Announcements from the Federal Office of Rural Health Policy

October 12, 2017

What’s New

Tackling Domestic Violence. October is National Violence Awareness Month and our agency, the Health Resources and Services Administration (HRSA), has just released a strategy for collaboration at federal, state, and local levels to address Intimate Partner Violence (IPV). Widely regarded as a private issue, IPV has an enormous impact on the broader public: raising incidence of chronic disease, reducing worker productivity and driving up health care costs – more than $8 billion in clinical, physical and mental health care services. While rates of reported violence in rural areas is on par with the national average, victims in rural communities face significant barriers, including social isolation and stigma, limited access to health and community services, and too few referrals and protocols for providers. FORHP’s role in the HRSA Strategy to Address Intimate Partner Violence will be to make the IPV Health Partners Toolkit relevant to rural providers and communities, increase the number of evidence-based programs in the Rural Community Health Gateway, and encourage rural-specific research and programs through funding opportunities.

CDC: New Facts on Obesity and Cancer. The Centers for Disease Control and Prevention (CDC) released a new fact sheet in their Vital Signs series showing that overweight and obesity are associated with 13 types of cancer. More than half of Americans don’t know that overweight can increase their risk for cancer, and rural areas experience higher rates of obesity and overweight than the nation as a whole. The guide outlines interventions taken at the federal, state and local levels and steps individuals can take to reach and maintain a healthy weight. See the Funding Opportunities section below for a federal program addressing obesity at the community level.

What to Know about Alcohol Treatment. The National Institute on Alcohol Abuse and Alcoholism has created an online tool to help patients understand options for treatment, what questions to ask to ensure quality, and a zip code-based directory of facilities. Rates of substance abuse in rural areas is comparable to urban/suburban areas, but it’s more difficult to combat in rural communities because of limited resources for prevention, treatment and recovery.

Funding Opportunities

Local Foods, Local Places – October 25. Local governments, tribal organizations, and non-profits are eligible to receive planning assistance tailored to their locality for projects that 1) create livable, walkable, economically vibrant main streets and mixed-use neighborhoods, 2) boost economic opportunities for local farmers and main street businesses, and 3) improve access to healthy, local food, especially among disadvantaged populations. Special consideration will be given to applications focused on places in high-obesity counties, many of them rural, identified by CDC as having an adult obesity rate greater than or equal to 40 percent.

Support for Rural Financial Institutions – November 30. The U.S. Department of Treasury Community Development Financial Institutions (CDFI) Fund rewards banks for increasing their investment in CDFIs or improving access to financial products or affordable lending services in high-poverty communities. The greater the annual increase, the larger the award to be invested in similar future activities. Nearly 30% of CDFIs primarily serve rural communities where poverty rates are higher and partners for economic development are fewer. As rural hospitals and health care providers recognize the need to address social determinants of health, there are more opportunities to partner with CDFIs for hospital financing and investment in areas ranging from improved housing to grocery stores. The opportunity for a Treasury award may encourage bank support for smaller and resource-limited rural CDFIs partnered with rural health care. For examples of what investments can do at the community level, this interactive map provides CDFI profiles searchable by state and lending type.

Rural Health Care Services Outreach Program – December 6. Up to 25 rural public and nonprofit entities forming a consortium of three or more organizations will be awarded total funding of $5 million/year to expand health care services into underserved areas. This unique program administered by FORHP allows communities to determine their most pressing health need and the best approach for addressing them. Applicants may apply for the traditional Outreach Program track addressing a health need specific to their community, or they may apply to a newly created track, the Health Improvement Special Project (HISP) focusing on cardiovascular disease risk. HISP applicants will be required to meet certain requisites as outlined in the Notice of Funding Opportunity and, if awarded, will utilize the Centers for Disease Control and Prevention (CDC) Heart Age Calculator to assess cardiovascular disease risk and track the same subset of individuals in their community throughout the 3-year project period. You can learn more about the work of our Outreach Program grantees on the Rural Health Information Hub, which includes videos of current and past work. FORHP will host a live technical assistance webinar on Tuesday, November 14, 2017 at 2 p.m. ET to review the NOFO guidance. For more information, please contact Meriam Mikre at mmikre@hrsa.gov.

Rural Health Research

AHRQ Chartbook on Rural Health Care. This month, as part of its annual reports to Congress on national health care quality and disparities, the Agency for Healthcare Research and Quality (AHRQ) updated data points on rural health. The Chartbook focuses on more than 250 measures of quality and disparities and summarizes trends that affect access and affordability of health care, effective treatment, and coordination of services, among other measures of population health. The Chartbook shows that over half these measures improved for rural areas in the last 15 years. Compared to suburban residents, however, rural residents received worse quality of care for more than 30 percent of the measures tracked. A PowerPoint version is also available that users can download for presentations.

Policy Updates

Questions about Rural Health Policy Updates? Write to ruralpolicy@hrsa.gov

Comments Requested: Job Corps Centers Closures – October 26. The U.S. Department of Labor (DOL) administers Job Corps, a residential education and vocational training program to help youth aged 16-24 find employment. DOL proposes additional flexibility in locating Job Corps centers to match local and regional employment opportunities with Job Corps locations. Research has shown that nearly 1 in 5 rural youth are disconnected from work or school.

Enrollment for Medicare and Prescription Drug Plans for 2018. From October 15th to December 7th, individuals may enroll in Medicare or switch to Medicare Advantage, which will have lower monthly premiums for 2018. During this same period, individuals may enroll in the Medicare Part D prescription drug program, also expected to be lower in cost. See announcement below for exceptions for hurricane-impacted areas.

Special Enrollment Periods for Those Impacted by Hurricanes. In response to Hurricanes Harvey, Irma, and Maria, CMS will make available special enrollment periods for all Medicare beneficiaries and to certain individuals seeking health plans through the Federal Health Insurance Exchange.

Request for Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests Nominations. CMS published requests nominations for the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests (CDLT). The panel is composed of 15 individuals, meets up to 4 times a year, and advises the Secretary of the Department of Health and Human Services (HHS) and the Administrator of the Centers for Medicare & Medicaid Services (CMS) on issues related to clinical diagnostic laboratory tests. Members may include individuals with expertise in laboratory science or health economics, clinical lab researchers, clinical lab representatives, and molecular pathologists.

Review New Uncompensated Care Reporting Instructions. CMS has revised instructions for cost report Worksheet S-10 to ensure hospitals are appropriately reporting their uncompensated care costs. For example, reported charity care may include discounts given to uninsured patients, and bad debt reported from all payers must include any recovered payments. CMS will gradually incorporate Worksheet S-10 data to calculate a hospital’s share of Medicare uncompensated care funds. CMS estimates uncompensated care payments to rural hospitals will increase by more than 17% in FY 2018 following this change, likely due to higher rates of uninsured patients in rural communities. Best practices for charity care and bad debt can also help rural hospitals facing high uncompensated care costs.

Resources, Learning Events and Technical Assistance

Virtual Job Fair for Primary Health – Tuesday, October 17 from 6:45 – 10:15 pm ET. If you are a medical, nursing, dental, behavioral health provider, or another primary care clinician, you are highly encouraged to attend this online recruitment event with health care organizations nationwide. Job openings are at NHSC-approved sites, but membership in the National Health Service Corps is not required to participate. Students and residents in-training can also register to learn about more than 1,000 open positions, hear details about relocation, benefit packages, and populations served.

NHSC 101 – Wednesday, October 18 at 1:30 pm ET. Students and graduates pursuing careers in primary care can join this live webcast to learn more about National Health Service Corps, Scholarship, Loan Repayment and Students to Service Loan Repayment programs.

Resource of the Week

New, Free Tool: Stratis Health MIPS Estimator. The Stratis Health MIPS Estimator is now available online to help clinicians prepare for the Quality Payment Program (QPP). Clinicians can use this tool, at no cost, to determine which measures and data submission methods should give them the highest Merit-based Incentive Payment System (MIPS) final score. The higher their score, the better positioned clinicians are to receive the highest possible positive Medicare payment adjustment in 2019 under MIPS. The tool is not rural specific, but is appropriate for use by rural clinicians.

Approaching Deadlines