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Announcements from the Federal Office of Rural Health Policy

May 2, 2017

What’s New

The Role of Medicaid in Rural AmericaA new brief from the Kaiser Family Foundation describes Medicaid’s role for 52 million children and nonelderly adults living in the most rural areas in the United States and discusses how expansions or reductions in Medicaid could affect rural areas. According to the report, Medicaid plays a central role in helping to fill gaps in private coverage in rural areas.  Although private insurance accounts for the largest share of health coverage in rural areas, nonelderly individuals in rural areas are less likely to have private insurance compared to those in urban and other areas (61% vs. 64% respectively). Medicaid  helps fill the gap in private coverage, covering nearly one in four (24%) nonelderly individuals in rural areas and, in many states, Medicaid coverage rates are higher in rural areas than in urban or other areas.

Awareness for Children’s Mental Health.  On Thursday, May 4th the Substance Abuse and Mental Health Services Administration (SAMHSA) will focus on the importance of social, emotional, behavioral, and physical health needs of children, youth, and young adults.  A national broadcast scheduled for 7:00 pm ET will feature an interactive panel discussion on mental and behavioral health needs and effective strategies.  Last month, the CDC issued a report on mental and behavioral health for children as part of its series on health in rural areas.  On Wednesday, May 3rd, the Rural Health Information Hub will have a discussion of the report with Q&A. See events section below for details.

Funding Opportunities

Become an NHSC Site – June 6.  Rural providers in a designated Health Professional Shortage Area can apply to become a site for the National Health Service Corps, a federal program that offers financial and other support to primary care providers and sites in underserved communities.  Eligible sites include health care facilities that provide outpatient, ambulatory and primary health care services (medical, dental, and behavioral) to populations residing in high-need areas. Critical Access Hospitals (CAHs) are the only inpatient facilities that can qualify to become an NHSC site and must be affiliated with an NHSC-approved outpatient clinic.

Rural Community Hospital Demonstration  –  May 17.  CMS has released the third solicitation for applications for the Rural Community Hospital Demonstration, which tests the impact of a cost-based payment methodology for Medicare inpatient hospital services furnished by small, rural hospitals.  To be eligible to apply, hospitals must have fewer than 51 acute care inpatient beds, make available 24-hour emergency care services, and not be eligible for, or designated as, Critical Access Hospitals (CAH).  To select new demonstration participants, the 21st Century Cures Act authorizes CMS to prioritize applicants from the 20 states with the lowest population density and consider the impact of rural hospital closures in the last five years.

Policy Updates

Questions about Rural Health Policy Updates? Write to ruralpolicy@hrsa.gov

Nominate rural SNF experts and patients – May 12. CMS seeks nominees to serve on a Technical Expert Panel to develop and maintain quality measures for the Skilled Nursing Facility Quality Reporting Program (SNF QRP). CMS seeks 10-12 experts and patients to provide feedback on current measures, develop new measures, and identify areas for future measure development. As CMS clarified in the 2017 update to SNF payment rules (81 FR 52010), potential rural nominees should be aware that the SNF QRP applies to “all non-CAH swing-bed rural hospitals.” Interested nominees should complete a nomination form and email it to Ryan Nguyen at rnguyen@rti.org.

Comment: Advanced Alternative Payment Model – May 18.  The American Academy for Family Physicians has proposed an Advanced Primary Care Alternative Payment Model (APM) to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) that would allow participation of any primary care physician regardless of location.   This proposed new Medicare payment model includes a global payment for direct care services, a population based payment, and performance-based incentive payments for primary care physicians nationwide.  To better serve the needs of patients and providers in underserved areas, PTAC encourages APM proposals that could include rural physicians and other safety net providers, and they encourage public comment on the merits of the proposals.  Send emails with subject line: “Public Comment – [name of document]” to PTAC@hhs.gov.

Comment: Accelerating Broadband Health Tech Availability – May 24. The Federal Communications Commission (FCC) recently released a Public Notice seeking comments, data, and information on a broad range of regulatory, policy, technical and infrastructure issues related to broadband-enabled health care. This includes a request for comments on how to strengthen the FCC’s Rural Health Care Program, which supports telecommunications and broadband services to improve the quality of health care in rural communities. Stakeholders may consider commenting on key policies including, but not limited to, ensuring eligible safety-net providers can access program funding, assessing the annual funding cap of $400 million, and reducing administrative complexity. Interested parties may file comments on or before May 24, 2017. The FCC has posted more detailed information on the request and instructions for filing comments.

Comment requested: universal education for opioid prescribers – July 10. The Food and Drug Administration (FDA) announced a public workshop to obtain input on issues and challenges associated with Federal efforts to support training for health care providers on pain management and the safe prescribing, dispensing, and patient use of opioids. The Centers for Disease Control and Prevention has reported that rural areas are affected by higher rates of opioid misuse and overdose.  FDA will host the workshop May 9-10 at the Sheraton Hotel in Silver Spring, Md. Participants must register online before May 1. FDA welcomes public comment and suggestions on promising approaches in prescriber education and training programs.

Resources, Learning Events and Technical Assistance

CDC Rural Health Series Webinar – Wednesday, May 3, 2017 at 12:00 pm ET.  The Rural Health Information Hub will host a free webinar featuring authors of the CDC’s recent report on mental and behavioral health for rural children.  Discussion of the research that finds higher rates in rural areas of self-reported mental, behavioral and developmental disorders for children will be followed by insights from Ben Archer Health Center, a successful HRSA grantee, on their community’s response to the issue. Time will be available for a Q&A with the presenters. Connection details will be emailed to you immediately upon registration, and a recording will be available after the event.

Sustainable Farm Families Project – Thursday, May 4 at 11:00 am ET.  The AgriSafe Network will host this look at a program developed in Australia to address the unique challenges to health for farming families. Attendees at the one-hour webinar will learn about the tools, techniques and skills to more effectively manage their health, well-being and safety.

Rural Health Clinics Technical Assistance – Thursday, May 4th at 2:00 pm ET.  In late 2016, CMS announced finalization of new “Emergency Preparedness” rules for federally certified facilities, including Rural Health Clinics.  ALL RHCs will be subject to these news rules and must be able to demonstrate that they have put an “Emergency Preparedness” plan in place and engaged in a variety of activities as part of the new requirements.  In this webinar, Nathan Baugh, Director of Government Affairs at the National Association of Rural Health Clinics, will be outlining the new rules for RHCs.  Dial-in information will be made available at the link above on the day of the session and a recording will be posted online a few days after at https://www.hrsa.gov/ruralhealth/resources/conferencecall/index.html.

Preserving Affordable Rural Rental Housing: New Tools and Promising Practices – Thursday, May 4th at 3pm ET. Thousands of affordable rental properties in rural communities are in danger of being lost to disrepair or market forces in the next decade. This free Connecting Communities® webinar, sponsored by the Federal Reserve, will explore strategies that are being implemented to try and preserve them, with a focus on recently released data and tools that can help community organizations. Presenters include representatives from PolicyMap, USDA Rural Housing Service and a practitioner from the Southwest Minnesota Housing Partnership.

Upcoming MIPS Webinars from CMS – May 5 at 3:00 pm ET. CMS is hosting two upcoming webinars to provide information on quality reporting under the Quality Payment Program’s Merit-Based Incentive Payment System (MIPS). The first, on May 5, will focus on how to select measures and maximize quality performance in MIPS. On May 11 at 1:00 pm ET, CMS will host a second webinar to provide an overview of group reporting under MIPS and highlight requirements for participation.  Rural clinicians who meet certain criteria, including some who practice in Critical Access Hospitals, may be eligible to participate. In late April through May, practices will get a letter from the Medicare Administrative Contractor with information on the participation status of each MIPS clinician associated with the Taxpayer Identification Number or TIN in a practice.

NHSC Virtual Job Fair – Tuesday, May 9 from 6:45 – 10:15 pm ET.  Primary care clinicians in eligible disciplines can register to attend this virtual job fair and learn about vacancies at sites approved for the National Health Service Corps.  Those who may be interested in working in an underserved area can interact with representatives from 30 to 40 sites, many in rural areas, for as many as 190 job openings in primary care medical, dental and mental/behavioral health disciplines.

Medicare-Medicaid Accountable Care Organization Model Medicare-Medicaid – Thursday, May 11 at 1:00 pm ET.  CMS will host this webinar to provide an overview of the MMACO Model, including details on the model’s beneficiary attribution, financial methodology, and quality measurement options.  The webinar will also provide information on the state application process and how to submit letters of intent. Under the Model, CMS will collaborate with states to allow ACOs in the Medicare Shared Savings Program to also be accountable for the Medicaid costs of their assigned beneficiaries who are dually eligible for Medicare and Medicaid. model preference will be given to states with sufficiently high shares of dually eligible beneficiaries and low ACO saturation, which are traits of a number of states that are largely rural.

Training Series for Health Care Providers on Prescribing Opioids – Ongoing. The CDC has launched an eight-part online training series to help health care providers apply recommendations in their clinical settings through interactive patient scenarios, videos, knowledge checks, tips, and resources. Rural practitioners report their concern about the potential for opioid abuse, but at the same time report insufficient training in prescribing opioids. This is why the CDC created the 2016  Guideline for Prescribing Opioids for Chronic Pain and associated training. The first training  Addressing the Opioid Epidemic: Recommendations from CDC is available now. Future topics include: communicating with patients, treating chronic pain without opioids, and prescribing decision making.

Resource of the Week

Managing Financial Risk for Critical Access Hospitals.  The Rural Health Value team, a FORHP-supported collaboration that analyzes rural health care delivery and provides technical assistance, has developed an Excel-based financial modeling tool to help Critical Access Hospitals assess the financial implications of joining a Medicare Shared Savings Plan Accountable Care Organization.

Approaching Deadlines

Next Generation ACO  – May 4
Youth Farm Safety Education – May 10
NURSE Corps Scholarship Program – May 11
Chronic Disease Management for Older Adults – May 12
Primary/Behavioral Health Care Integration – May 17
Comment: Advanced Alternative Payment Model – May 18
Comment: Accelerating Broadband Health Tech Availability – May 24

Improving Rural Economies – May 26
Become an NHSC Site – June 6

Behavioral Health Workforce Education and Training – June 12
Diabetes Prevention Program in Underserved Areas – June 12
Relatives As Parents Program – June 15

NIDA Funding To Expand Treatment For Opioid Abuse – June 20
Community Facilities Program – Ongoing
Summer Food Service Program – Ongoing

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