Federal Office of Rural Health Policy Announcements

Date: September 23, 2021

HHS and USDA Launch Resource Guide for Child Care in Rural Areas. The U.S Departments of Agriculture (USDA) and Health & Human Services (HHS) released a new federal guide to strengthen and expand child care facilities in rural communities. The USDA-RD HHS-ACF Joint Facilities Resource Guide (pdf) includes best practices, innovative approaches, success stories and a list of federal resources available.  The Administration of Children and Families (ACF) is the HHS agency administering federal programs for child care; Rural Development (RD) at the USDA focuses on improving the economy and quality of life in rural America. 

Open Enrollment for Healthcare.gov Extended. Usually, the annual period for buying or changing health insurance plans for the next calendar year begins in November and runs until December 15. Starting this year, the federal government is extending the open enrollment period to January 15 for states that use Healthcare.gov, the federal website for health insurance. State Marketplaces not using the federal eligibility and enrollment platform (Healthcare.gov) can decide their own end date, provided that it is no earlier than December 15. The Centers for Medicare & Medicaid Services made this and other changes to the Health Insurance Marketplace in the final rule for Benefits and Payment Parameters (pdf), further detailed in the Policy Updates section below. It is estimated that 65 percent of uninsured rural adults could have access to a health plan with a $0 premium on Healthcare.gov. 

HRSA Releases New Projections for the Health Workforce. According to data collected by the National Center for Health Workforce Analysis (NCHWA), the supply of primary care physicians in the U.S. will see a shortage by the year 2030; a surplus of nurse practitioners and physician assistants is projected for the same time span. The forecast shows the largest shortages in Nevada, Mississippi, Oklahoma, and Arizona. The NCHWA is part of the Bureau of Health Workforce (BHW) at the Health Resources and Services Administration. Last week, BHW announced funding for a new federal program to increase the number of physician assistants in rural areas. Accredited training programs that can demonstrate a high rate of rural placement for graduates may apply for the HRSA Physician Assistant Rural Training Program through December 9. 

CDC: Overdose Deaths Up by a Third. The Centers for Disease Control and Prevention (CDC) released the latest data on reported deaths due to overdose within the 50 states and the District of Columbia. While final counts are not yet complete, 90,133 deaths occurred between February 2020 and February 2021, an increase of more than 30 percent over the previous year.

ONC: Challenges to Interoperability. The ability to exchange electronic health data between facilities, known as interoperability, is essential to the long-term goals of the Office of the National Coordinator for Health IT (ONC). This report examines the challenges for acute care hospitals – including rural hospitals and Critical Access Hospitals – exchanging electronic health information with public health agencies. The report uses data collected in 2019 and identifies ongoing barriers that may have been exacerbated by the pandemic. 

RAND Weighs in on Vaccine Hesitancy. The RAND Corporation is a non-partisan, nonprofit organization that researches and analyzes public policy. Their recommendations promote the World Health Organization’s “three Cs” model: 1) boosting confidence in the safety and effectiveness of vaccines, 2) combating complacency about the pandemic, and 3) increasing the convenience of getting vaccinated. Earlier this year, the Centers for Disease Control and Prevention cited data showing lower COVID-19 vaccination coverage in rural areas.

Household Food Security in the U.S. Last Year. The Economic Research Service (ERS) at the U.S. Department of Agriculture released its annual report on access to adequate food for households in the U.S.  The survey data collected in December 2020 showed an estimated 89.5 percent of households had food access throughout the year, a number not significantly different from the same survey taken at the end of 2019. The prevalence of very low food security for rural areas, 4.5 percent, was slightly higher than the national average of 3.9 percent.

Federal Office of Rural Health Policy Announcements

Date: September 16, 2021

New COVID-19 Provider Funding Available. The Health Resources and Services Administration (HRSA) at the U.S. Department of Health & Human Services (HHS) is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. Of that funding, $8.5 billion from the American Rescue Plan is designated for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients. The remaining $17 billion is from Provider Relief Fund (PRF) Phase 4 payments for a broad range of providers who can document revenue loss and expenses associated with the pandemic. For these payments, smaller providers will receive reimbursements for lost revenues and COVID-19 expenses at a higher rate compared to larger providers. Phase 4 will also include bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patients, who tend to be lower income and have greater and more complex medical needs. Providers will apply for both programs with a single application, and the application portal will open on September 29, 2021.

Grace period for PRF Reporting. To support those facing natural disasters and the Delta variant surge, HHS announced a grace period on the reporting deadline for Round 1 of the Provider Relief Fund (PRF). While the September 30 deadline for reporting has not changed, recoupment or other enforcement actions will not be initiated during the grace period, lasting October 1 – November 30, 2021

Rural Health Clinic Experiences from the COVID-19 Testing Program. The National Association of Rural Health Clinics (NARHC) published a report on the federal program that funded COVID-19 testing in rural areas.  First launched in May 2020, the program sent a total of more than $225 million to eligible RHCs in almost every state.  The report captures how the RHCs used the funds, the challenges they faced, and anecdotes of their experiences.

Awards announced for the CMS Rural Transformation Project. The Centers for Medicare & Medicaid Services (CMS) made four awards for its new, rural-focused Community Health Access and Rural Transformation (CHART) Model. This voluntary payment model, the first of its kind from the CMS Innovation Center, will test whether upfront investments, predictable capitated payments, and operational and regulatory flexibilities will enable rural health care providers to improve access to care while reducing health care costs. Selected participants are from Washington, South Dakota, Alabama, and Texas. 

GAO Examines Nurse Corps Loan Repayment Program. Until last year, the federal program that repays education loans for nurses required that they work only at non-profit facilities.  The pandemic-related CARES Act eliminated that restriction in March 2020, allowing Nurse Corps members to serve at for-profit critical shortage facilities (CSFs). The Government Accountability Office (GAO) examined the change and determined that it’s too early to tell its effects. Officials at non-profit CSFs such as Critical Access Hospitals expressed concern that for-profit facilities can offer higher wages, resulting in fewer nurses willing to work at non-profit CSFs in rural and other underserved areas. 

Rural Matters Podcast Discussion on Telehealth. The bi-weekly podcast highlights federal efforts to expand telehealth to rural areas in the last year. Heather Dimeris, the Director of HRSA’s Office for the Advancement of Telehealth, discusses changes in 2020 that increased telehealth visits to health centers to more than 28 million, with nearly 6 million of these visits in rural-serving facilities.

Federal Office of Rural Health Policy Announcements

Date: September 10, 2021

HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding

Applications open on September 29

The Health Resources and Services Administration at the U.S. Department of Health & Human Services (HHS) is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes:

  • $8.5 billion from the American Rescue Plan (ARP) for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients. ARP rural payments to providers will be based on the amount of Medicaid/CHIP and Medicare services provided to patients living in rural areas as defined by the Federal Office of Rural Health Policy; and
  • $17 billion for Provider Relief Fund (PRF) Phase 4 payments for a broad range of providers who can document revenue loss and expenses associated with the pandemic. For these Phase 4 payments, smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—will receive reimbursements for lost revenues and COVID-19 expenses at a higher rate compared to larger providers. Phase 4 will also include bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patients, who tend to be lower income and have greater and more complex medical needs.

Providers will apply for both programs with a single application, and the application portal will open on September 29, 2021.

For more information about eligibility requirements, the documents and information providers will need to complete their application, and the application process for Phase 4 and ARP Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.

The announcement also includes an important update about PRF reporting for payments received in the first half of 2020. Given challenges from recent natural disasters and the Delta variant, HHS announced a 60-day grace period to help providers complete their PRF Reporting requirements if they fail to meet the September 30, 2021 deadline for reporting payments received from April 10, 2020 to June 30, 2020. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during the grace period. 

See the HHS press release for more information.

Federal Office of Rural Health Policy Announcements

Date: September 9, 2021

Helping Families Sign Up for the Child Tax Credit. Representatives from the Department of Treasury will join the Health Resources and Services Administration (HRSA) for a brief training on advance payments of the Child Tax Credit, a part of the economic recovery effort that sends families monthly payments of $250 or $300 per child through December of this year. The payments are made automatically to families that filed tax returns for 2019 and 2020. Non-filers may also qualify; this training is for safety net providers in underserved areas that may be in a position to help those families sign up. More than 20 percent of rural children are living in families that are poor and data show a strong link between poverty and health.  

  • The Child Tax Credit: Ensuring Successful and Equitable Implementation – Tuesday, September 28 at 3:00 pm. HRSA has invited representatives from the Department of Treasury and White House to help awardees understand the Child Tax Credit, with a particular focus on enrolling families that may not usually file taxes. Join a one-hour session for an overview of the Child Tax Credit and instructions on how to help enroll families using the Non-Filer Portal.  If you prefer to join by phone, dial: 833-568-8864; meeting ID: 161 456 3976.

AmeriCorps and CDC Launch New Organization for Public Health. AmeriCorps, the federal agency for volunteering and national service, has launched Public Health AmeriCorps, a new partnership with the Centers for Disease Control and Prevention (CDC) to support the recruitment, training, and development of a workforce ready to respond to the nation’s public health needs.  The program, which is supported by a $400 million investment from the American Rescue Plan Act, is anticipated to fund up to 5,000 AmeriCorps positions over the next five years.  

  • AmeriCorps State and National Public Health AmeriCorps – November 8. The federal agency for volunteering and national service will invest $400 million over five years to recruit and train a public health workforce at the community level. AmeriCorps members will serve primarily in state, local, Tribal, and territorial public health departments or in service to public health departments.  Eligible applicants include state, local, and Tribal governments; public institutions of higher education; public housing authorities; and nonprofit organizations. 

First Annual Report of the Pennsylvania Rural Health Model. The project was designed by the Center for Medicare & Medicaid Innovation to reduce the risk of rural hospital closures by giving them a predictable revenue stream. This report examines the experiences of participating hospitals and their financial performance in 2019, the first year of the project. 

JAMA: Paying for Telemedicine in Smaller Rural Hospitals. In an open-access opinion piece, the Journal of the American Medical Association (JAMA) discusses barriers to hospitals that could most benefit from telemedicine and potential policy solutions. 

Federal Office of Rural Health Policy Announcements

September 2, 2021

HHS: What Works and What Doesn’t in COVID-19 Vaccine Outreach. The U.S. Department of Health & Human Services (HHS) provides an overview of lessons learned from vaccine programs and gives several examples of federal and state programs that could serve as models for new strategies. 

CDC on Mental Health/Substance Abuse Among Adults with Disabilities During the Pandemic. Using Internet surveys, researchers at the Centers for Disease Control and Prevention (CDC) found that adults with disabilities experienced greater incidents of anxiety or depression, new or increased substance use, and suicidal ideation than did adults without disabilities.  The report includes data for rural locations and recommends that clinicians consider screening all patients for issues related to the pandemic.

Expanded Number of Health Care Navigators. Through $80 million in grant awards for the 2022 plan year, 60 Navigator awardee organizations will be able to train and certify more than 1,500 Navigators to help uninsured consumers find coverage in 30 states with a Federally-Facilitated Marketplace. Navigators can assist with enrollment applications and help consumers receive financial assistance through HealthCare.gov. Earlier this year, the U.S. Department of Health & Human Services reported that Medicaid expansion played a key role in expanding health insurance coverage; Medicaid coverage rates increased from 12.2 percent of the rural population in 2010 to 17.1 percent in 2019. With the additional funding for Navigator assistance, organizations can help more uninsured individuals and families get coverage. 

Interactive Map Shows Results of 2020 Census. The map allows users to zoom in and find population data for each county in the country. State profiles give more detail on demographic changes between 2010 and 2020. Other infographics and visualizations show information topics such as population change by county, food assistance eligibility, and more detailed breakdown of race and ethnicity. Population counts from the U.S. Census are used to allocate federal funding, provide data for policymaking, plan economic development, and provide data for research, among countless other needs for quality of life.

Provider Relief Fund Information Moves to HRSA Website. Information on the Provider Relief Fund (PRF) program, which gives financial support to providers who have seen lost revenues and increased expenses during the COVID-19 pandemic, previously hosted on the Department of Health and Human Services (HHS) website is now available on the Health Resources and Services Administration (HRSA)website. Users who visit hhs.gov/providerrelief (previous URL) will be automatically re-directed to the new site. All archived content will remain available to the public. For updates about the PRF and other HRSA programs, please subscribe to the HRSA eNews.

HRSA Reorganization. This week, the Health Resources and Services Administration (HRSA) announced a reorganization of its bureaus and offices to accommodate changing needs in the agency’s mission to improve health care for people who are geographically isolated and/or medically underserved. Among the changes, the Office for the Advancement of Telehealth has moved from its longtime home in the Federal Office of Rural Health Policy to become an operational focal point for telehealth across all of HRSA’s programs. 

Federal Office of Rural Health Policy Announcements

August 26, 2021

Awards for the Rural Behavioral Health Workforce – Northern Border Region program. The Federal Office of Rural Health Policy recently announced $1.365M supporting three awards to improve behavioral health care services in rural counties served by the Northern Border Regional Commission. This three-year project will support education and training for health professionals in treatment and interventions for behavioral health disorders, including substance use disorder.

FDA Warns Against Use of Ivermectin. Following reports of increased calls to Poison Control related to Ivermectin [pdf], the Food and Drug Administration (FDA) issued an advisory against its use for prevention or treatment of COVID-19. The drug is intended to treat or prevent parasites in animals and only approved for human use in small doses for parasitic worms, or as a topical treatment for head lice and skin conditions like rosacea. Severe illness and hospitalizations from overdose have also been reported; symptoms include nausea, vomiting, diarrhea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma and even death.  HRSA-supported Poison Control Centers can be reached online or by phone at 1-800-222-1222.

Federal Office of Rural Health Policy Announcements

August 19, 2021

More Federal Support for Rural Telehealth. The U.S. Department of Health & Human Services announced awards of more than $19 million to expand telehealth services in rural areas and underserved communities. In addition to projects that connect rural providers to specialists for complex conditions, the funding continues the work of HRSA-supported Telehealth Resource Centers that provide guidance for implementing telehealth in every part of the country. 

CDC Clinician Outreach: Additional mRNA COVID-19 Vaccines for Immunocompromised PeopleThe U.S. Food and Drug Administration has issued Emergency Use Authorizations for additional doses of vaccines for moderately to severely immunocompromised people who are at increased risk for severe COVID-19. Studies indicate that some immunocompromised people who have been vaccinated have a reduced immune response compared to vaccine recipients who are not immunocompromised. Studies have further demonstrated that an additional vaccine dose in some immunocompromised populations may enhance immune response. During this clinician outreach call that took place on August 17, presenters from the Centers for Disease Control and Prevention (CDC) discussed the current data and CDC’s guidance on additional COVID-19 doses in immunocompromised people.

“The Critical Role of Monoclonal Antibodies as the COVID-19 Pandemic Continues” Webinar Recording Available. The Health Resources and Services Administration recently held a webinar featuring Michael R. Anderson, MD, a Senior Advisor to the Department of Health and Human Services’ (HHS) Assistant Secretary for Preparedness and Response, who discussed how monoclonal antibody therapeutics can help prevent serious illness from COVID-19.  Dr. Anderson shared updates on available COVID-19 therapeutics including efficacy, new administration routes and novel treatments in the pipeline, reimbursement resources, and provider and patient tools and fact sheets. For further questions, contact Dr. Anderson and his team. 

Awards for the Rural Northern Border Region Planning Program. The Federal Office of Rural Health Policy recently announced four awards of approximately $760,000 each for a new program identifying health care challenges in rural counties served by the Northern Border Regional Commission. This eighteen-month project will support planning activities such as, but not limited to, community needs assessments, formal strategic planning processes, and infrastructure development.

New Insights on Maternity Care, Clinical Quality Measures, and Medication-Assisted Treatment. HRSA’s Health Centers Program published new research briefs exploring health center capacity in maternity care deserts, differences in clinical quality measures among Appalachian and non-Appalachian health centers, and the role of health centers in providing medication-assisted treatment. The briefs were developed through the UDS Mapper—a tool that helps evaluate the geographic reach, penetration, and growth of the Health Center Program and its relationship to other federally-linked health resources.

ERS: Rural Poverty Has Distinct Regional and Racial Patterns. A study from the Economic Research Service (ERS) at the U.S. Department of Agriculture found that, out of 310 counties with high and persistent poverty in 2019, 86 percent were rural. Nearly half of rural residents who identify as Black or African American and American Indian or Alaska Native lived in these persistent poverty counties; by comparison, 20 percent of poor Hispanics and 12 percent of rural non-Hispanic Whites resided in those counties. 

History of the Swing Bed.  The feature of the latest Rural Monitor reviews the history of the swing bed program, which provides continued care for patients after injury or illness in a rural hospital. The article describes how post-acute care for rural residents shifted from urban hospitals and aspects of the swing bed program that contributed to its success.

Federal Office of Rural Health Policy Announcements

August 5, 2021

HHS Sends More Aid for SUD and Maternal Care in Rural CommunitiesThe U.S. Department of Health & Human Services (HHS) awarded nearly $90 million for programs addressing substance use disorder (SUD), and to improve access to maternal and obstetrics care. 

CDC and OMH Launch Minority Health Social Vulnerability IndexA new interactive tool helps public health officials plan their support in communities before, during, and after a public health emergency.  Social vulnerability refers to a number of factors, including poverty, lack of access to transportation, and crowded housing that may cause excessive human suffering and financial loss in a disaster.  With this map, the Centers for Disease Control and Prevention (CDC) use county-level data from the U.S. Census and other public sources to show percentiles for socioeconomic status, minority status and language, and housing types, among other social variables. The mapping also includes rates for medical vulnerabilities that are prominent in rural areas such as diabetes, obesity, and cardiovascular disease.  According to recent work from the Rural Health Research Gateway, approximately 1 in 5 rural residents identifies as Black, Hispanic, American Indian/Alaska Native, Asian American/Pacific Islander, or mixed race.  The Social Vulnerability Index was launched in July [pdf] by the HHS Office of Minority Health in partnership with the CDC.  Last week, the CDC released data showing a higher percentage of poor health among adults in rural areas

Federal Agencies’ Investment in Rural Cancer Control.  The latest edition of The Rural Monitor gives an in-depth look at a federally funded network of academic, public health, and community partners across the country who collaborate to reduce cancer disparities.  The work began in 2018 when the National Cancer Institute joined with HRSA’s Federal Office of Rural Health Policy, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services’ Rural Health Council for the Accelerating Rural Cancer Control Research meeting.

Federal Office of Rural Health Policy Announcements

July 22, 201

Rural Health Clinics Receive $100 Million for COVID-19 Vaccine Outreach. The U.S. Department of Health & Human Services announced that the funds will go to more than 1,980 Rural Health Clinics (RHCs) to help residents understand the benefits of vaccination against COVID-19 and other infectious diseases.  The funds will be administered by the Health Resources and Services Administration (HRSA) through the Rural Health Clinic Vaccine Confidence Program.

COVID-19 Pubic Health Emergency Renewed. Effective July 20, the U.S. Department of Health & Human Services has renewed the COVID-19 public health emergency declaration for another 90 days.

NIH Reports on COVID-19 Variants. The National Institutes of Health (NIH) report that the more that SARS-CoV-2 spreads, the greater the chance that its genetic material will change or mutate, and create new variants or strains.  As it passes from person to person, the virus builds up mutations.  Currently, there are four known mutations, known as variants of concern, with the highly transmissible Delta variant dominant across the country.  The COVID-19 data hub created last year by the U.S. Department of Health & Human Services indicates that, as of July 15, new cases across the country were up nearly 70 percent over the previous week; deaths were up 26.3 percent.  According to the Centers for Disease Control and Prevention, the COVID-19 cumulative death rate in non-metropolitan areas has exceeded that of metropolitan areas since December 2020.   

HHS Reviews State Medicaid Telehealth Policies Before and During the Pandemic. While as many as 47 state Medicaid programs were paying for some form of care via telehealth before the COVID-19 Public Health Emergency, data show that services increased more than 20-fold between February and April 2020.  Rates declined after April but still remained far above pre-pandemic level.  This issue brief from the U.S. Department of Health & Human Services (HHS) examines how the use changed during the pandemic and identifies selected changes in telehealth policy related to Medicaid. 

CDC: Acceptability of COVID-19 Vaccination Among Adolescents and Parents of Adolescents. In its latest Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention (CDC) surveyed teens aged 13-17 years and parents of youth aged 12-17 to determine their intent to vaccinate during April 15 – April 23 of this year, prior to vaccine authorization for this age group.  Among parents of unvaccinated adolescents, 55.5 percent reported they would “definitely” or “probably” have their adolescent receive a vaccination.  Among adolescents surveyed, 51.7 percent reported they would “definitely” or “probably” receive a vaccine. 

CDC Provision Drug Overdose Death Counts for 2020. The Centers for Disease Control and Prevention (CDC) present a visualization of reported and predicted provisional counts of deaths due to drug overdose occurring in the 50 states and the District of Columbia.  While provisional counts are incomplete due to pending investigation into causes of death, the data show a 29.4 percent increase in overdose deaths for the year.

Request for Information: HHS Seeking Input on Advancing Sensitivity Toward Asian Americans and Pacific Islanders – due August 17. The U.S. Department of Health & Human Services (HHS) seeks input from Asian American and Pacific Islander (AAPI) communities and AAPI-serving organizations to inform the development of guidance describing best practices for advancing cultural competency, language access, and sensitivity toward Asian Americans and Pacific Islanders in the context of the Federal Government’s COVID-19 response.

2020 Transportation Trends. The National Aging and Disability Transportation Center identifies issues affecting the availability of accessible transportation for older adults and people with disabilities.  The report identifies “an innate strength” in rural culture that uses a neighbor helping neighbor strategy, and includes examples of programs underway in rural areas to address transportation needs.

Call for Abstracts for the National Telehealth Research Symposium – August 2. Hosted by the Society for Education and the Advancement for Research in Connected Health (SEARCH), the National Telehealth Research Symposium will showcase connected health efforts and research for telemedicine, telehealth, eHealth, mHealth, and other healthcare technologies.  The symposium will be held virtually on November 8-10, 2021.  SEARCH is seeking submissions for podium presentations and posters in categories that include research, policy, education, and state of the art. 

Federal Office of Rural Health Policy Announcements

July 15, 2021

HHS Boosts Funding for COVID-19 Response in Rural Areas.  The U.S. Department of Health & Human Services (HHS) announced $398 Million for COVID-19 testing and mitigation.  The funds will be distributed by State Offices of Rural Health to 1,540 rural hospitals through the Small Rural Hospital Improvement Program.

One Month Left to Enroll in, or Change, Health Insurance Marketplace Coverage.  HHS released a report on current trends and challenges to accessing affordable health care in rural America.  Analysts found that, although uninsured rates have fallen in rural areas, other barriers to care such as geographic distances, infrastructure limitations, and provider shortages contribute to rural health disparities.  The report comes one month before the special enrollment period for qualified individuals and families ends on August 15.  As noted in the HHS brief, 65 percent of the 1.9 million rural uninsured individuals in HealthCare.gov states may be able to find a zero-premium plan on the platform.

NOSORH Accepting 2021 Community Star Nominations.  The National Organization of State Offices of Rural Health (NOSORH) seeks nominations until August 2 of individuals, organizations, or consortia making a big difference in the health of rural communities.