and rural communities. Additionally, $125 million would be added to the Ending the HIV Epidemic in the United States Initiative, specifically to increase evidence-based practices and support HIV care for clients including those in the seven states with substantial rural HIV burden.

FQHC & RHC CMS Policy Manual Update

The FQHC & RHC CMS Policy Manual Update highlights policy changes in the 2022 and 2023 Final Physician Fee Schedules, but not included in the FQHC/RHC CMS Policy Manual, regarding mental health face-to-face and telehealth encounters, and care management services. Details when permanent policies take effect. Discusses the current CMS modified definition of a mental health visit. Provides clarification on the Medicare allowance for general care management services including chronic care, chronic pain, and behavioral health integration.

CMS News: Medicare

COVID-19: Don’t Report CR Modifier & DR Condition Code After Public Health Emergency

The end of the COVID-19 public health emergency (PHE) is expected to occur on May 11, 2023. Since the CR modifier and DR condition code should only be reported during a PHE when a formal waiver is in place, plan to discontinue using them for claims with dates of service on or after May 12, 2023. For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38.

Behavioral Health Integration Services — Revised

Learn what’s changed, including new codes:

  • HCPCS code G0323 describing general behavioral health integration where a clinical psychologist or social worker, serving as the focal point of care integration, furnishes the mental health services
  • CPT code 90791 as an eligible initiating visit for G0323


Medicare Preventive Services — Revised

Learn about what’s changed:

  • Cardiovascular disease screening tests: Added information on lipid testing national coverage determination
  • Glaucoma screening: Added information on local coverage article
  • Medical nutrition therapy: Clarified frequency for subsequent years
  • Medicare Diabetes Prevention Program: Clarified information on A1c test values for diagnosing prediabetes or diabetes
  • Prostate cancer screening: Added CPT code 0359U effective January 1, 2023

Medicare Physician Fee Schedule Database: April Update

See the attachment in the instruction to your Medicare Administrative Contractor to learn about the April quarterly changes to the Medicare Physician Fee Schedule Database:

  • New codes
  • Procedure status changes

Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier (Revised)

Learn about the requirement to include a modifier on claims for separately payable Part B drugs and biologicals acquired under the 340B Program. Find out what’s changed, including:

View the latest CMS MLN Connects Newsletters here.

End of COVID-19 Public Health Emergency (PHE) Pharmacy Allowances

Informational Letter (IL) 2119-MC-FFS-CVD1 and IL 2123-MC-FFS-CVD2 established pharmacy allowances in accordance with COVID-19 PHE pharmacy policies and benefits. With the announcement that the PHE will end on May 11, 2023, the latest informational letter states the pharmacy allowances will revert to Iowa Medicaid pharmacy policies and benefits in effect prior to the PHE. Read the letter here.

How Will RHCs be Impacted by the Ending of PHE Declaration

The Biden Administration announced the COVID-19 Public Health Emergency (PHE) Declaration is anticipated to end on May 11, 2023. This will significantly impact CMS Certified Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Please click here for the CMS publication to learn more.

Video About Eligibility Renewal is Now Posted to the Iowa HHS Website

The National Association of Medical Directors (NAMD) along with State Health and Value Strategies put together a video explaining member renewal and what the state needs from members and customized it to each state's Medicaid program. The video is available in both English and Spanish, and are cut into three different lengths: 60 seconds, 30 seconds and 15 seconds. Find them in the Unwind Resource Library. Watch the video here.

New Study: Factors Affecting Recruitment, Retention of Rural Clinicians

The Economic Research Service at the U.S. Department of Agriculture surveyed health care professionals in 150 small towns across nine U.S. states: Arkansas, Iowa, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, Texas, and Wisconsin. Researchers learned that, among those surveyed, personal and professional relationships were the most important factor for moving to and staying in a rural practice. Read the full report here.

FCC Publishes Request for Comment on Proposed Changes to the Universal Service Rural Health Program

In January, the Federal Communications Commission (FCC) adopted an order and further notice of proposed rulemaking (FNPRM) (FCC 23-6) to amend Universal Service Rural Health Care (RHC) Program rules. The order restored the method of calculating rural and urban rates as it existed before adoption of the 2019 Rule and Order that created a rates database. It also simplified invoicing procedures and altered priority rules if the program cannot fully fund all applications submitted. The FNPRM sought comment on new application data collection plans to verify that requested support is consistent with prevailing charges for similar telecommunications services in the area. It also proposed capping support for satellite service at the level of terrestrial service, proposes changes to expedite new health care provider review and proposed other changes to streamline the application process. The order and FNPRM was published in the Federal Register on March 23, 2023, starting a 30-day public comment period (ending April 24, 2023) and a subsequent 30-day reply comment period (ending May 22, 2023) for people to comment on other filer’s comments. Interested parties may comment in the Electronic Comment Filing System (ECFS) under WC Docket No. 17-310 at:

Grant and Funding Opportunities

USDA Seeks Applications for Grants to Build Community-Oriented High-Speed Internet Networks for People in Rural Areas

WASHINGTON, March 20, 2023 – U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small announced that USDA is accepting applications for grants to build community-oriented, high-speed internet networks for people in rural areas.

The Department is making up to $79 million in grants available under the Community Connect program. Recipients may use the funds to establish high-speed internet networks that will foster economic growth and deliver enhanced educational, health care and public safety benefits.

Grant recipients must agree to provide high-speed internet service at community-serving institutions free of charge for up to two years. These institutions include schools, libraries, fire stations and other public safety sites.

Eligible applicants are state and local governments, Federally recognized Tribes, nonprofits, for-profit corporations and limited liability companies. USDA does not provide funding directly to individuals under this program.

All applications must be submitted electronically by 11:59 a.m. Eastern Time on June 20, 2023, to This funding opportunity will also be posted to For additional information, see page 16579 of the March 20, 2023, Federal Register. To subscribe to receive USDA Rural Development updates, visit GovDelivery subscriber page.

NHSC Loan Repayment Program

The National Health Service Corps (NHSC) has opened the application cycle for three programs. Eligible clinicians providing primary medical, dental, or behavioral health care services or evidence-based substance use disorder treatment can qualify for loan repayment of up to $50,000 with an NHSC Loan Repayment Program award, up to $75,000 for the NHSC Substance Use Disorder Workforce Loan Repayment Program, and up to $100,000 for the NHSC Rural Community Loan Repayment Program. Click here to compare programs, find your NHSC program fit, and learn more about eligible disciplines, site types, and service commitment. For information you need to apply, read the 2023 NHSC LRP Application and Program Guidance. Check out this Application Checklist to help you submit your application by the deadline. Application deadline is Tuesday, April 25, 2023, 6:30 p.m. CT. To get help with your application, attend the NHSC LRP webinar on March 21, 2023 from 12:00-1:00pm. Meeting ID: 160 068 0754.

HRSA Payment Program for RHC Buprenorphine-Trained Providers

Update: Clinicians no longer need DATA 2000 Waiver training to prescribe buprenorphine; however, the payment program to defray earlier training costs is still active. Launched in June 2021, the initiative pays for providers who previously received a waiver to prescribe buprenorphine, a medication used to treat opioid use disorder. Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who previously trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019. Approximately $900,000 in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted. Send questions to [email protected].

NARHC News, Policy, & Resources

NARHC 2023 Policy Priorities

NARHC’s policy and advocacy efforts advance the NARHC mission, enhancing the ability of RHCs to deliver cost-effective, quality health care to patients in rural, underserved communities. NARHC’s government affairs team, based in Washington, D.C. serves as the primary resource to Congress, federal agencies, and the Administration on federal Rural Health Clinic issues.

Together with the NARHC Policy Committee, we focus on both regulatory and legislative options to increase access to care, remove unnecessary regulatory burdens, protect the integrity of the RHC program, and enhance reimbursement policies that incentivize and support rural, outpatient health care services. Advocacy and comment letters sent to CMS, HHS, and Members of Congress can be found here.

NARHC's 2023 Policy Priorities include:

For more information about each of the policy priorities, visit the NARHC website here.

NARHC Escalates "Urbanized Area" Issue | CMS Policy Urgently Needed

In early January, NARHC shared with RHCs the recent Census Bureau definition changes and their potential impacts on Rural Health Clinic location eligibility, given the lack of a finalized policy from CMS.

Since then, in the absence of such a policy from CMS, NARHC learned of RHC applications either being inappropriately rejected based on assumptions of what the new policy is or simply blocked by states waiting for a clarification.

On March 6th, NARHC sent a letter to the CMS Administrator sharing the halting impacts of the lack of policy and the immediate need to publicize a policy clarification in a manner that preserves the historical location requirements for the RHC program. The letter was also widely shared with Congressional staff.

NARHC will update the RHC community as soon as they receive any updates through the NARHC listserv. With any questions, please contact Nathan Baugh, NARHC Executive Director, at [email protected] or Sarah Hohman, NARHC Director of Government Affairs, at [email protected].

RHCs & the Medicare Shared Savings Program - What You Need to Know | Webinar Recording

Did you miss the NARHC Medicare Shared Savings Program webinar? Watch the recording or view the slide presentation below.

NARHC provides technical assistance webinars covering the most current and up-to-date information for RHCs. View more TA webinars here.

Contact Us


Questions? Ideas you want to share? Concerns or barriers you’re facing? Feel free to reach out to staff at [email protected] - we’ll try to help or get you connected. Or you can reach out to your colleagues by posting a question on the IARHC listserv. Simply send an email to [email protected]. This listserv gives you access to the current IARHC membership – use it as a tool to learn from each other!

IARHC Staff Members

Hannah Toresdahl

[email protected]


Iowa Association of Rural Health Clinics | | [email protected]