Federal Office of Rural Health Policy Announcements

January 10, 2019

What’s New

HRSA Announces Winners in Maternal & Child Health Challenge. This week, the Health Resources and Services Administration (HRSA) announced seven winners in its challenge to improve care coordination for children with special health care needs. The solutions created by these organizations build on HRSA investments to engage health care professionals with families using the latest approved health data technologies. This is the first phase of the challenge, awarding $100,000 to each winner to develop their proto-type and begin small-scale testing in July 2019. This challenge is one of four Grand Challenges launched by HRSA’s Maternal and Child Health Bureau (MCHB), all addressing critical maternal and child health issues. Recently, MCHB released state fact sheets for one its well-known programs, Maternal, Infant, and Early Childhood Home Visiting (MIECHV). Of the 888 U.S. counties served by the MIECHV program in 2017, fifty percent were rural.

Funding Opportunities

Awards for Addressing Social Determinants of Health in Rural Communities – January 25. The Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials will select five local health departments serving predominantly rural areas for their Achieving SDOH Population Improvement in Rural Environments (ASPIRE) award. The goal of the ASPIRE Award is to recognize excellence in rural communities that are committed to addressing the social determinants of health (SDOH).

RWJF: Health and Climate Solutions – February 8. The Robert Wood Johnson Foundation (RWJF) is seeking proposals from public and non-profit entities for projects that improve community health while also addressing climate change adaptation or mitigation. Communities vulnerable to effects of climate change can propose projects that focus on one or more of a range of factors that affect health—including, but not limited to: air quality, energy sources, transportation or mobility design, food and water systems, housing, and health systems. Because rural economies depend on outdoor industries such as agriculture, timber, recreation, and sport, the 2018 National Climate Assessment predicts a decline in productivity and revenue for rural areas due to effects of severe climate change.

Rural Sexual Assault, Domestic Violence and Stalking Program – February 14. The Office on Violence Against Women at the U.S. Department of Justice will make 50 awards for a total investment of $35 million to enhance the safety of rural victims of sexual assault, domestic violence, dating violence, and stalking and to support projects uniquely designed to address and prevent these crimes in rural areas.

Environmental Justice Small Grants Program – February 15. The U.S. Environmental Protection Agency (EPA) will make 50 awards of up to $30,000 each to help underserved communities address local environmental and public health issues. The grants support projects that engage, educate, and empower local residents – particularly in minority, low income, rural, tribal, indigenous, and homeless populations – in understanding environmental issues, building consensus, and developing strategies to address them.

Increasing Access to HIV Primary Health Care Services – March 22. Rural communities may request funding preference for this $4 million investment through HRSA’s Ryan White/HIV AIDS Program. Twenty-six awards will go to public and non-profit private entities, including faith-based and community-based organizations. Tribes and tribal organizations are also eligible to apply. Funding is intended to support one short-term activity that can be completed within the one-year period of performance. Supported activities include care efforts such as HIV case finding and treatment adherence, and infrastructure development such as for electronic health records and management information systems.

Rural Health and Economic Development Analysis – March 27. The Health Resources and Services Administration (HRSA), through the Federal Office of Rural Health Policy, seeks to fund one applicant to quantify the impact of rural health care. The funded organization will conduct analyses of the link between the health of the economy in rural communities and the health outcomes of residents, disseminate findings, and assist rural stakeholders in performing these analyses. The award is offered for up to $225,000 per year for three years. Eligible applicants include domestic public, private, and nonprofit organizations.

National Indian Health Board Health Policy Fellowships – March 30. Native youth, ages 18-24, who are members of a federally-recognized tribe may be eligible to apply for a one-year fellowship to explore Indian health policy, healthcare, and governance. From June 2019 through May 2020, the fellows will attend virtual trainings and three in-person meetings to learn advocacy skills. The fellowship pays for travel and hotel costs to attend in-person meetings and provides opportunities for professional development, leadership, and skills building.

Policy Updates

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

New Medicare ACO “Pathways to Success” Announced – Letters of Intent January 18. CMS re-vamped the Medicare Shared Savings Program (SSP), now referred to as Pathways to Success, with the goals of transitioning ACOs to take on greater risk and reward, and qualifying as Advanced Alternative Payment Models (A-APMs) more quickly. The participation options have been redesigned to include a BASIC and ENHANCED track; each with 5-year agreement periods. The first two years of the BASIC track do not have any risk, and then each subsequent year of the agreement period gradually increases potential risk and reward. Since 2015, few rural ACOs participated in a track that includes risk. Eligible rural ACOs new to SSP may opt for an additional year without risk and then assume a higher level of risk and reward in the fourth year. Letters of Intent are due by January 18, and participation begins July 1, 2019.

Comments Requested: Screening for Hepatitis B in Pregnant Women – February 4. The U.S. Preventive Services Task Force (USPSTF) has issued a draft statement recommending that all pregnant women get screened for the hepatitis B virus during their first prenatal visit. According to the Centers for Disease Control and Prevention, hepatitis B is an acute, short-term illness that can spread from sexual contact, and from sharing needles and other drug-injection equipment. It can also spread from mother to baby at birth, raising the chance that it will lead to chronic, long-term infection in the child. Chronic hepatitis B can lead to serious health issues in adulthood, such as cirrhosis or liver cancer. Data show that the prevalence of maternal hepatitis B infection was 85.8 cases per 100,000 women in 1998 and that the rate of infection has increased by 5.5 percent every year in the 20 years since then. The USPSTF found convincing evidence that universal prenatal screening and vaccination of all infants will reduce the rate of infection.

Comments Requested: Proposed Changes to the Medicare Advantage Risk Adjustment Model – February 19. CMS requests comments on its proposed changes to the risk adjustment model used to calculate payments to Medicare Advantage plans. Proposed changes to the methodology include increased use of diagnoses reported on Medicare Advantage encounter claims, additional condition categories for mental health, substance use disorder, and chronic kidney disease, and incorporating a variable that counts the number of conditions a beneficiary has. This methodology is also used to determine provider payments in other CMS programs, and research has found rural and urban differences in the resulting provider risk scores.

10 Opportunities for States to Better Serve Dual Eligibles. This letter from CMS to State Medicaid Directors outlines 10 ways to improve care for beneficiaries dually eligible for Medicare and Medicaid without using a demonstration or a waiver. For example, states can bolster integrated care through Dual Special Needs Plans (D-SNPs) and reviewing payment rates for Programs of All-Inclusive Care for the Elderly (PACE). There are also strategies to simplify eligibility and enrollment processes. Rural beneficiaries are more likely to be dually-eligible than their urban counterparts.

Learning Events and Technical Assistance

The Opioid Crisis in Region VIII – Thursday, January 10 at 1:30 pm ET. HRSA’s Office of Regional Operations will host this 90-minute webcast on the opioid crisis affecting Region VIII, which includes Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming. The presentation will provide a look at trends in the region, factors contributing to the crisis, and ways that communities can address them. The latest data from the Centers for Disease Control and Prevention count 70,237 deaths from opioid overdose in the U.S. in 2017. Among counties categorized by population, micropolitan counties (population less than 250,000 people) had the largest rate increase of nearly 15% over their rate in 2016.

Interplay of Environmental Stressors and Infectious Disease – January 15-16. Emerging findings suggests that environmental pollutants such as heavy metals, pesticides, and airborne particulate matter may weaken the immune system and that exposure to some pollutants may reduce vaccine effectiveness. The National Academies of Sciences, Engineering and Medicine will hold this two day workshop (at their offices in Washington, DC and with a live-streamed webcast) to explore the growing body of research on the links between environmental stressors, infectious disease, and human health. In rural areas, environmental quality is challenged by industry-related toxins and pollutants that have long-term impact on population health.

National Drugs & Alcohol Facts Week – January 22-27. The National Institute on Drug Abuse (NIDA) created this week specifically to teach kids the difference between myth and facts about substance use. NIDA provides everything educators and communities need to explain science-backed facts, host their own events, and connect through social media. For more resources beyond the week, visit the Rural Health Information Hub for research, topic guides and promising models for preventing teen substance use in rural communities.

Occupational Therapy’s Role in Pain Management – Wednesday, January 23 at 1:00 pm ET. The University of North Dakota School of Medicine and Health Sciences will host this one-hour online session for practitioners of occupational therapy. Attendees will participate in case-based clinical discussions focused on pain management for patients under treatment of opioid use disorder. Because many physically demanding occupations are in rural areas, the injury rate is higher and these injuries often require treatment with opioids to mitigate pain.

AgriSafe: Using Future Search to Bring Stakeholders Together – Wednesday, January 23 at 1:00 pm ET. In December 2018, the STAND (Stakeholder Team up for Action in New York Dairy) Workshop brought together diverse agricultural stakeholders to begin addressing the issue of toxic stress among farmers. Using Future Search methodologies, the group worked together to understand historical perspectives of the issue as well as current trends. The workshop concluded with the development of common ground goals for the future and action items supporting those goals. The AgriSafe Network will hold this one-hour webinar to discuss the Future Search method and process, and the outcomes of this workshop.