Announcements from the Federal Office of Rural Health Policy

September 20, 2017

What’s New

Combating the Opioid Epidemic.  Last week, the Health Resources and Services Administration (HRSA) awarded more than $200 million to health centers and rural health organizations in every state to increase access to substance abuse and mental health services.  More than $3 million of these funds will support programs in the Federal Office of Rural Health Policy:  the Rural Health Opioid Program supports collaboration at the community level to find individuals with opioid use disorder and direct them into treatment; and the Substance Abuse Treatment Telehealth Network Grant Program allows treatment providers to cover a wider geographic region. Use the Find Grants Tool (“Grants-Awarded” under Data by Topic) at the HRSA Data Warehouse to learn more about the rural organizations awarded by FORHP.

The Geography of HIV.  The Centers for Disease Control and Prevention (CDC) issued a map showing that, while the majority of HIV diagnoses in the U.S. are in urban areas, there are parts of the country where the rates are surprisingly high for suburban and rural areas.  These include the South, where 23% of new HIV diagnoses are suburban/rural, and the Midwest where the number is 20%.  CDC provides fast facts with the map, indicating that geography is only one factor creating challenges for prevention, treatment and care.

Funding Opportunities

Small Rural Hospital Transition Project – October 16.  Nine rural hospitals will be selected to receive on-site technical assistance for the transition to value-based care and Alternative Payment Models.  Applicants may select either a financial operational assessment or quality improvement project.  Preview questions in advance of the application period opening September 25th and get helpful hints for submitting a successful application.

Federal Investment in Rural Transportation – October 16. The U.S. Department of Transportation (DOT) will provide $500 million in federal funding for transportation infrastructure projects that spur local economies.  The Transportation Investment Generating Economic Recovery (TIGER) program reserves no less than $100 million for rural and tribal communities, with special consideration to projects improving access to reliable, safe, and affordable rural transportation. DOT funded nine rural TIGER projects in 2016, including a safer, less congested main street in Live Oak, CA and improved access to the Great Smoky Mountains National Park in Walland, TN. Consider contributing to TIGER projects by helping eligible applicants describe how better transportation choices and access to care can improve health and quality of life. To learn more about how to submit a successful application, including a special session for rural and tribal applicants, register for the 2017 TIGER webinar series.

Loan Repayment for Health Disparities Research – November 15.  The National Institutes of Health will pay up to $35,000 toward health profession education loans in exchange for a two-year commitment to research health disparities populations, including rural, Native American/Alaska Natives and those who are socioeconomically disadvantaged.

Rural Health  Research

Overdose Deaths, Hospital Visits and Unfilled Jobs.   Researchers in Missouri and Kansas looked at data to analyze the relationship that opioid use may have with unemployment and worker productivity in those states, particularly in rural areas and the manufacturing sector.

Policy Updates

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Nominate Experts for Rural Health Quality – September 29. The National Quality Forum (NQF) is a nonprofit, non-partisan organization of members who work toward improving health care.  Under contract with the U.S. Department of Health and Human Services, NQF is forming a workgroup of experts familiar with the challenges of reporting data that measures health care quality in rural areas. The Measure Applications Partnership (MAP) Rural Health workgroup will ensure the perspectives of rural residents and providers and make recommendations to CMS. If you or someone you know has a good understanding of quality measures and clinical care within a rural setting, nominations are due no later than 6:00 pm ET on Friday September 29.  This project, which was a key recommendation from previous work on Performance Measurement for Rural Low-Volume Providers, is sponsored by FORHP.

Important Policy Reminder: Medicare-Dependent Hospital Expiration – September 30. The Medicare Dependent Hospital (MDH) program, which provides enhanced payments to small, rural hospitals treating a high proportion of Medicare beneficiaries, is scheduled to expire on September 30. CMS estimates in the Medicare Inpatient Prospective Payment Services (IPPS) Final Rule that the expiration will reduce payments to these hospitals by $119 million in fiscal year 2018. If the program expires, MDHs may apply for Sole Community Hospital (SCH) status to receive the higher of federal inpatient prospective payment or a hospital-specific rate based on cost.  The IPPS Final Rule also includes provisions if the MDH program is re-authorized.

Comments Requested: Rural Rental Housing Loans – November 13. The U.S. Department of Agriculture Rural Housing Service (RHS) administers the Section 538 Guaranteed Rural Rental Housing Loan Program to increase the supply of affordable multi-family rental housing in rural communities. RHS seeks comment on ways to improve the quality, utility, and clarity of information collected on the costs, benefits, and feasibility of proposed housing projects (OMB No. 0575-0174). Commenters may consider suggesting how RHS could incorporate elements of a health impact assessment to help lenders in rural areas make housing choices that improve population health.

CMS Clarifies “Hospital” Definition. CMS issued a survey and certification letter on September 6 with new guidance for Medicare’s statutory definition of “hospital” and determining whether hospitals are “primarily engaged” in serving inpatients. In addition to meeting all Medicare and Medicaid conditions of participation, CMS clarified that a hospital must have at least two inpatients at the time of survey. CMS will use average daily census and average length of stay as two primary factors, among others, to determine if a hospital is “primarily engaged.” Note: this new guidance is not applicable to Critical Access Hospitals or psychiatric hospitals.

Resources, Learning Events and Technical Assistance

Project Venture for AI/AN Youth – Wednesday, September 20 at 3:00 pm ET.  Project Venture is an evidence-based intervention for American Indian and Alaska Native youth that combines traditional native wisdom with outdoor adventure and service learning.  In this one hour webinar, project leaders will explain the core elements of the project that has been implemented in 25 states and 8 Canadian provinces.

Rural Hospital Financial Distress and Closure – Thursday, September 21 at 1:00 pm ET.  Since 2005, 122 rural hospitals have closed – 80 since 2010.  Researchers tracking these data at the North Carolina Rural Health Research and Policy Analysis Center present new data and describe a model that predicts financial distress and closure in rural hospitals.

Data for Decision-Making in Rural Health Clinics – Thursday, September 21 at 3:00 pm ET. A one-hour webinar hosted by the National Organization of State Office of Rural Health will help participants better understand performance measurement and how to implement a data collection system.

Rural and Tribal Applicants Competing for TIGER – Friday, September 22 at 2:00 pm ET.  This two-hour webinar will discuss $500 million in federal funds for the Transportation Investment Generating Economic Recovery (TIGER) program.  Staff from the Department of Transportation will explain the funding, how to apply and provide information for rural and tribal applicants.

Physician Compare National Provider Call – Thursday, September 28 at 1:30 pm ET. The Medicare Learning Network hosts this 90 minute call to discuss and answer questions about Physician Compare, the online tool that allows Medicare beneficiaries to find and compare providers.  Patient satisfaction is one measure for improving health care quality in rural areas, and clinicians and practice managers joining this call can learn how to review their performance information before it is published.

Preventing Adverse Drug Events – Thursday, September 28 at 2:00 pm ET.  Adverse drug events (ADEs) are injuries caused by medical interventions related to a pharmaceutical drug.  They include medication errors and allergic reactions and overdoses, and can be a challenge to identify in small rural hospitals where there is limited pharmacist support.  Two out of three ADEs are related to three specific types of drugs:  opioids, anticoagulants, or diabetes agents.  This one-hour webinar will discuss efforts by federal health agencies to track ADEs and reduce patient harm with the National Action Plan for Adverse Drug Event Prevention.

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.

Approaching Deadlines

Comments Requested: 340B Drug Pricing Program – September 20
Comments Requested: Verifying CAHs Meet Medicare Requirements September 29
Nominate Experts for Rural Health Quality – September 29
USDA Loans for Rural Broadband – September 30
Health Care Transit Design Challenge – October 5
Comments Requested:  Cervical Cancer Screening – October 9
Research to Reduce Tobacco Use – October 11
Small Rural Hospital Transition Project – October 16
Federal Investment in Rural Transportation – October 16
Comments Requested: CMS Cancels Cardiac Bundles – October 16
Comments Requested: CMS Revises Joint Replacement Bundles – October 16
Students to Service (S2S) Loan Repayment Program – October 19
Comments Requested: USDA Summer Meals Program
– October 23
Address Suicide Research Gaps in Rural Communities  – November 2
Comments Requested: Rural Rental Housing Loans – November 13
Drinking Water and Waste Disposal for Rural and Native Alaskan Villages – Ongoing
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