Federal Office of Rural Health Policy Announcement

August 8, 2019

What’s New

HRSA awards over $111 million to 96 organizations to combat the opioid epidemic in rural communities. Today, the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy awarded over $111 million to 96 rural organizations across 37 states as part of its multi-year Rural Communities Opioid Response Program (RCORP) initiative.  These funds, which also include support for an evaluation of the initiative, will strengthen rural communities’ capacity to provide needed substance use disorder prevention, treatment, and recovery services and build the evidence base for interventions that are effective in rural settings.

CDC: Naloxone Prescriptions Up but Still Fall Short in Rural Areas.  The Centers for Disease Control and Prevention (CDC) examined trends and characteristics of prescriptions for naloxone, a drug that can help prevent overdose deaths by reversing the effects of opioids.  By analyzing data from retail pharmacies across the U.S., the CDC found that the number of naloxone prescriptions increased substantially from 2012 to 2018 with an increase of 106 percent from 2017 to 2018 alone.  The CDC Guideline for Prescribing Opioids for Chronic Pain recommends prescribing naloxone for patients who are at high risk for overdose, but the new research found that only one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions – with the lowest rate in rural counties.  Last week, the CDC’s National Center for Health Statistics released a brief, Urban-Rural Differences in Drug Overdose Death Rates, showing rates were higher in urban areas for overdose deaths involving heroin, synthetic opioids, and cocaine, but higher in rural for natural and semisynthetic opioids, and psychostimulants with abuse potential.  The CDC will discuss this report on overdose death rates and other unintentional injury in urban-rural areas in an upcoming webinar (see events section below).

Funding Opportunities

USDA Rural Broadband Access Loan and Loan Guarantee Program – September 30.  The U.S. Department of Agriculture (USDA) furnishes loans and loan guarantees for the costs of construction, improvement, and acquisition of facilities and equipment for broadband service in rural areas.  Eligible entities are corporations, limited liability companies, tribal organizations, and state or local governments in rural areas where at least 15 percent of households do not have broadband services.  See Electronic Code of Federal Regulations part 1738 for further details on eligible rural areas.

USDA Rural Energy for America Program (REAP) – October 31. The U.S. Department of Agriculture (USDA) lists health care facilities as eligible for grant and loan guarantees for the purchase, installation and construction of renewable energy systems.  These may include solar, wind, and hydrogen powered energy systems, or they may be energy-efficient improvements made to heating/ventilation/air conditioning systems or lighting, insulation, cooling and refrigeration systems.  Eligible applicants are small businesses and agricultural producers in eligible rural areas.

Policy Updates

Visit the FORHP Policy page to see all recent updates and send questions to ruralpolicy@hrsa.gov.

CMS Finalizes Medicare Payment Updates to Hospitals for FY2020.  CMS updated the Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for the 2020 fiscal year, which begins October 1, 2019.  In addition to announcing payment rates for the upcoming year, this rule finalizes wage index calculations for low wage index hospitals, many of which are rural, to reduce disparities; adoption of the Safe Use of Opioids-Concurrent Prescribing measure for the inpatient quality reporting program (IQR); and updates to the Promoting Interoperability program.   A CMS Fact Sheet on these updates is available here.

Comments Request: Current Use of Telemental Health for Suicide Prevention in Emergency Department Settings – August 29.  This request for information (RFI) jointly issued by several Federal offices, including Health and Human Services’ National Institutes for Health, Veterans Affairs, and the Department of Defense, seeks information about the use of telehealth in hospital emergency medical care settings to facilitate the care of individuals with suicide risk.  Topics of interest include what telehealth services are being used, what contributed to the selection and implementation of those services, what are the characteristics of the emergency department (i.e. urban/rural setting), and approaches used to identify suicide risk of patients in the emergency department.  In 2015, suicide death rates in rural counties were higher than the rates in larger metropolitan counties.

CMS Finalizes Policies on Post-Acute and Hospice Care for FY2020. Last week, CMS published a number of final rules making updates to payment and policies for skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and long-term care hospitals (LTCH) in fiscal year (FY) 2020. For FY 2020 compared to FY 2019, CMS projects aggregate payments will increase by 6.2 percent for rural SNFs, 4.4 percent for rural IRFs, and 2.7 percent for rural LTCH discharges paid using the LTCH PPS standard Federal payment rate. CMS also published a final rule updating hospice payment rates, wage index, and cap amount for FY 2020. For FY 2020, CMS projects rural hospice payment rates will increase by 1.8 percent.

CMS Finalizes Policies for Inpatient Psychiatric Facilities for FY2020. Last week, CMS published the final rule for inpatient psychiatric facilities (IPF) in fiscal year (FY) 2020. For FY 2020 compared to FY 2019, CMS projects aggregate payments will increase by 1.34% for rural IPFs. Rural IPFs have received a 17% percent payment adjustment since the inception of the IPF prospective payment system, and this will continue to apply in FY 2020.

Learning Events and Technical Assistance

AgriSafe: Focus on Rural Mental Health – Monday, August 12 at 1:00 pm ET.  The AgriSafe Network hosts this hour-long webinar to help rural health care providers and safety professionals prepare for and respond to mental health challenges experienced by farmers and their families.

AgriSafe: Assessing Risks for Opioid Misuse Among Agricultural Workers – Tuesday, August 13 at 1:00 pm ET.  The AgriSafe Network hosts this one-hour webinar to help rural clinicians learn risk factors for opioid misuse among farmers and effective alternatives for treating chronic and acute pain.

Understanding the Federal Coverage to Care (C2C) Initiative – Tuesday, August 13 at 2:00 pm ET.  The CMS Office of Minority Health is hosting a webinar entitled From Coverage to Care: How to Successfully Navigate Health Coverage.  It is an opportunity to learn more about the C2C initiative and the free materials that are available to help patients and caregivers understand their health coverage and how to connect to primary care, preventive, and behavioral health services. Learn more about health insurance coverage and access to care in rural areas at RHIhub.

Improving the Health of Rural Communities Through Collaboration – Thursday, August 15 at 1:00 pm ET. This webinar introduces a new resource, A Guide for Rural Healthcare Collaboration and Coordination. Hear how rural hospitals, community health centers, local public health departments and other rural stakeholders work together to assess and address their rural communities’ health needs. Two innovative rural health organizations will be highlighted that have developed strategies to meet population health goals, address social determinants of health, and improve health outcomes. Solutions to support rural health organizations’ financial viability and lessons learned will also be shared.  The guide was created by the Federal Office of Rural Health Policy and the Health Centers program at the Health Resources and Services Administration.

Supporting Emergency Departments in Addressing Pediatric Mental Health Thursday, August 15 at 3:00 pm ET. The Health Resources and Services Administration (HRSA) has a new resource, the Critical Crossroads Toolkit, for hospitals with strategies and best practices for addressing pediatric mental health within the emergency department (ED). This resource is targeted to all hospitals, but rural hospitals have been specifically included as a key audience for this resource from its inception, and the guide includes examples from a few rural hospitals across the country on what they’ve put in to place within their EDs.   This 30-minute webcast will provide background and overview of the new resource, which is a collaborative effort between HRSA’s Maternal and Child Health Bureau and the Federal Office of Rural Health Policy.

Research on Healthy People 2020 Benchmarks for Urban-Rural Areas – Tuesday, August 20 at 12:00 pm ET.  The HRSA/FORHP-supported Rural Health Research Gateway will host this one-hour webinar to report on their analysis of death rates for seven major causes of death (coronary heart disease, cancer, diabetes, stroke, chronic obstructive pulmonary disease, unintentional injury, and suicide) in light of Healthy People 2020 benchmarks.

Unintentional Injury Death Rates in the United States – Thursday, August 29 at 1:00 pm ET.  The Rural Health Information Hub will host this hour-long webinar featuring experts from the National Center for Health Statistics discussing two recently released reports:  Unintentional Injury Death Rates in Rural and Urban Areas: United States, 1999–2017 and Urban–Rural Differences in Drug Overdose Death Rates, by Sex, Age, and Type of Drugs Involved, 2017. The presentation will cover historical trends and patterns by urbanization for unintentional injury deaths overall, with a more detailed look at motor vehicle traffic injuries, drug overdose, and falls.

CMS National Training Program Workshops – Through September 12.  The Centers for Medicare & Medicaid Services (CMS) will hold five workshops around the country, each lasting 2-3 days, to increase knowledge about updates to the Medicare program.  Attendees of the workshops will learn about new changes and innovations for this program that provides significant support for rural health care delivery, including information on opioids and other current topics. Click for more information on the agendas in each of the five cities – Philadelphia, San Francisco, Chicago, Arlington, and Providence.

Save the Date: 3RNet 2019 Annual Conference – September 24-26 in Wichita, KS. The National Rural Recruitment and Retention Network (3RNet) is a nonprofit organization that matches health care professionals to employers in rural and underserved areas.  Attendees of this annual two-day conference will network with other 3RNet members, learn strategies for rural recruitment and retention, and gain insight from experienced leaders in health professions staffing.  Last year, 3RNet made more than 2,500 clinician placements in rural, frontier, and underserved urban communities.

Approaching Deadlines

USDA Tribal Colleges Research Grants – August 9

CMS Requests Feedback Reducing Regulatory Burden – August 12

ACL Alzheimer’s Disease Program Initiative – August 13

RWJF: Health Care’s Role in Meeting Patients’ Needs – August 15

ACF Leadership Academy for Preventing Trafficking among Native Youth – August 16

Connecting Kids to Coverage: Outreach to AI/AN Children – Letters of Intent August 19

Mini-Grants for Research Into Children’s Agricultural Health and Safety – August 19

Foundation for Opioid Response Efforts Request for Proposals – Letters of Intent August 25

NRHA Rural Health Fellows Program – August 27

Comments Requested:  Proposed VA Center for Innovation for Care and Payment – August 28

Comments Request: Current Use of Telemental Health for Suicide Prevention in Emergency Department Settings – August 29

Comments Requested: FCC Proposes $100 Million Connected Care Pilot Program – August 29

AHA Rural Hospital Leadership Team Award – August 30

HRSA Teaching Health Center Graduate Medical Education Program – August 30

Pew/RWJF Community Opioid Response and Evaluation (CORE) Project – August 30

Comments Requested: CY 2020 Home Health Proposed Rule – September 9

NIH Research for Tobacco Control Policies – Letters of Intent September 11

Comments Requested: Methods for Assuring Access to Covered Medicaid Services-Rescission – September 13

Small Rural Hospital Transition Project – Letters of Intent September 15

Comments Requested: Specialty Care Models to Improve Quality of Care and Reduce Expenditures – September 16

Comments Requested: Medicare Physician Fee Schedule Proposed Policy, Payment, and Quality Provisions for CY 2020 – September 27

Comments Requested: Proposed Updates to Medicare Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System – September 27

Comments Requested: ESRD and DMEPOS CY 2020 Proposed Rule – September 27

USDA Rural Broadband Access Loan and Loan Guarantee Program – September 30

Radiation Exposure Screening and Education Program – October 28                                             

USDA Rural Energy for America Program (REAP) – October 31

HRSA Rural Health Network Development Planning Program – November 29

Indian Health Service Loan Repayment Program – Ongoing through August 2019

NIH: Research for Disparities Among Minority/Underserved Children – Cycles thru May 2020

Guaranteed Loans for Rural Rental Housing – Ongoing through 2021

SBA Guaranteed Loans for Small Business – Ongoing

Drinking Water State Revolving Fund – Ongoing

Seeking Nominations: National Advisory Committee on Migrant Health – Ongoing

HUD Hospital Mortgage Insurance Program – Ongoing

RWJF Investigator-Initiated Research to Build a Culture of Health – Ongoing

Telecommunications Infrastructure Loans – Ongoing

Funding for Rural Water and Waste Disposal Projects –  Ongoing

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