Announcements from the Federal Office of Rural Health Policy

July 20, 2017

What’s New

Critical Access Hospitals Measure up for Quality. Quality improvement efforts by Critical Access Hospitals (CAHs) were recognized on Wednesday with awards to the ten states achieving the highest reporting rates for quality over the past year. Through their state-level participation in FORHP’s Medicare Rural Hospital Flexibility (Flex) grant program, the ten awardees – Wisconsin, Maine, Utah, Minnesota, Illinois, Pennsylvania, Michigan, Nebraska, Indiana and Massachusetts – supported their CAHs by providing technical assistance resources and sharing best practices for quality improvement.  Under the Flex program, low-volume hospitals take on quality improvement initiatives in the Medicare Beneficiary Quality Improvement Project (MBQIP) and voluntarily report on quality measures relevant to the care they provide.

Awards for Radiation Exposure Screening and Education. FORHP recently awarded approximately $1.6 million over a three-year project period to support outreach services to individuals affected by nuclear weapons testing that took place from 1945 to 1962, impacting 12 Southwestern states and exposing tens of thousands of uranium miners, truck drivers and desert-dwellers known as “downwinders” to radiation.  The Radiation Exposure Compensation Act (RECA) was instituted in 1990 to compensate affected people and the act was broadened in 2000 to include the Radiation Exposure Screening and Education Program (RESEP).  Many downwinders, former uranium industry workers, and participants who were onsite for testing are now deceased but may have surviving family members who are eligible for compensation. The eight RESEP grantees recently awarded will disseminate information on radiogenic diseases and the importance of early detection, screen eligible individuals for the diseases and cancers that result from radiation exposure, and provide referrals for medical treatment.  A priority for these organizations is to assist with the filing of new RECA claims.

Funding Opportunities

Telehealth Center of Excellence August 21.  FORHP’s Office for the Advancement of Telehealth (OAT) will make one award for $1,000,000 for a Telehealth Center of Excellence (COE).  The Telehealth COE will examine the efficacy of telehealth services in rural and urban areas and will serve as a national clearinghouse for telehealth research and resources, including technical assistance.  Applicants must be public academic medical centers located in states with high chronic disease prevalence, high poverty rates, and a large percentage of medically underserved areas.  OAT staff will hold a technical assistance webinar for applicants on Tuesday, August 1, 2017 at 2:00 pm ET.  To participate, dial 1-888-603-6973, passcode 8827004.

State Systems Development for Maternal and Child Health – September 5.  HRSA’s Maternal Child Health Bureau (MCHB) will make 51 awards of $100,000 each through the State Systems Development Initiative (SSDI).  The SSDI expands capacity for data collection on needs and performance of the Title V MCH Block Grant program and is essential for helping states make informed decisions about resource allocation for the health of women, infants, children and youth.  Review of previous reports for MCH Block Grant funding have shown eight states or jurisdictions with unique challenges and a portion of the SSDI funds will go toward a separate data collection mechanism to meet those needs.  Visit the Rural Health Information Hub for the latest data on health disparities for rural women, infant mortality rates and challenges to child wellness.

Policy Updates

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Comments Requested: Interoperability Standards – July 31.  Rural providers with experience using electronic health records can give feedback to the Office of the National Coordinator for Health Information Technology (ONC) on a proposed framework for measuring and assessing healthcare interoperability standards. This framework would help health IT developers, health information exchange (HIE) organizations, and health care providers move towards a set of uniform measures to assess interoperability progress.

Comments Requested: Researching Pregnancy Screening for Hepatitis B – August 9.  The U.S. Preventive Services Task Force (USPSTF) released its draft research plan on prenatal screening for hepatitis B virus (HBV) infection, which can be spread from mothers to infants during childbirth and cause life-long, chronic infection. Key questions for researchers revolve around the benefits and harms of universal screening and vaccination. Relatively few chronic HBV cases occur each year among persons infected at birth but among the states reporting new chronic HBV cases in 2015, ten accounted for nearly 73% of cases, including the rural-heavy state of Missouri.

AHRQ Seeks Rural Experts – August 26.  The Agency for Healthcare Research and Quality (AHRQ) seeks seven individuals to serve on the National Advisory Council for Healthcare Research and Quality, a 21-member panel that provides advice and recommendations to the AHRQ Director and Secretary of HHS on national priorities for health services research. Qualified panelists have experience and success in health services research, health care quality improvement, health care delivery or administration, or health care economics or policy, among other fields. Of note, at least one member of the Council must be a specialist in rural aspects of healthcare safety, quality, access, and research. Nominations should be emailed to

Comments Requested: Policy for Hospital Outpatient Services – September 11. CMS released its proposed rule updating payment and policy for 2018 under the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The rule includes a major policy proposal to reduce Medicare Part B reimbursement for drugs purchased in the 340B program and estimates drug payments to 340B hospitals may be lowered by as much as $900 million.  Critical Access Hospitals (CAHs) would not be affected by this proposal and would continue to be reimbursed at 101% of reasonable costs. Overall, changes to OPPS are projected to increase payments to hospitals by 1.9%, or $897 million, in 2018 compared to last year.  Further, the proposal maintains the 7.1% payment increase for outpatient services performed at sole community hospitals.  Also of note for rural hospitals, the rule proposes a two-year extension of the moratorium on enforcing the direct supervision requirement currently in place for CAHs and small rural hospitals. CMS requests feedback from the public about the proposed changes and asks for ideas to reduce unnecessary burden and improve quality, efficiency, and health outcomes.

Comments Requested: Changes to Physician Fee Schedule/Diabetes Prevention – September 11.  This proposed rule from CMS makes annual updates to clinician payment under the Medicare Physician Fee Schedule (PFS) for 2018. The proposal would reduce current PFS payment rates for non-excepted, off-campus provider-based hospital departments paid under the PFS by 50 percent, add seven new codes to the list of telehealth services and eliminate required reporting of the telehealth modifier, add new care coordination services and payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs), remove the attestation requirement for beneficiary assignment policies for RHCs and FQHCs in Medicare Shared Savings Program ACOs, and implement policies for the Medicare Diabetes Prevention Program expanded model starting in 2018. Once the rule is officially published on July 21, comments can be submitted online, by mail or delivered by hand/courier until September 11. In addition to the payment and policy proposals, CMS is releasing a Request for Information (RFI) to welcome feedback on positive solutions to improve transparency, flexibility, program simplification, and innovation. This will inform the discussion on future regulatory action related to the PFS.

Resources, Learning Events and Technical Assistance

TwitterChat: Behavioral Health Workforce – TODAY – Thursday, July 20 at 3:00 pm ET.  The National Health Service Corps (NHSC) will hold an hour-long discussion on the role of primary care providers in supporting behavioral health in underserved communities.  In a policy brief from the Rural Health Research Gateway, researchers describe the provider-to-population ratio of behavioral health professionals in rural areas as less than half that in metropolitan areas.  To join the discussion with NHSC, log on to Twitter and follow #BHealthy.

21st Century Kick Off for Health Information Technology – Monday, July 24 from 9:30 am – 4:30 pm ET.  The Office of the National Coordinator for Health Information Technology (ONC) will hold a series of meetings and webinars for stakeholders across the Health IT spectrum – including clinicians, policymakers, state and federal agencies, exchange service providers and the private sector – to discuss and inform ONC’s work supporting the 21st Century Cures Act enacted by Congress last year.  The legislation, which supports advanced research and drug development for better patient outcomes, makes provision for better delivery of health care through improved health information technology and nationwide interoperability (Section 3001 of the act).  Last year, ONC issued a data brief suggesting that rural and Critical Access Hospitals have had challenges meeting interoperability standards and outlined specific approaches to increasing connectivity in rural areas.

Recovery After Farm Floods – Wednesday, July 26 at 1:00 pm ET.  The AgriSafe Network will host this one-hour session online to inform disaster recovery efforts that could be made more dangerous to first responders by displaced machinery, livestock and agricultural chemicals.  Attendees will learn essentials for a disaster preparedness plan and how to identify common human health risks faced during a farm flood.

Critical Access Hospital Pro Forma for Shared Savings – Wednesday, July 26 at 1:00 pm ET. This webinar will present a new Excel-based tool developed by the Rural Health Value team and Premier, Inc. This publicly available and free tool, the Critical Access Hospital Pro Forma for Shared Savings, can help CAHs assess the financial implications of joining a Medicare Shared Savings Plan Accountable Care Organization.

Save the Date and Register for 3RNet’s Annual Conference – September 12-14.  The National Rural Recruitment and Retention Network (3RNet) will hold its annual conference in Scottsdale, AZ. 3RNet members represent over 5,000 communities across the U.S. that actively recruit physicians and other health care providers to work in rural areas.  Attendees will benefit from workshops and a speaker line up sharing insight on rural recruitment challenges, resources and tools.

Training Series for Health Care Providers on Prescribing Opioids – Ongoing. The CDC has an eight-part online training series to help health care providers apply CDC’s prescribing 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. For this reason, the CDC created the 2016  Guideline for Prescribing Opioids for Chronic Pain and associated training. Topics in the series include communicating with patients, treating chronic pain without opioids, and prescribing decision making.

Resource of the Week

Antibiotic Stewardship at Small and Critical Access Hospitals. In a collaboration with FORHP, the American Hospital Association and The Pew Charitable Trusts, the Centers for Disease Control and Prevention (CDC) have published a guide for implementing antibiotic stewardship at small and rural hospitals.  Improving antibiotic use in hospitals is important to improving patient outcomes, decreasing antibiotic resistance, and reducing healthcare costs.  This new guide takes into account the challenges of limited staffing and resources for smaller facilities, outlines the core elements of a successful program, and provides a range of implementation options that might be useful.  In 2015, more than 200 critical access hospitals reported implementation of all seven core elements of antibiotic stewardship.

Approaching Deadlines

Rural Health Opioid Program – July 21
Community Facilities Technical Assistance Grant – July 24
Community Economic Development Projects – July 24
Rural Community Development Initiative – July 25
Grants for Socially-Disadvantaged Groups – July 25
Training Rural Teachers – July 28
Expanding Medication Assisted Treatment – July 31
First Responders to Opioid Overdose – July 31
Empowered Communities/Healthier Nation – July 31
Comments Requested: Interoperability Standards – July 31
Improved Nutrition Services for Elders – August 7
Support for Veteran and Minority Farmers and Ranchers – August 7
Public Health in Tribal Communities – August 7
Funding for Children Affected by Substance Abuse – August 9
Developing Future Victim Specialists for Indian Country – August 9
Comments Requested: Researching Pregnancy Screening for Hepatitis B  – August 9
Telehealth Center of Excellence – August 21
Comments Requested: Payment Changes for Medicare Clinicians – August 21
HIT Strategies for Patient-Reported Outcome Measures – Ongoing
HIT to Improve Health Care Quality and Outcomes – Ongoing
Community Facilities Program –  Ongoing
Summer Food Service Program – Ongoing