Federal Office of Rural Health Policy Announcements

December 13, 2018

What’s New

Rural Hospitals Selected for Assistance.  Nine small rural hospitals were selected to receive on-site technical assistance through FORHP’s Small Rural Hospital Transition Project (SHRT).  Selection was based on hospital leadership, commitment, and organizational preparedness for transitioning to alternative payment and care delivery models.  Technical assistance will target financial operational assessments and quality improvement. The SRHT Project is supported by a FORHP/HRSA contract to Rural Health Innovations, a subsidiary of the National Rural Health Resource Center.

New Projections for the Behavioral Health Workforce.  HRSA’s National Center for Health Workforce Analysis recently released its updates and projections for the nation’s behavioral health workforce from the year 2016 through 2030.   The report includes updated fact sheets and state-level projections on the supply and demand for eight occupations: addiction counselors, marriage and family therapists, mental health and school counselors, psychiatric technicians and psychiatric aides, psychiatric nurse practitioners and psychiatric physician assistants, psychiatrists, psychologists, and social workers.  There is a significant need for mental health services in rural America. According to the Results from the 2017 National Survey on Drug Use and Health, 19 percent of residents aged 18 or older in nonmetropolitan counties had Any Mental Illness (AMI) in 2017, approximately 6.8 million people. In addition, 4.9 percent, or nearly 1.7 million, of residents of nonmetropolitan counties experienced serious thoughts of suicide during the year. Visit the Rural Health Information Hub for programs, toolkits,  and other resources for behavioral health workforce in rural areas.

Internet Subscription in Rural Counties Low.  In its recent release of American Community Survey (ACS) data, the U.S. Census Bureau reports that “nationally, 78 percent of households subscribe to the internet, but households in both rural and lower-income counties trail the national average by 13 points.” The ACS is a survey of American life, taken every five years to track trends on more than 40 social, economic, housing and demographic topics in every U.S. county.  Low internet subscription rates in rural areas hinder adoption of telehealth, which could improve quality of care while reducing cost.

Comments Requested: Recommendation for Preventing Spread of HIV – December 26.  The U.S. Preventive Services Task Force (USPSTF) issued a draft statement that recommends clinicians offer Pre-Exposure Prophylaxis (PrEP), a pill taken every day by individuals who do not have HIV but who are at substantial risk of getting it.  Among those considered high risk are men and women with inconsistent condom use during sex with other high risk individuals, and people who inject drugs and/or share drug injection equipment.  Overall, the majority of people who receive an HIV diagnosis live in urban areas, but new diagnoses in rural and suburban areas have been linked to drug use.  Comments from the public on this recommendation will be received until December 26 and considered by the USPSTF in their final recommendation.

Funding Opportunities

Research Fellowships for American Voices Project – First Round January 7.  The American Voices Project seeks 80 research fellows for “a fact-finding census of 200 rural, urban and suburban communities,” conducting in-person interviews in each of the 50 states.  The paid fellowship will begin in the summer of 2019 and is designed for graduating seniors, graduate students, and “anyone committed to tackling the country’s most pressing problems.”  The first of two application rounds has a January 7 deadline; the second round deadline is February 7.

Funding for Patient-Centered Outcomes Research – Letters of Intent February 1.  The Patient-Centered Outcomes Research Institute (PCORI) will award $20.5 million for “projects that encourage active integration of patients, caregivers, clinicians, and other healthcare stakeholders as integral members of the patient-centered outcomes research/clinical effectiveness research (PCOR/CER) enterprise.”  PCORI views this broad engagement as healthcare stakeholders taking part in the research process – from topic selection through design and conduct of research to dissemination of results.  Eligible applicants include any public, private, non-profit or for-profit organization or any unit of local, state, or federal government.  Past research projects have uncovered gaps in understanding and lessons learned from rural patient engagement in health-related research.

Public Safety and Victim Services in Tribal Communities – February 26.  The U.S. Department of Justice (DOJ) expects to make 371 awards for total funding of $193.7 million for several DOJ grant programs that build and support public safety and crime victim services.  Among the nine programs for this Coordinated Tribal Assistance Solicitation are grants for the Children’s Justice Act Partnership, Violence Against Women, Tribal Youth Program, and Justice System Infrastructure for Indian Tribes.  With some exceptions specific to several of the programs, only federally recognized tribes or tribal consortiums are eligible to apply.  Reduction of crime and violence has been identified as a crucial social determinant of health for Healthy People 2020 objectives.  A report issued earlier this year, “Priorities in Tribal Public Health”, examines the historical, political, and culture factors contributing to poorer outcomes in tribal health.

Rural Health  Research

Cancer Mortality in Rural America: 1999-2016. For scholars and policymakers alike, understanding the burden of cancer on society is a critical topic for investigation. Cancer consistently ranks as the second leading cause of death in the U.S., and cancers of the prostate, breast, lung, and colorectal areas are particularly problematic. This policy brief from the Southwest Rural Health Research Center works to understand the scope of cancer mortality in rural and urban areas of the U.S. and across census regions. It finds that age-adjusted mortality rates are higher for lung, prostate, and colon cancer in rural areas than in urban areas but also that mortality rates are lower for breast and cervical cancers in rural areas than in urban areas. In addition, this brief identifies important discrepancies in cancer mortality across regions, with lower rates in the West for all analyzed cancer types except prostate cancer, and higher rates for most cancers in the rural South.

Policy Updates

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

Nominations: Advisory Committee on Heritable Disorders in Newborns and Children – January 4.  HRSA’s Maternal and Child Health Bureau (MCHB) is seeking nominations one position in 2019 and four in 2020.  The committee advises the U.S. Department of Health & Human Services on policy to programs to reduce morbidity and mortality in newborns and children  having, or at risk for, heritable disorders. Nominees sought are medical, technical, or scientific professionals with special expertise in the field of heritable disorders or in providing screening, counseling, testing, or specialty services for newborns and children with, or at risk for having, heritable disorders; individuals who have expertise in ethics (e.g., bioethics) and infectious diseases and who have worked and published material in the area of newborn screening; members of the public having special expertise about, or concern with, heritable disorders; and/or representatives from such federal agencies, public health constituencies, and medical professional societies. Interested applicants may self-nominate or be nominated by another individual or organization.

Rural Hospitals Perform Well Overall in Latest CMS Quality Results. Recently, the Centers for Medicare & Medicaid Services (CMS) published the fiscal year FY 2019 results for the Hospital Value-Based Purchasing Program (VBP). The Hospital VBP adjusts what Medicare pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of inpatient care the hospitals provide to patients. On average, rural hospitals performed better in the Safety, Person and Community Engagement, and Efficiency and Cost Reduction domains. For FY 2019, the average Total Performance Score (TPS) across all rural hospitals of 42.4 was greater than the national average TPS of 38.1.

Resources, Learning Events and Technical Assistance

AgriSafe: Prevention of Grain Dust Explosions – Thursday, December 13 at 1:00 pm ET.  This one-hour webinar from the AgriSafe Network will review dangers to agricultural workers in the grain industry as well as health and safety tips.  Hazard Mapping in the Ag Classroom on Monday, December 17 at 4:30 pm ET is a train-the-trainer course for identifying and eliminating hazards in agricultural production.

RHC Technical Assistance Webinar – Tuesday, December 18 at 2:30 ET. The next Rural Health Clinic (RHC) Technical Assistance webinar will feature presenters from the Centers for Medicare & Medicaid Services (CMS). CMS presenters will discuss the new RHC service expansion scheduled to take effect on January 1, 2019.  They will also be available to answer your questions about Medicare payment policy and RHC services. No advance registration is required.

Resource of the Week

Missouri School of Medicine Rural Training Track.  This feature article in the latest edition of The Rural Monitor details the effort of one medical school’s effort to train and retain the next generation of primary care physicians in rural parts of the state.

Approaching DeadlinesNBCC Minority Fellowship for Addictions Counselors – December 15

NBCC Minority Fellowship for Mental Health Counselors – December 15

NHSC: Students to Service Loan Repayment Program – December 20

Comments Requested: Recommendation for Preventing Spread of HIV – December 26

Rural Economic Development Loan and Grant Program – December 31

Comments Requested: Telehealth for Substance Use Disorder Treatment – December 31

Comments Requested: Medicare Part B Drug Pricing – December 31  

Comments Requested:  Implementing Provisions of the Bipartisan Budget Act (BBA) of 2018 – December 31

Nominations: Committee on Heritable Disorders in Newborns and Children – January 4

Support for Enrollment of Children in Medicaid and CHIP – Letters of Intent January 4

Tribal Behavioral Health Grant Program – January 4

AHRQ Dissemination of Research for Unhealthy Alcohol Use – January 4

Research Fellowships for American Voices Project – First Round January 7

Advanced Nursing Education Workforce (ANEW) – January 8

AmeriCorps VISTA Seeking Proposals for Community Projects – January 14

Physician Assistant Program for Primary Care Enhancement – January 14

Rural Communities Opioid Response Planning – January 15

Geriatrics Academic Career Award Program – January 15

Environmental Public Health Internship Program – January 18

Comments Requested: Proposed Drug Pricing Changes for Medicare Advantage (MA) and Part D Plans – January 25

Support for Enrollment of Children in Medicaid and CHIP – January 28

Funding for Integrating Behavioral Health and Primary Care – January 28

Environmental Cleanup Through Brownfields Grants – January 31

Funding for Patient-Centered Outcomes Research – Letters of Intent February 1

Tribal College Extension Special Emphasis – February 1

Geriatrics Workforce Enhancement Program – February 6

Research Fellowships for American Voices Project – Second Round February 7

Rural Veterans Health Access Program – February 12

Grants for Patient-Centered Outcomes Research Institute (PCORI) – February 12

Rural Health Innovation and Transformation Technical Assistance – February 22

Public Safety and Victim Services in Tribal Communities – February 26

Rural Residency Planning and Development Program – March 4

Rural Primary Care SBIRT for Maternal Opioid Use – March 29

Indian Health Service Loan Repayment Program – Ongoing through August 2019

Guaranteed Loans for Rural Rental Housing – Ongoing through 2021

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