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Announcements from the Federal Office of Rural Health Policy

September 27, 2017

What’s New

Roadmap to Behavioral Health.  A consumer guide that connects individuals to resources for disaster distress, suicide prevention, veterans crisis and recovery from substance use disorder was created by the Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA).  The guide provides simple explanations of feelings and behaviors that may need attention, a check list for getting help and treatment, and tips for managing long-term behavioral health care.  According to SAMSHA data from 2015, more than 18% of residents in non-metropolitan counties had some sort of mental illness in the previous year, which amounts to more than 6 million people.

CMS Reveals New Medicare Cards. CMS redesigned Medicare cards to include a unique, randomly assigned number in place of one’s Social Security number. Medicare beneficiaries can expect to receive their new card in the mail beginning in April 2018 and all cards must be replaced by April 2019. CMS will provide 21 months for health care providers and Medicare beneficiaries to transition to the new cards during which they can use either their current SSN-based Medicare number or their new Medicare number. Congress required new Medicare cards to prevent fraud and combat identity theft in the elder population. Rural hospitals can help by protecting facilities against malicious software attacks.

Effective Post-ER Suicide Prevention. Suicide is the tenth leading cause of death in the U.S. and varies by geography. Rural communities have higher rates of suicide than urban areas and the disparity has widened over time. Recent research supported by the National Institute of Mental Health showed that sending caring postcards or letters each month to at-risk patients following an emergency visit reduced suicide attempts and deaths and slightly reduced health care costs. Universal screening of ER patients for suicide risk could substantially increase the public health benefits of the post-ER postcard intervention and other prevention efforts. Additional resources on suicide prevention can help rural hospitals and other providers improve mental health care in their communities.

Funding Opportunities

For CAHs: Pediatric Readiness Quality Improvement – October 13.  The Emergency Medical Services for Children Program at HRSA requests applications from Critical Access Hospitals (CAHs) to participate in this initiative.  Participating hospitals will receive mentoring from the Pediatric Readiness Quality Collaborative (PRQC); physicians can earn Maintenance of Certification Part IV credit and nurses can receive Continuing Nursing Education credit. The PRQC will focus on pediatric patient safety, patient assessments, inter-facility transfer guidelines, and disaster preparedness. Using a train-the-trainer model, teams will be supported through targeted quality improvement education, the provision of tools and resources to support local efforts, and sharing of best practices.  The deadline to submit a letter of interest has been extended to October 13, 2017. More information about the Pediatric Readiness Quality Improvement Collaborative is at https://emscimprovement.center/collaboratives/PRQuality-collaborative/  Additional questions can be directed to qeca@texaschildrens.org.

Rural Health  Research

Cost-saving Benefits of Home Health Services in Rural America.  Because the elderly population in rural America is growing faster than its urban counterpart, researchers studied geriatric services provided in the home to better understand current challenges to a care delivery model that could raise quality and reduce costs. Among benefits, rural health innovators shared that integrating health care and social services helped them find resources available in the community and telehealth solutions helped to monitor patients in their home and respond quickly when their conditions changed.  A separate study on end-of-life hospice care in rural areas found that expanding these services could reduce the need for more expensive and inconvenient medical treatments.

Policy Updates

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

Comments Requested: PTAC on Payment Models – September 29.  The Physician-focused Payment Model Technical Advisory Committee (PTAC) has posted proposals for new Medicare payment models for public comment that contain features relevant to rural providers.  A rural ACO has proposed a payment solution for annual wellness billing at Rural Health Clinics (RHCs), and South Dakota-based Avera Health has proposed an alternative payment model for intensive care management in skilled nursing facilities (SNFs) that includes geriatrician-led telemedicine.  Email comments to PTAC@hhs.gov by September 29 for the RHC proposal and October 6 for the SNF proposal.

Comments Requested: Improving Care for Medicare Beneficiaries – November 20.  The CMS Innovation Center (CMMI) posted a Request For Information seeking public input on new guiding principles and payment reform models to promote patient-centered care and test market-driven reforms in Medicare.  This is an opportunity for rural providers and stakeholders to contribute their ideas on how to expand participation in Advanced Alternative Payment Models and what payment waivers would encourage innovative care delivery in rural areas.  Submit ideas through the online survey or email CMMI_NewDirection@cms.hhs.gov until November 20, 2017.

OIG Report Finds Inappropriate Medicare Payments to CAHs and Other Facilities. The Office of the Inspective General (OIG) at HHS found over $51 million in inappropriate Medicare payments for outpatient services provided to inpatients of other facilities, including rural Critical Access Hospitals (CAHs). Generally, Medicare should not pay an acute-care hospital for outpatient services provided to an inpatient of another facility. Instead, the services should be provided under arrangements between the two facilities, and Medicare should pay the inpatient facility for all services provided.  The OIG recommends that CMS recover overpayments and instruct those hospitals to refund beneficiaries for incorrect deductibles and coinsurance and that Medicare contractors educate hospitals on this policy.

340B Office of Pharmacy Affairs Information System is now available. Rural hospitals and other covered entities can now register through the 340B Office of Pharmacy Affairs Information System (340B OPAIS), that became available for all stakeholder use on September 18. The HRSA Office of Pharmacy Affairs transitioned to this new information system with upgraded security and user functionality features in August and early September, delaying annual 340B covered entity recertification and establishing guidance for states and territories under public health emergency. For help or answers to additional questions, contact the 340B Prime Vendor Program.

Resources, Learning Events and Technical Assistance

MAT in Groups for Opioid Use Disorder – Wednesday, September 27 at 3:00 pm ET.  The Seattle Indian Health Board will share insights on how the integration of behavioral health with primary care transformed into a group visit model to provide medication-assisted treatment (MAT) for opioid use disorder.  This webinar is hosted by HRSA’s  Office of Regional Operations (ORO) Region X in Seattle.

Physician Compare National Provider Call – Thursday, September 28 at 1:30 pm ET. The Medicare Learning Network hosts this 90 minute call to discuss and answer questions about Physician Compare, the online tool that allows Medicare beneficiaries to find and compare providers.  Patient satisfaction is one measure for improving health care quality in rural areas, and clinicians and practice managers joining this call can learn how to review their performance information before it is published.

#RuralHealthChat: Opioid Use in Rural Areas – Thursday, September 28 at 2:00 pm ET.  Research and policy experts (including FORHP’s Nisha Patel) will discuss why the opioid crisis is hitting rural areas harder, and innovative ways that communities are fighting back.  Join the latest in RHIHub’s TwitterChat series using hashtag #RuralHealthChat.

Non-Traditional Professionals Addressing Opioid Crisis – Thursday, September 28 at 3:00 pm ET.  HRSA’s Region X will also host this 90 minute webinar explaining how the ECHO program can extend expertise from urban areas to nurses, medical assistants and other paraprofessionals in remote locations to address the opioid crisis.

Preventing Adverse Drug Events – Thursday, September 28 at 2:00 pm ET.  Adverse drug events (ADEs) are injuries caused by medical interventions related to a pharmaceutical drug.  They include medication errors and allergic reactions and overdoses, and can be a challenge to identify in small rural hospitals where there is limited pharmacist support.  Two out of three ADEs are related to three specific types of drugs:  opioids, anticoagulants, or diabetes agents.  This one-hour webinar will discuss efforts by federal health agencies to track ADEs and reduce patient harm with the National Action Plan for Adverse Drug Event Prevention.

Medicaid Value-Based Payment Approaches – Thursday, October 5 at 3:00 pm ET.  CMS’s Medicaid Innovation Accelerator Program (IAP) is hosting a learning webinar on Medicaid value-based payment (VBP) approaches, including pay for performance, bundled payments, shared savings/shared risk approaches, and global payments.  It is an opportunity for rural providers and State Offices of Rural Health to learn more about state considerations for implementing VBP in Medicaid.

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.

Resource of the Week

Farm Safety and Health Webinar SeriesThe AgriSafe Network has made a series of Farm Safety Week webinar recordings on agricultural health subjects available to the public through October 13th.  Experts share their knowledge on preventing and treating heat and respiratory illness, safety for children and youth on farms, and mitigating injury and death on vehicles.  A more extensive library of resources is available to AgriSafe members, covering topics such as occupational safety, stress management and women’s health.

Approaching Deadlines

Comments Requested: Verifying CAHs Meet Medicare Requirements September 29
Comments Requested: PTAC on Payment Models – September 29
Nominate Experts for Rural Health Quality – September 29
USDA Loans for Rural Broadband – September 30
Health Care Transit Design Challenge – October 5
Comments Requested:  Cervical Cancer Screening – October 9
Research to Reduce Tobacco Use – October 11
For CAHs: Pediatric Readiness Quality Improvement – October 13
Small Rural Hospital Transition Project – October 16
Federal Investment in Rural Transportation – October 16
Comments Requested: CMS Cancels Cardiac Bundles – October 16
Comments Requested: CMS Revises Joint Replacement Bundles – October 16
Students to Service (S2S) Loan Repayment Program – October 19
Comments Requested: USDA Summer Meals Program – October 23
Address Suicide Research Gaps in Rural Communities  – November 2
Comments Requested: Rural Rental Housing Loans – November 13
Loan Repayment for Health Disparities Research – November 15
Comments Requested: Improving Care for Medicare Beneficiaries – November 20
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

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