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Announcements from the Federal Office of Rural Health Policy

June 22, 2017

What’s New

Continuing Population Loss for Rural Areas.  USDA’s Economic Research Service (ERS) tracks demographic change in non-metro areas and conducts research to help explain the relationship between population change and socio-economic well-being of rural residents. In its Population & Migration report released last week, the ERS finds that 14% of residents live in non-metro counties across the U.S., which cover 72 percent of the nation’s land area. This is only a -0.4 percentage loss over last year, but population loss is not evenly distributed across all rural areas. For those regions experiencing the most out-migration, ERS identifies rising unemployment, housing market challenges and energy sector developments as factors in a continuing decline in rural populations.

HHS Cybersecurity Keeps an Eye on Threats.  Last week, Microsoft and the Department of Homeland Security (DHS) reported on vulnerabilities with Microsoft products similar to those that allowed the “WannaCry” virus to shut down large computer networks in May. DHS has identified a new threat, labeled “Hidden Cobra” that could possibly target health care and public health systems in the U.S.  Rural facilities may not be targeted as much as larger systems, but they may be less likely to have the resources to respond if they are hit, so it is especially important to remain vigilant and avoid these threats altogether.   HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) monitors cyber threats and maintains an up-to-date website with resources that may help.

Funding Opportunities

Delta Region Community Health Systems – July 17.  Public, private and non-profit organizations are among those eligible to compete for $2 million awarded annually to one entity for up to three years to provide intensive technical assistance to health care providers in the Delta region.  The funds will support HRSA’s collaboration with the Delta Regional Authority to help underserved communities identify and better address local health care needs and to help small rural hospitals improve their financial and operational performance.  FORHP will provide more assistance with the application process at a webinar on June 28th at 1:00 pm ET (see events below).  More information about the program and its requirements can be found on the Package tab in the Grants.gov link headlining this item.  Click Preview under Actions, then Download Instructions.

Rural Health Opioid Program – July 21.  Rural health care providers (i.e., local health departments, hospitals, primary care practices, and substance abuse treatment providers) are eligible to apply for up to $250,000 per year for a three year program supporting treatment and recovery from opioid use disorder.  Successful applicants will form a consortium of at least three health providers in a network that coordinates care with other community-level entities such as social service providers, faith-based organizations and law enforcement.  To access more program information and application requirements, find the Package tab in the Grants.gov link above, click on Preview under Actions and then “Download Instructions.”  Watch this space for details on an upcoming webinar to assist applicants.

Grants for Socially-Disadvantaged Groups – July 25.  USDA Rural Development seeks applicants for the Socially-Disadvantaged Groups Grant (SDGG), a program offering up to $175,000 for technical assistance providers to benefit “group[s] whose members have been subjected to racial, ethnic, or gender prejudice because of their identity as members of a group without regard to their individual qualities.” Recent rural demography shows that racial and ethnic minorities represent a significant proportion of rural communities in the South (17% Black) and West (16% Hispanic and 10% American Indian or Alaskan Native). Eligible cooperative development centers, individual cooperatives, or groups of cooperatives in any area must serve socially-disadvantaged groups in rural areas with technical assistance activities to expand economic opportunities, such as feasibility studies, business plans, strategic planning, or leadership training.

Training Rural Teachers – July 28. The Department of Education (ED) seeks applications for the High School Career and Technical Education (CTE) Teacher Pathway Initiative to increase the supply of high school CTE teachers in states and communities with teacher shortages. The current shortage of teachers, particularly in rural areas, may limit capacity to deliver CTE programs for in-demand industry sectors or occupations, including health care. As research shows, education leads to health benefits for individuals, communities, and the larger society. ED will provide up to $900,000 for as many as seven applicants and is particularly interested in applications from rural school districts. Eligible applicants include state boards or agencies responsible for state CTE programs, school districts, area CTE schools, educational service agencies, or a consortium of these organizations. Of note, this program requires a cash or in-kind match of at least 20% of the amount requested from ED.

Rural Health  Research

For more rural health research and to receive updates on new reports, visit the Rural Health Research Gateway.

Rural and Urban Utilization of the Emergency Department for Mental Health and Substance Abuse Services. Researchers from North Dakota and NORC Rural Health Reform Policy Research Center looked at data from seven states to determine Emergency Department (ED) use for mental health and substance abuse services and describe differences among rural and urban areas.  Results indicate that ED utilization in rural communities is different from urban in ways that may impact cost of care and proposed interventions.

CMS Hospital Star Ratings: No Stars is the Problem for Rural Hospitals. The North Carolina Rural Health Research Center looked at the Hospital Quality Star Rating list published in April 2017, by the Centers for Medicare & Medicaid Services (CMS).  Stakeholders debate the list’s usefulness in comparing hospital quality, but little focus has been given to the large number of rural hospitals with no rating.  In this brief, researchers look more closely at the characteristics of rural hospitals with and without star ratings and explain why missing data is a barrier to assessing their quality.

Policy Updates

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

Comments Requested: Payment Changes for Medicare Clinicians – August 21.  On June 20th, CMS released a proposed rule for the second year of the Medicare Quality Payment Program (QPP) and seeks feedback from the public on changes to the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).  Major proposals of interest to rural stakeholders include exempting additional clinicians from MIPS by increasing the low-volume threshold for small practices, adding a bonus to the MIPS score for small practices and another for complex patients, allowing FQHCs and RHCs that voluntarily report to opt-out of sharing their data on Physician Compare, clarifying policies for participation in MIPS virtual groups, modifying the MIPS scoring criteria and payment adjustment, proposing policies for “topped-out” quality measures, updating Advanced APM scoring and risk standards, and giving more detail about how CMS will implement the All-Payer Combination Option for Advanced APM participation. Once the rule is officially published on June 30th, comments can be submitted online, by mail or delivered by hand/courier until August 21.  See events section below for information about an upcoming webinar hosted by CMS on Monday, June 26 to discuss these proposed changes.

Resources, Learning Events and Technical Assistance

Overview of Proposed Changes to Quality Payment Program – Monday, June 26 from 1:00 – 2:30 pm ET.  CMS will provide an overview of proposed changes to the Quality Payment Program with special consideration for small and rural practices.  See Policy Updates section above.

Application Assistance for Delta Region Health Systems Funding – Wednesday, June 18 at 1:00 pm ET.  FORHP project officers will explain the purpose of the Delta Region Health Systems Notice of Funding Opportunity (NOFO), provide guidance on the application process and answer questions.

Lessons Learned from the Rural Opioid Overdose Program – Wednesday, June 28 at 2:00 pm ET.  Program experts from FORHP will discuss outcomes and lessons learned from the 2015 Rural Opioid Overdose Reversal Program, a one-year project to expand access to emergency devices that reverse the effects of overdoses.

Training Series for Health Care Providers on Prescribing Opioids – Ongoing. The CDC has an eight-part online training series to help health care providers apply CDC’s prescribing 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. For this reason, the CDC created the 2016  Guideline for Prescribing Opioids for Chronic Pain and associated training. Topics in the series include communicating with patients, treating chronic pain without opioids, and prescribing decision making.

Save the Date and Register for 3RNet’s Annual Conference – September 12-14.  The National Rural Recruitment and Retention Network (3RNet) will hold its annual conference in Scottsdale, AZ. 3RNet members represent over 5,000 communities across the U.S. that actively recruit physicians and other health care providers to work in rural areas.  Attendees will benefit from workshops and a speaker line up sharing insight on rural recruitment challenges, resources and tools.

Approaching Deadlines

Comments Requested: Hospice Payment Rates and Policy – June 26
Comments Requested: Skilled Nursing Facility (SNF) Payment Rates –  June 26
Comments Requested: Inpatient Rehabilitation Facility (IRF) Payment Rates –June 27
Faculty Loan Repayment Program (FLRP) – June 29
Rural Health and Safety Education – June 30
Comments Requested: Developing Measures for Telehealth – June 30
Rural Health Experts Wanted – July 3
Building Communities of Recovery – July 3
Comments Requested:  HUD Healthy Homes Survey – July 3
Comments Requested: Universal Education for Opioid Prescribers – July 10
Comments Requested: Improving the ACA Insurance Market – July 12
CPC+ Expands to 4 New (Mostly Rural) Regions – July 13
Transitional Living Program/Maternity Group Homes – July 14
Delta Health Care Service Grant Program – July 17
Repair or Rehab Housing for Low-income Rural Residents – July 17
USDA Rural Telemedicine Development – July 17
Suicide Prevention – July 18
Community Facilities Technical Assistance Grant – July 24
Rural Community Development Initiative – July 25
Expanding Medication Assisted Treatment – July 31
First Responders to Opioid Overdose – July 31
Empowered Communities/Healthier Nation – July 31
Comments Requested: Interoperability Standards – July 31
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

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