Federal Office of Rural Health Policy Announcements

July 18, 2019

What’s New

HRSA awards $20 million to 27 organizations to increase the rural workforce through the creation of new rural residency programs. Today, the Health Resources and Services Administration (HRSA) awarded approximately $20 million for Rural Residency Planning and Development Program (RRPD) grants. Recipients across 21 states will receive up to $750,000 over a three-year period to develop new rural residency programs while achieving accreditation through the Accreditation Council for Graduate Medical Education.

The RRPD program, administered by HRSA’s Federal Office of Rural Health Policy (FORHP) and Bureau of Health Workforce (BHW), is part of a multi-year initiative by HRSA to expand the physician workforce in rural areas by developing new, sustainable residency programs in family medicine, internal medicine, and psychiatry. The recipients of the awards include rural hospitals, community health centers, health centers operated by the Indian Health Service, Indian tribes or tribal organizations, and schools of medicine. Rural residency programs often face challenges in securing sustainable financing and faculty support. The RRPD grant award funding will help recipients address these challenges.

Funding Opportunities

RWJF: Health Care’s Role in Meeting Patients’ Needs – August 15. The Robert Wood Johnson Foundation (RWJF) seeks two grantee organizations or one collaborative of organizations for a new initiative aimed at defining the role of health care in meeting patients’ social and economic needs, also known as social determinants of health. The selected grantee/s will lead one or both of two components of the program: Part I) Clear Principles that set a high standard for the health care sector to provide equitable care that fully addresses people’s physical, emotional, and social needs; and Part II) Guidance for implementing care delivery that is fully responsive to patients’ goals, needs, and life circumstances, using maternal morbidity and mortality as a case example. The overall objective is to use evidence and engagement to articulate a set of principles for the health care sector in meeting a full spectrum of patients’ needs, demonstrate those principles, and then communicate them to stakeholders. RWJF will hold a webinar for applicants on Tuesday, July 23 at 2:00 pm ET.

NIH Research for Tobacco Control Policies – Letters of Intent September 11. The National Institutes of Health (NIH) seeks applications for research projects to help address health disparities in tobacco use in the United States. Areas of inquiry include, but are not limited to 1) protecting nonsmokers from secondhand smoke exposure, 2) insurance coverage for tobacco dependence treatment, and 3) other promising public and private tobacco control policy approaches. According to the Centers for Disease Control and Prevention, prevalence of cigarette smoking among U.S. adults is highest among those living in rural areas. The deadline for applications is October 11; a letter of intent is due on September 11.

SBA Guaranteed Loans for Small Business – Ongoing. The U.S. Small Business Administration (SBA) provides loan guarantees for financial institutions that loan funds to small businesses, including small health care practices. Privately owned medical facilities including hospitals, clinics, emergency outpatient facilities, and medical and dental laboratories are eligible. Among other purposes, businesses may use funds to: purchase land, expand an existing business, refinance debt, or purchase machinery, supplies and fixtures.

Policy Updates

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

Comments Requested: FCC Proposes $100 Million Connected Care Pilot Program. The Federal Communications Commission (FCC), under its existing Rural Health Care Program authority, is proposing a three-year, $100 million Connected Care Pilot program that would support bringing telehealth services directly to low-income patients and veterans. It would provide an 85 percent discount on connectivity for broadband-enabled telehealth services that connect patients directly to their doctors and are used to treat a wide range of health conditions. The Notice of Proposed Rulemaking (NPRM) adopted by the Commission seeks comment on testing the new program. In particular, the NPRM seeks comment on the appropriate budget, duration, and structure of the Pilot, along with other issues. Comments are due 30 days after publication in the Federal Register, and reply comments are due 60 days after publication in the Federal Register. For more information, visit the Center for Connected Health Policy, part of the HRSA/FORHP-supported National Telehealth Policy Research Center.

Comments Requested: CY 2020 Home Health Proposed Rule – September 9. On July 11, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Home Health Prospective Payment System (Home Health PPS). This includes routine updates to the home health payment rates for calendar year (CY) 2020 and a proposal to implement a new home infusion benefit for beneficiaries in CY 2021. The proposed rule would also increase Medicare payments to home health agencies (HHAs) by 1.3 percent ($250 million) overall, which reflects a 0.2 percent decrease in CY 2020 payments due to the rural add-on percentages mandated through CY 2022 by the Bipartisan Budget Act of 2018. Unlike previous rural add-ons, which were applied to all rural areas uniformly, the extension provided varying add-on amounts depending on the rural county (or equivalent area) classification. The average increase in payments to rural providers overall is 4.7 percent. RHIhub provides additional information on Rural Home Health Services as well as helpful FAQs.

Comments Requested: Methods for Assuring Access to Covered Medicaid Services-Rescission – September 13. On July 11, CMS released a proposed rule that would remove the regulatory text that sets forth the current required process for states to document whether Medicaid payments in fee-for-service systems are sufficient to enlist enough providers to assure beneficiary access to covered care and services consistent with the Medicaid statute. In the proposed rule, CMS noted that states have raised concerns over the administrative burden associated with the current regulatory requirements. CMS also issued on July 11 an informational bulletin announcing the agency’s strategy to measure and monitor beneficiary access to care across Medicaid. For more information on rural Medicaid issues in general, the Rural Health Research Gateway provides a selection of policy briefs on the topic.

Comments Requested: Specialty Care Models to Improve Quality of Care and Reduce Expenditures – September 16. On July 10, CMS put on public display a proposed rule that would implement two new mandatory Medicare payment models under section 1115A of the Social Security Act—the Radiation Oncology Model (RO Model) and the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model). The proposed RO Model is an innovative payment model designed to improve the quality of care for cancer patients receiving radiotherapy treatment and reduce provider burden by moving toward a simplified and predictable payment system. The ETC Model is one of five new payment models CMS announced last week aimed at transforming kidney care to improve access to high quality care and reducing Medicare expenditures. The rule details the proposed geographic units of section for model participation, Core Based Statistical Areas (CBSAs) for the RO Model and Hospital Referral Regions (HRRs) for the ETC Model, with implications for rural participation. The proposed rule is scheduled to be published in the Federal Register on July 18, and public comments are due 60 days after publication.

HHS To Transform Care Delivery for Patients with Chronic Kidney Disease. On July 10, CMS announced five new payment models aimed at transforming kidney care to improve access to high quality care and reducing Medicare expenditures. One of the new proposed models, the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model, is a mandatory model focused on encouraging greater utilization of home dialysis and kidney transplants through Medicare payment adjustments for selected ESRD facilities and clinician, including rural providers. The adjustments will apply to applicable Medicare claims with dates from January 1, 2020 through June 30, 2026. CMS will review public comments on the proposed mandatory model. CMS also proposed four voluntary payment models: the Kidney Care First (KCF) Model and three Comprehensive Kidney Care Contracting (CKCC) Models. These models will build upon an existing model and provide new incentives for providers to better manage and coordinate the care of Medicare beneficiaries with chronic kidney disease stages 4 or 5 and for those on dialysis. Applications will be accepted in Fall 2019, and the models are expected to run from January 1, 2020 through December 31, 2023.

CMS Issues New Guidance on State Waiver for Health Insurance. Section 1332 of the Patient Protection and Affordable Care Act permits states to apply for State Innovation Waivers (aka Section 1332 Waivers or State Relief and Empowerment Waivers) to pursue innovative strategies for providing high value and affordable individual health insurance regardless of income, geography, age, gender, or health status. As a follow-up to the guidance released last year, CMS has created concept papers and templates for four waiver concepts to help states develop new approaches to providing health coverage: State Specific Premium Assistance, Adjusted Plan Options, Account-Based Subsidies, and Risk Stabilization Strategies. In 2018, rural areas had fewer insurers offering individual health insurance and higher average adjusted premiums compared to urban areas.

Learning Events and Technical Assistance

NAM Guidance for Tapering Opioids – Tuesday, July 22 at 3:00 pm ET. The National Academy of Medicine (NAM) will bring in experts to discuss current guidance for opioid tapering, how it is applied in practice, and the strength of the evidence behind it. Five panelists will present various patient case scenarios and discuss pain management challenges through patient and caregiver perspectives, in order to inform best practices and identify evidence gaps.

AgriSafe: Opioid Prescribing for Safety-Sensitive Agricultural Occupations – Tuesday, July 23 at 3:30 pm ET. Farm duties frequently demand the use of heavy machinery and use of opioids alongside safety-sensitive work can be dangerous. This hour-long training from the AgriSafe Network educates healthcare providers on how to assess occupational agricultural risks and corresponding patient guidance for those who are taking opioid medications.

SUD Treatment for Pregnant and Parenting Women – Wednesday, July 24 at 3:00pm ET. This hour-long webinar will share promising practices by two HRSA-supported health centers to treat and support the needs of pregnant and parenting women diagnosed with a substance use disorder (SUD). Additionally, experts from the American College of Obstetricians and Gynecologists (ACOG) will share maternal and child health safety resources concerning the prevention and treatment of substance use disorder. Join the webinar via Adobe Connect Room Link and audio Conference Line: 888-942-9264, Passcode: 9893674. There is no need to pre-register.

HRSA Virtual Job Fair – Wednesday, August 7 at 7:00 pm ET. The Health Resources and Services Administration (HRSA) will hold a three-hour virtual job fair to connect job-seeking primary care trainees and practicing clinicians with employment opportunities at participating health care facilities.

CMS National Training Program Workshops – July 30 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 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 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.

Resources of the Week

Pathways to Safer Opioid Use Training. This interactive online training is sponsored by the American Public Health Association and the U.S. Department of Health and Human services to help clinicians and public health officials understand safe and effective use of opioids to manage chronic pain. Continuing education credits are available for the one-hour course.

Reducing Stigma: Cultural Competency for Behavioral Health Professionals. Licensed alcohol and drug counselors, nurses, psychologists, psychiatrists, and social workers can get continuing education credit for this five-hour e-learning course on cultural competency. The course covers all aspects of cultural identity – including ethnicity, ability, gender identity, and socioeconomic status among others – that have an influence on the therapeutic process.