Federal Office of Rural Health Policy Announcements

June 13, 2019

What’s New

Challenges of the Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Previous research on HIV and hepatitis C (HCV) among people who inject drugs (PWID) has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. In this report, researchers examine the increasing rurality of opioid injection, the challenges to treatment and prevention that are unique to rural areas, and the public health interventions needed to address them. See the Learning Events and Resources of the Week sections below for federal information on programs that can help prevent transmission of infections associated with needle use.

Healthy Brain Initiative: Roadmap for Indian Country. This report, supported by the Alzheimer’s Association and the Centers for Disease Control and Prevention, was created to help tribal community leaders understand how dementia and associated caregiving is affecting their community and then consider what approaches, including public health strategies, they might pursue. The first part explains the challenge of dementia in Indian Country and makes the case for the role of public health in reducing its burden. The Road Map then offers eight public health strategies for American Indian/Alaska Native leaders to consider as part of a broad response to dementia. These strategies are based on input from experts, practitioners, tribal health directors, and leaders in Indian Country. They are intentionally flexible and designed to be adapted to a wide array of local priorities.

HRSA Releases Allied Health Workforce Projections for 2016–2030. The Health Resources and Services Administration (HRSA) recently released Allied Health Workforce Projections providing national-level health workforce estimates for the following occupations: chiropractors and podiatrists, emergency medical technicians and paramedics, medical and clinical laboratory technologists, occupational and physical therapists, optometrists and opticians, pharmacists, registered dieticians, and respiratory therapists. While shortages of health care providers in rural areas is well-known, consistent data on rural allied health professionals has been difficult to collect and analyze. Visit HRSA’s Bureau of Health Workforce website to see more data, projections, and federal programs.

Funding Opportunities

USDA Telehealth Innovations for Women, Infants, Children – Letters of Intent June 25. The U.S. Department of Agriculture (USDA) will enter into a cooperative agreement with a single entity to support the implementation and evaluation of telehealth services in the Women, Infants and Children (WIC) federal nutrition assistance program that serves low-income women and children up to 5 years old who are at nutrition risk. Eligible applicants are public and private accredited colleges and universities that can research and support telehealth innovations to increase access to WIC programs, particularly in rural areas. The project awards up $3.5 million for a four-year project; up to $5 million will be awarded as sub-grants to WIC State Agencies through a competitive process. Application deadline is July 29; a non-binding letter of intent, due June 25, is required to apply.

Supporting HRSA’s Maternal Health Innovation Program – July 15. The Health Resources and Services Administration (HRSA) will enter into a cooperative agreement with a single entity to support HRSA award recipients who focus on improving maternal health, states, and key stakeholders in their efforts to reduce and prevent maternal mortality and severe maternal morbidity. A total of $2.6 million will go toward a five-year project to provide capacity-building assistance to award recipients of the State Maternal Health Innovation Program and the Rural Maternity and Obstetrics Management Program to implement innovative and evidence-informed strategies.

DOJ Tribal Victim Services Set-Aside Program – July 29. The U.S. Department of Justice (DOJ) provides grants for tribal communities to improve services for victims of crime. Funding may support a comprehensive range of activities including needs assessment, strategic planning, program development and implementation, program expansion, and other activities needed to address the needs of a wide variety of crime victims in tribal communities. Federally recognized tribal governments and organizations are eligible for total funding of $90 million with awards of up to $720,000 each.

USDA Tribal Colleges Research Grants – August 9. The U.S. Department of Agriculture (USDA) will invest $3.7 million for research projects that address concerns and needs of tribal and reservation communities, including projects that focus on health, environment, and agricultural production needs of remote reservation communities. Eligible applicants are the mostly rural 1994 Tribal Land Grant institutions.

Rural Health Research

Unmet Need for Personal Care Assistance Among Rural and Urban Older Adults. Despite differences in health, health services, economic, and demographic characteristics, little is known about whether rural and urban areas differ in unmet need for personal care for older adults with functional limitations. This brief from the University of Minnesota Rural Health Research Center addresses that gap by analyzing rural-urban differences in unmet need for help across 11 activities.

Policy Updates

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

HRSA Requests Public Feedback on Health Center Service Areas – July 8. The Health Resources and Services Administration (HRSA) is seeking input from the public on service area considerations that may inform decisions to expand the program through the addition of new service delivery sites onto existing health centers. The considerations include factors such as proximity to existing health centers, parameters for unmet need, and consultation with other local providers.

Indian Health Service Requests Feedback on Community Health Aide Program – July 8. The Community Health Aide Program (CHAP) is a multidisciplinary system of mid-level behavioral, community, and dental health professionals working alongside licensed providers to offer patients increased access to quality care in rural Alaskan areas. In 2016, The Indian Health Service (IHS) consulted with Tribes on expanding the program, and in 2018, formed the CHAP Tribal Advisory Group (CHAP TAG) to expand CHAP to the lower 48 states. The IHS is requesting feedback from the public on its draft policy to expand the program.

CMS Requests Feedback Reducing Regulatory Burden – August 12. On June 6, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking new ideas from the public on how to reduce administrative and regulatory burden as part of the agency’s Patients over Paperwork initiative. CMS is especially seeking innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve: reporting and documentation requirements; coding and documentation requirements for Medicare or Medicaid payment; prior authorization procedures; policies and requirements for rural providers, clinicians, and beneficiaries; policies and requirements for dually enrolled (i.e., Medicare and Medicaid) beneficiaries; beneficiary enrollment and eligibility determination; and CMS processes for issuing regulations and policies.

VA Announces Final Community Care Regulations under MISSION Act. On June 5, the U.S. Department of Veterans Affairs (VA) announced the publication of two final regulations as part of its new Veterans Community Care Program under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018. One of the rules focuses on a new urgent care benefit. VA also published the final regulation for the Veterans Community Care Program governing how eligible Veterans receive necessary hospital care, medical services, and extended care services from non-VA entities or providers in the community. The new Veterans Community Care Program replaces the Veterans Choice Program, which expired June 6, 2019. Of note, the final rule addresses payment of higher rates to health care providers in highly rural areas. The term “highly rural area” means an area located in a county that has fewer than seven individuals residing in that county per square mile.

Learning Events and Technical Assistance

NHSC Rural Community LRP Application Assistance – Thursday, June 13 at 1:00 pm ET. Applicants to the National Health Service Corps (NHSC) Rural Community Loan Repayment Program (LRP) can get information about the process during this 90-minute webinar. Dial-in 800-857-1286; Passcode 4667956.

Using the Law and Policy to Promote Health Equity – Thursday, June 13 at 1:00 pm ET. In this one-hour webinar hosted by the Office of Disease Prevention and Health Promotion, experts from public and nonprofit organizations will take a comprehensive look at legal and policy strategies that can address health inequities.

Northeast Telehealth Resource Center Regional Conference – June 17-18 in Portland, ME. This two-day conference in Portland, Maine features a keynote presentation by Chris Gibbons, MD, MPH – Chief Health Innovation Adviser, FCC and the Future for Digital Health, a special panel on Federal and Regional Telehealth Policy Perspectives, and other key topics from national and regional telehealth leaders. There are more than fifteen breakout sessions on a wide variety of areas including: strategies for planning and sustaining telehealth programs, telehealth use cases across various environments, models for serving vulnerable populations through telehealth, and more. This year’s event also includes a Pre-Conference Tele-behavioral Health Workshop: “A Provider’s Guide to TeleMental Health: Key Concepts and Use Cases”, and two hands-on technology labs with the National Telehealth Technology Assessment Resource Center.

Effective HIV and SUD Interventions for Latino/a Clients – Tuesday, June 18 at 2:00 pm ET. This hour-long webinar will focus on the intersection of HIV and substance use disorder (SUD) and finding a translational approach to SUD service programs, reducing stigma, and improving authenticity and communication with Latino clients and communities. Lessons learned and replications tips will be provided. The webinar will also include a question and answer session. The webinar is presented by the HRSA HAB-supported Ryan White HIV/AIDS Program Part F, Special Projects of National Significance (SPNS) Integrating HIV Innovative Practices (IHIP) project.

Standards for Minimizing Pesticide Exposure – Thursday, June 20 at 1:00 pm ET. The EPA’s Worker Protection Standard (WPS) is the primary federal regulation that provides workplace protections for farmworkers who are exposed to pesticides. This session, featuring experts from Farmworker Justice and Migrant Clinicians Network, will provide an update on the status of the WPS, review major provisions that aim to prevent exposure to farmworkers and their families, and the roles and responsibilities of clinicians and other stakeholders regarding worker protection. Additionally, this session will provide participants with resources to help educate farmworkers and their families about the WPS and pesticide exposure, to facilitate reporting of pesticide exposure, and to assist clinicians in the recognition and management of pesticide exposures.

Models of Hepatitis C Care for People with SUD – Thursday, June 20 at 2:00 pm ET. This hour-long webinar will present models of care for the hepatitis C virus (HCV) care for people with substance use disorders (SUD). The overall goal of the webinar is to encourage more providers to integrate hepatitis C care into their practices both for people living with hepatitis C and those that are co-infected with HIV and HCV. See recent research on HIV and HCV in rural areas in the What’s New section above.

National Rural Institute on Alcohol and Drug Abuse – June 23-27 in Menomie, WI. Registration is open for this unique annual conference for rural alcohol and drug abuse professionals, federal agency representatives and nationally-known experts. Key resource professionals from throughout the U.S. will present intensive study tracks and special topics on current innovative and emerging topics.

National Opioid Leadership Summit – Tuesday, June 25 in Sacramento, CA. Join the Public Health Institute, U.S. Surgeon General Jerome Adams and colleagues from across the country on June 25, 2019 in Sacramento to learn about, share and collaborate on real solutions to the opioid crisis that bridge the criminal justice, health care, and public health sectors.

Hospital Co-location Listening Session — Thursday, June 27 at 2:00 pm ET. CMS is holding a listening session on June 27 to hear your feedback on new draft guidance for Appendix A of the State Operations Manual. Under the Medicare Conditions of Participation, hospitals may co-locate with other hospitals or health care entities, meaning they share certain common areas on the same campus or building. CMS is seeking your input on staffing, contracted services, emergency services, and distinct and shared spaces. You may email comments/questions in advance of the listening session to HospitalSCG@cms.hhs.gov with June 27 in the subject line. These may be addressed during the listening session or used for other materials following the session. After the call, CMS will continue to seek comment on these draft revised policies until July 2.

Using Telehealth to Treat Substance Use Disorder – June 28, 2019 at 3:00pm ET. Anyone may attend this online session for community health centers (CHC) and federally qualified health centers (FQHC), hosted by the HRSA/FORHP-supported Telehealth Resource Centers. Experts will discuss the types of substance use disorder (SUD) services that can be provided via telehealth, how they can be integrated into primary care, and the potential issues that may be encountered. Though recent reports have found that telehealth adoption is slower in rural areas, more federal programs and funding have been implementing telehealth to bring SUD treatment to remote areas.

Save the Date: 3RNet 2019 Annual Conference – September 24-26 in Wichita, KS. The National Rural Recruitment and Retention Network (3RNet) is a nonprofit that matches health care professionals to employers in rural and underserved areas. Attendees at their annual two-day conference will network with other 3RNet members, learn strategies for rural recruitment and retentions, and get 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.

Resources of the Week

Free Online Training for Indigenous Environmental Health. The National Indian Health Board worked with Oregon State University to create training modules to help tribes assess and adapt to climate change. The Climate Ready Tribes project adapts the Building Resilience Against Climate Effects (BRACE) Framework to better reflect indigenous health definitions and priorities, demonstrating ways that Tribes may tailor the process and methods for use in their own communities. The BRACE Framework was formulated by the Centers for Disease Control and Prevention to help all communities across the country prepare for the health effects of climate change.

CDC Information on Syringe Services Programs. The Centers for Disease Control and Prevention (CDC) recently updated information they provide on community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing, and linkage to care and treatment for infectious diseases.

Approaching Deadlines

Research for Smoking Cessation in Disadvantaged Populations – June 13

CDC Emergency Department Surveillance of Non-fatal Suicide Outcomes – June 14

HRSA Medical Student Education Program – June 14

NIH Research to Address Opioid Epidemic and Minority Health Disparities – June 14

Comments Requested: Clarification of Ligature Risk Interpretive Guidance – June 17

Comments Requested: Proposed Changes to Payment and Policy for Inpatient Psychiatric Facilities – June 17

Comments Requested: Proposed Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities – June 17

Comments Requested: Trusted Exchange Framework for Electronic Health Information – June 17

Comments Requested: Proposed Update to Hospice Payment Rate – June 18

Comments Requested: Proposed Payment and Policy Changes for Medicare Skilled Nursing Facilities – June 18

USDA Local Food Promotion Program – June 18

Comments Requested: Proposed Updates for FY2020 Medicare Inpatient and Long-term Care Hospital Payments – June 24

USDA Telehealth Innovations for Women, Infants, Children – Letters of Intent June 25

New Opportunity to Apply to be a Medicare Shared Savings Program ACONotice of Intent June 28

Proposals Requested: Medicare Measures for Promoting Interoperability – June 28

Hardship Exclusion for Medicare Interoperability – July 1

HUD Comprehensive Housing Counseling Grant Program – July 1

IHS Tribal Management Grant Program – July 1

Comments Requested: CMS Issues Draft Guidance on Hospital Co-location – July 2

Request for Information: State Waivers for Health Insurance – July 2

Contractor Sought for RWJF Rural Leadership Pathways Learning Initiative – July 8

HRSA Requests Public Feedback on Health Center Service Areas – July 8

Indian Health Service Requests Feedback on Community Health Aide Program – July 8

USDA Rural Housing Preservation Grant – July 8

DOT Public Transportation on Indian Reservations – July 9

Federal Investment in Rural Transportation – July 15

DOL Workforce Opportunity for Appalachian and Delta Regions – July 15

Supporting HRSA’s Maternal Health Innovation Program – July 15

NHSC Rural Community Loan Repayment Program – July 18

Seeking Host Applicants for Citizens’ Institute on Rural Design – July 22

CDC National Harm Reduction Syringe Services Program Monitoring and Evaluation – July 26

DOJ Tribal Victim Services Set-Aside Program – July 29

USDA Telehealth Innovations for Women, Infants, Children – July 29

USDA Tribal Colleges Research Grants – August 9

CMS Requests Feedback Reducing Regulatory Burden – August 12

AHA Rural Hospital Leadership Team Award – August 30

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

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