Federal Office of Rural Health Policy Announcements

November 7, 2019

What’s New

SAMSHA Launches FindTreatment.gov. The Substance Abuse and Mental Health Services Administration (SAMHSA) launched a newly designed website that will help connect those who are looking for substance abuse treatment with approximately 13,000 locations across the United States. Visitors can enter a ZIP Code to find nearby locations of state-licensed facilities, treatment options, payment and insurance information, and what to expect on the first call. Providers may fill out an application to list their facility.

November is National Diabetes Month. According to the Centers for Disease Control and Prevention, more than 30 million people in the United States have diabetes and 1 in 4 of them don’t know they have it. Adults with diabetes are nearly twice as likely to die from heart disease or stroke; for people living in rural areas, the risk factors associated with diabetes are higher. To raise awareness, the National Institute of Diabetes and Digestive and Kidney diseases encourages everyone to take a quiz – for themselves or someone else – to assess their risk of developing diabetes and the factors within their control.

AJPH Call for Papers on Rural Public Health – January 15. The American Journal of Public Health (AJPH) invites papers assessing the role of government policy in the status and revitalization of rural health. They seek papers that describe rural health research, report on interventions in rural settings, assess the impact of laws and policies, and examine the human health impact of climate change in rural areas. AJPH also invites editorials and commentaries proposing ways to apply public health methods that have been successful in other regions of the world, describing potential sources of funding, and depicting a vision for a rural public health of the 21st century. Potential authors should visit the AJPH website to review instructions for authors and specific guidelines for the various types of manuscript formats.

Funding Opportunities

USDA Disaster Relief for Community Facilities Program – While Funds are Available. The U.S. Department of Agriculture will provide $150 million to help rural communities affected by natural disasters that occurred in calendar years 2018 and 2019. Applications will be accepted on a continual basis until funds are exhausted. The funds are supplemental to the USDA’s Community Facilities Program, which accepts applications on an ongoing basis through the USDA’s Rural Housing Service. (See link for the Community Facilities Program in the Approaching Deadlines section below.)

Instructor Training Grants for Physical Activity Programs in Local Parks – November 26. The National Recreation and Park Association will make 130 grants to local park and recreation agencies to train instructors in evidence-based physical activity programs designed to positively affect chronic disease management, increase physical activity engagement, help seniors age in place, and improve quality of life. The program is supported by the Centers for Disease Control and Prevention, which evaluated a physical activity program in rural Alabama earlier this year.

DOT Access and Mobility for All Pilot Program – January 6. The U.S. Department of Transportation (DOT) will invest $3.5 million for 30 awards in a pilot program to improve transportation options for older adults, individuals with disabilities, and people in low-income communities. Funds will support innovative capital projects that coordinate community services for nonemergency medical transportation as well as connecting people to everyday destinations such as healthy food outlets, jobs, education, and health services.

DOJ Sexual Assault Services for Tribes – January 10. The U.S. Department of Justice (DOJ) will make six awards of up to $2 million each to increase the availability of trained Sexual Assault Forensic Examiners (SAFEs) and trained sexual assault victim advocates (advocates) in tribal communities, including Alaska Native villages.

USDA Emergency Community Water Assistance Grants – Ongoing. U.S. Department of Agriculture provides funds to help prepare or recover from an emergency that threatens the availability of safe, reliable drinking water. Eligible applicants include state and local governments, nonprofit organizations, and federally-recognized tribes in rural areas and towns with populations of 10,000 or less.

Rural Health Research

Dissemination of Rural Health Research: A Toolkit. Designed to help researchers develop appropriate, timely, and accessible products, the toolkit describes multiple modes of dissemination – policy briefs, fact sheets, infographics, journal publications, etc. – for a diverse audience that includes health consumers, stakeholders, and policymakers at all levels of government. The toolkit, which is free and downloadable, also includes a brief discussion on the purpose of each product, which product is appropriate given the topic and intended audience, and tips on formatting and design. This expertise is provided by the Rural Health Research Gateway, an online library of research funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration.

Policy Updates

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

Deadline for Critical Access Hospitals to Submit a Hardship Exception Application – December 2. CMS requires that all Critical Access Hospitals (CAHs) use either the 2014 or 2015 Edition certified electronic health record technology (CEHRT) to meet the reporting requirements of the Medicare Promoting Interoperability Program and successfully demonstrate meaningful use. Downward payment adjustments must be applied to CAHs that are not meaningful users of CEHRT. However, CAHs may avoid the Medicare downward payment adjustments by completing a hardship exception application by December 2 to show that meeting the meaningful EHR user requirements would result in a significant hardship.

Payment Updates for Home Health Agencies and Home Infusion Therapy Benefit. Last week, CMS finalized the calendar year 2020 payment rates for home health agencies and policies to implement the home infusion therapy benefit for calendar year 2021. In addition, CMS modified regulations to allow therapist assistants to perform maintenance therapy in accordance with individual state practice requirements, and they adopted a number of standardized patient assessment data elements (SPADEs) to assess cognitive function and mental status, medical conditions and comorbidities, and social determinants of health (i.e., race and ethnicity, transportation, and social isolation) among others. Visit RHI Hub for more information on the importance of home health services in rural areas.

CMS Finalizes Payment Policies for CY2020 End-Stage Renal Disease (ESRD) and Durable Medical Equipment (DMEPOS). On October 31, CMS finalized payment policies and rates under the ESRD Prospective Payment System (PPS) and Quality Incentive Program (QIP) effective on or after January 1, 2020. The rule also updates the acute kidney injury (AKI) dialysis payment and establishes a transitional add-on payment adjustment to support the use of new and innovative renal dialysis equipment and supplies. CMS projects that updates to the CY 2020 ESRD PPS will result in a 1.8 percent increase in payments for rural ESRD facilities compared to CY 2019. In addition, CMS established a gap-filling methodology for pricing new Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items/services and streamlines a set of requirements for ordering DMEPOS items. The final rule will be published in the Federal Register on November 8.

CMS Finalizes Medicare Clinician Policy, Payment, and Quality Provisions for CY 2020. On November 1, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020. This includes three new telehealth codes to describe a bundled episode of care for treatment of opioid use disorders, Medicare coverage for opioid treatment programs, updates to care management services, implementation of a ground ambulance data collection system, and a revision to the current supervision requirement to clarify physician supervision requirements for physician assistants (PAs), among other updates. The rule also makes updates to Medicare’s Quality Payment Program including performance thresholds and category weights for the 2020 performance period and clarifying the definition of rural for the purposes of the Merit-Based Incentive Payment System (MIPS). As part of this rulemaking, CMS included an interim final rule with comment period (IFC) to establish coding and payment for evaluation and management, observation and the provision of self-administered Esketamine, with comments on that proposal due no later than 5 pm on December 31, 2019.

Medicare Outpatient Payment Policies Finalized. On November 1, CMS finalized updates to the Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Care Center (ASC) Payment System for the 2020 calendar year. In addition to updating payment rates, this rule finalizes completing the two-year phase-in of site neutral payment for clinic visits when provided at an off-campus provider-based department. This final rule also finalizes to pay Average Sale Price (ASP) minus 22.5 percent for 340B-acquired drugs for CY 2020. Rural sole community hospitals are still exempted from the reduction and will continue to be paid ASP plus 6 percent. In the rule, CMS finalizes a change to the generally applicable minimum required level of supervision for hospital outpatient therapeutic services furnished by all hospitals and Critical Access Hospitals (CAHs) from direct supervision to general supervision. CMS is also finalizing for the OPPS, the other wage index policies adopted in the FY 2020 IPPS final rule. CMS plans to finalize these provisions on price transparency and requirements for making public a list of standard charges in a standalone document at a later date. As part of this rulemaking, CMS is accepting comments on the payment classifications assigned to the interim APC assignments and/or status indicators of new or replacement Level II HCPCS codes until 5 pm EST on December 2, 2019.

Learning Events and Technical Assistance

HIVAIDS in Rural America – Thursday, November 7 at 11:00 am ET. The recent CDC report, HIV Incidence: Estimated Annual Infections in the U.S., 2010-2016, estimates that the decrease in Human Immunodeficiency Virus (HIV) infections has plateaued because effective HIV prevention and treatment are not adequately reaching individuals with the highest need for these services, such as those in rural areas. This hour-long webinar will provide an overview of the “Ending the HIV Epidemic: A Plan for America” initiative, discuss the distribution of HRSA-funded Ryan White HIV/AIDS medical providers in rural areas of the U.S., and highlight the work of a current Ryan White recipient working in rural Alabama.

FCC Rural Health Care Program Kickoff – Thursday, November 7 at 2:00 pm ET. The Federal Communications Commission’s (FCC) Rural Health Care Program supports telecommunications and broadband services to improve the quality of health care in rural communities. In this one-hour webinar they will provide application information for FY2020 funding.

Facing Alzheimer’s in Indian Country: A Public Health Approach – Thursday, November 7 at 4:00 pm ET. The rise in Alzheimer’s disease and other dementias is a challenge for all communities, including those in Indian Country. During this hour-long webinar, the American Indian Public Health Resource Center will cover Alzheimer’s and other dementias, how dementia relates to diabetes and heart disease, and why dementia affects multiple generations.

NIHCM Solutions to Address Rural Health Disparities – Wednesday, November 13 at 2:00 pm ET. This 90-minute webinar will explore federal strategies to improve rural health, as well as innovative initiatives to respond to unmet social needs, address provider shortages, and expand telehealth. The National Institute for Health Care Management (NIHCM) is a nonprofit, nonpartisan organization awarding grants for research into health care policy.

Tracking Progress on the COPD National Action Plan – Wednesday, November 13 at 8:15 am ET. The National Heart, Lung, and Blood Institute (NHLBI) is holding a day-long workshop to discuss efforts by federal agencies and supporting organizations on the COPD National Action Plan. Chronic Obstructive Pulmonary Disease (COPD) is a lung condition identified as a major cause of death and disability in the United States, with a higher prevalence rate for individuals living in rural areas. Earlier this year, the Rural Health Information Hub created a Rural Toolkit for COPD, with an overview of the disease and current treatment protocols, resources for implementing effective COPD programs, and models of programs that have proven effective in rural communities. The NHLBI has closed registration for in-person attendance at this event, but will live-stream the first four hours online.

HHS Celebrates National Rural Health Day November 18-21. This annual observation that takes place on the third Thursday each November was created to increase awareness of rural health-related issues and challenges and to recognize those who are working to improve the health and wellbeing of the millions of people living in America’s rural communities. During the week of November 18-21 there will be a special webcasted celebration featuring leaders of the U.S. Department of Health & Human Services, twitter chats, webinars, and a virtual job fair for rural healthcare sites.

NEMSMA Rural & Small Provider Committee Meeting – Tuesday, November 19 at 3:30 pm ET. The National Emergency Medical Services Management Association (NEMSMA) announces a new committee focused on small and rural providers. During this 90-minute webinar, NEMSMA will discuss objectives for the committee and ways to support smaller organizations.