Announcements from the Federal Office of Rural Health Policy

May 10, 2017

What’s New

National Prevention Week.  May is Mental Health Awareness Month and next week, May 14-20, communities and organizations around the country will focus on the prevention of substance use, misuse and overdose.  Rural communities have been hit particularly hard by the opioid epidemic and our federal partners at the Substance Abuse and Mental Health Services Administration (SAMHSA) have developed a toolkit to help raise awareness to the importance of mental health and getting ahead of crisis through prevention.

Funding for CARA.  Congress passed a budget last week that included full funding of $181 million for the Comprehensive Addiction and Recovery Act, passed and signed into law in 2016.  CARA authorizes federal grants to state and local governments from the Departments of Justice and Health & Human Services to test new approaches to preventing and treating opioid addiction.

Mapping the Opioid Crisis.  Rural communities, families, health providers and law enforcement can see the impact of substance abuse, but various factors make it difficult to find real time data about its impact. The Center for Health Journalism has created a guide to a series of resources and data tools that can help communities develop an accurate picture of the opioid epidemic at the local level.

Report on State Telehealth Policies.  The Center for Connected Health Policy recently released its 5th annual report on telehealth laws and reimbursement policies of the 50 states and Washington, DC.  These regulations, unique to each state, affect the potential to increase telehealth capacity in rural areas lacking adequate access to health care.

Funding Opportunities

Building Communities of Recovery – July 3.  The Substance Abuse and Mental Health Services Administration expects to make 13 awards of up to $200,000 each to increase the availability and quality of Recovery Community Organizations (RCOs).  RCOs are nonprofit organizations such as Narcotics Anonymous or SMART Recovery that provide long-term support and counseling, in peer group settings, for recovery from substance abuse and addiction.  Grantees will use funds to build connections with other RCOs and reduce the stigma associated with addiction through public education and outreach efforts.

Policy Updates

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Comments Requested: Accelerating Broadband Health Tech Availability – May 24. The Federal Communications Commission (FCC) recently released a Public Notice seeking comments, data, and information on a broad range of regulatory, policy, technical and infrastructure issues related to broadband-enabled health care. This includes a request for comments on how to strengthen the FCC’s Rural Health Care Program, which supports telecommunications and broadband services to improve the quality of health care in rural communities. Interested parties may file comments on or before May 24, 2017. The FCC has posted more detailed information on the request and instructions for filing comments.

Comments Requested: Hospice Payment Rates and Policy – June 26. CMS has issued a proposed rule to update 2018 Medicare payment and polices. The proposal includes a 1.0% or $180 million increase in payments (rural areas would experience an average 1.1% increase compared to FY 2017); outlines requirements for the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey; and solicits comments on a clarifying change to regulation for certifying a life expectancy of six months or less.  A fact sheet regarding this proposed rule is available on the CMS website for more information.

Comments Requested: Skilled Nursing Facility (SNF) Payment Rates – June 26. CMS has issued a proposed rule to update 2018 Medicare payment rates and polices for skilled nursing facilities (SNFs). Changes include a payment rate increase of 1.0% ($390 million), proposals for the SNF Value-Based Purchasing Program, revisions to the SNF Quality Reporting Program, and clarification of the regulatory requirements for team composition for complaint investigation surveys. The proposed rule also includes a Request for Information to encourage continued feedback on improvements to the Medicare program including ideas for regulatory, sub-regulatory, policy, practice and procedural changes. A fact sheet is available on the CMS website for more information.

Comments Requested: Inpatient Rehabilitation Facility (IRF) payment rates –June 27. CMS has issued a proposed rule to update 2018 Medicare payment and polices for IRFs. Changes include an overall update of 1.0% (or $80 million), removal of the voluntary swallowing status item (Item 27) from the IRF-PAI, removal of the 25 percent payment penalty for late transmissions of the IRF-patient assessment instrument (IRF-PAI), changes to the IRF Quality Reporting Program (QRP), and changes to the 60 percent rule presumptive methodology. The proposed rule also includes a specific request for comments on the 60 percent rule regarding the criteria used to classify facilities for payment under the IRF PPS and announces that FY 2018 is the third and final year of the phase-out of the 14.9 percent rural adjustment for the 20 IRF providers that were designated as rural in FY 2015 and changed to urban under the new Office of Management and Budget (OMB) delineations in FY 2016: therefore CMS will no longer apply a rural adjustment for these IRFs. Additionally, the proposed rule includes a Request for Information to encourage continued feedback on improvements to the Medicare program including ideas for regulatory, sub-regulatory, policy, practice and procedural changes. A fact sheet is available on the CMS website for more information.

Resources, Learning Events and Technical Assistance

Medicare-Medicaid Accountable Care Organization Model – Thursday, May 11 at 1:00 pm ET.  CMS will host this webinar to provide an overview of the MMACO Model, including details on the model’s beneficiary attribution, financial methodology, and quality measurement options.  Attendees will also get information on the state application process and how to submit letters of intent. Under the Model, CMS will collaborate with states to allow ACOs in the Medicare Shared Savings Program to also be accountable for the Medicaid costs of their beneficiaries who are dually eligible for Medicare and Medicaid.  Model preference will be given to states with sufficiently high shares of dually eligible beneficiaries and low ACO saturation, which are traits of a number of states that are largely rural.

Scope of Practice: A Policymaking Tool – Friday, May 11 at 3:00 pm ET.  Nurse practitioners, physician assistants, dental hygienists and dental therapists are important elements of the health care workforce in rural and underserved areas and changes in state “Scope of Practice” laws can affect the ability of providers to provide health care. This webinar will allow users to become familiar with a new website that tracks Scope of Practice legislation.

Substance Abuse in Rural Communities: Prevention and Treatment – Wednesday, May 17 at 2:00 pm ET.   The Rural Health Information Hub (RHIhub) and NORC Walsh Center for Rural Health Analysis will introduce a new Rural Prevention and Treatment of Substance Abuse Toolkit providing best practices for implementing prevention programs, treatment and support services in rural communities. This webinar will feature two examples of successful programs funded by FORHP, including lessons learned.

CLAS for Rural Communities – Wednesday, May 17 from 3:00 – 4:30 pm. The second webinar in SAMHSA’s Rural Behavioral Health series will focus on Culturally and Linguistically Competent Behavior for diverse populations in rural communities.

Training Series for Health Care Providers on Prescribing Opioids – Ongoing. The CDC has launched an eight-part online training series to help health care providers apply recommendations in their clinical settings through interactive patient scenarios, videos, knowledge checks, tips, and resources. Rural practitioners report their concern about the potential for opioid abuse, but at the same time report insufficient training in prescribing opioids. This is why the CDC created the 2016  Guideline for Prescribing Opioids for Chronic Pain and associated training. The first training  Addressing the Opioid Epidemic: Recommendations from CDC is available now. Future topics include: communicating with patients, treating chronic pain without opioids, and prescribing decision making.

Resource of the Week

Mental Health First Aid for Rural Communities

The SAMSHA-HRSA Center for Integrated Health Solutions provides this overview of Mental Health First Aid, an in-person training, available in English and Spanish, for anyone who wants to learn about the risk factors and warning signs of mental illnesses, addiction and overdose.  The 8-hour course teaches participants a 5-step action plan to help a person in crisis.  In rural areas where there are fewer mental health service providers, the training can build basic knowledge about mental health and substance abuse issues, cut down on stigma that hinders treatment, and help residents gain confidence in intervening and referring a person to the resources that exist.   The organization Mental Health First Aid has a Quick Start guide outlining cost, how to find an instructor, and how to market mental health first aid in rural communities.

Approaching Deadlines

NURSE Corps Scholarship Program – May 11
Chronic Disease Management for Older Adults – May 12
Primary/Behavioral Health Care Integration – May 17
Rural Community Hospital Demonstration  –  May 17
Comment: Advanced Alternative Payment Model – May 18
Comment: Accelerating Broadband Health Tech Availability – May 24

Improving Rural Economies – May 26
Comment: Delayed Rules For Home Health Agencies – June 2
Become an NHSC Site – June 6

Behavioral Health Workforce Education and Training – June 12
Diabetes Prevention Program in Underserved Areas – June 12
Relatives As Parents Program – June 15

NIDA Funding To Expand Treatment For Opioid Abuse – June 20
Community Facilities Program – Ongoing
Summer Food Service Program – Ongoing