What’s New
Friday is World AIDS Day. This commemoration that takes place on the 1st of December each year comes at a turning point in the ongoing narrative of HIV/AIDS. In September, the Centers for Disease Control and Prevention (CDC) announced that, for the first time in the four-decade history of the Human Immunodeficiency Virus (HIV), individuals who take daily medication to suppress the virus have effectively no risk of sexually transmitting to an HIV-negative partner. Advocates believe this will bring a change in the perception of what it means to be HIV-positive and reduce barriers to getting tested and treated. Early stage HIV can be asymptomatic, and about 40% of new HIV infections come from people who don’t know they have HIV, including heterosexual men and women at increased risk and people who inject drugs. In rural areas, persons living with HIV/AIDS face additional barriers that limit access to testing, treatment and ongoing care. Earlier this year, the CDC issued a map showing that, while the majority of HIV diagnoses in the U.S. are in urban areas, there are parts of the country where the rates are surprisingly high for suburban and rural areas. These include the South, where 23% of new HIV diagnoses are suburban/rural, and the Midwest where 20% are urban/rural.
This week’s Funding section covers previously mentioned opportunities that are still open and may help providers with HIV/AIDS care in rural communities.
Funding Opportunities
Public Health Crisis Response – December 11. The Centers for Disease Control and Prevention (CDC) is seeking applications from public health departments in tribal, state and local governments for cooperative agreements meant to enhance their ability to rapidly mobilize and respond to specific public health emergencies. These emergencies may include infectious disease outbreaks, pandemics, and other public health emergencies that exceed jurisdictional capacity and resources. Awardees would be approved but unfunded until a crisis occurs, enabling them to plan for emergency activation activities. Eligible applicants must have an existing capacity and infrastructure to provide the CDC’s 10 essential public health services, which include a process and protocol to reach rural or isolated populations.
New Geographic Service Areas for HIV Intervention – January 2. Current grantees and new organizations proposing services for People Living With HIV (PLWH) may apply for funding through the Ryan White HIV/AIDS Part C Early Intervention Services (EIS) Program. The purpose of the EIS program is to provide comprehensive primary health care and support services in an outpatient setting for low income, uninsured, and underserved PLWH. Eligibility includes Rural Health Clinics and community-based organizations. Successful applicants will provide HIV testing, medical evaluation, counseling and treatment, among other services. For more information, contact Hanna Endale at hendale@hrsa.gov.
Policy Updates
Questions about Rural Health Policy Updates? Write to ruralpolicy@hrsa.gov
Comments Requested: CMS Letter to Insurers – December 11. CMS has released a draft of its updates and guidance to insurers seeking to offer qualified health plans on the federal health insurance marketplace in 2019. For rural providers operating in medically underserved areas that qualify as Essential Community Providers (ECPs), such as Rural Health Clinics, Federally Qualified Health Centers, Critical Access Hospitals, CMS proposes to continue to collect ECP information through the petition process and to allow insurers to write-in ECPs until the final application deadline in August 2018. Send comments on the letter to FFEcomments@cms.hhs.gov.
FCC Proposals for Rural Telehealth. The Federal Communication Commission (FCC) just proposed an update to the Rural Health Care Program (RHC). This program provides up to $400 million each year to fund broadband and telecommunications for public and non-profit health care providers serving rural areas across the country. In 2016 and again likely in 2017, demand exceeded the $400 million cap and the FCC is proposing changes to meet demand within the funding limit. Among several changes, proposals include an increase in the cap, prioritizing funding requests based on need and other parameters, redefining standards of cost-effectiveness, and simplifying the application process. One section of the document (beginning on page 36, paragraph 103) seeks to immediately address 2017 funding requests. This section of the notice is an Order that would waive FCC rules for the program to 1) roll forward unused funds from previous years with priority for rural providers not participating in an HCP buying consortium, and 2) encourage broadband/internet service providers to voluntarily lower their rates for program participants in order to ease the cost burden on health care providers caused by any 2017 funding shortfall. The FCC will vote at their Dec 14, 2017 meeting to issue a Notice of Proposed Rulemaking (NPRM) that will require a 30-60 day period for public comment on proposed reforms. They will also vote to implement the Order to waive rules to permit funding roll-forward and service cost-reduction by vendors. If the NPRM and Order are passed, FORHP will convene a call for interested rural health care providers to help them understand the issues and consider their response to these actions.
CMS Updates Hospital Policy for Inpatient Services – CMS recently updated guidance to provide clarification related to hospital inpatient services. In order to participate under Medicare and Medicaid, a hospital (but not a critical access hospital) must meet the statutory provisions of §1861(e) of the Social Security Act. Through this guidance, CMS further clarifies that in order for a hospital to be “primarily engaged” in inpatient services, the hospital must formally admit a patient as an inpatient with the expectation that he or she will require hospital care that is expected to span at least two midnights. Therefore, an average length of stay of two midnights would be one of the benchmarks considered for certification as a hospital. This policy guidance applies to rural hospitals (but not Critical Access Hospitals) subject to section 1861(e)(1) of the Social Security Act. For more information, see the CMS memo to State Survey Agency Directors.
Resources, Learning Events and Technical Assistance
EHR Hospital Transition Overview – Tuesday, December 5 at 1:00 pm ET. Medicare eligible hospitals and Critical Access Hospitals (CAHs) that formally certify for the Electronic Health Record (EHR) Incentive Program will transition to a new platform, the QualityNet Secure Portal (QNet) beginning January 2, 2018. At this 90-minute webinar, CMS will provide an overview of the transition and instructions on how to register, attest, and submit objectives and measures.
Making Pharmacy Services Accessible – Thursday, December 7 at 1:00 pm ET. The AgriSafe Network will hold a one-hour webinar about clinical pharmacy services in rural communities and describe how students of health professions schools are being trained to provide health care outreach in rural areas .
Rural Health Clinics (RHCs) Technical Assistance – Wednesday, December 13 at 2:00 pm ET. This webinar will provide an overview of RHC best practices. Several topics will be covered such as: using quality tracking tools and mock surveys; describing a streamlined chart review process incorporating Physician Assistant and Nurse Practitioner review; formatting an “evidence binder” of the documents needed during a survey and showing how to keep this updated and current; Incorporating mental health policies and procedures; discovering a staffing model that decreases call-out rates and helps with coverage; and learning how to get providers to adopt standardization, and to share improvements. Dial-in information will be made available at the link above on the day of the session. This webinar will also be recorded.
Webcast: Mental Illness Committee Meeting – Thursday, December 14 at 10:30 am ET. The Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC), which includes Federal and non-Federal members, will discuss advances related to serious mental illness and serious emotional disturbance as well as rural-relevant topics, such as the effect of federal programs on the quality of mental and substance use disorders treatment services. The public can attend via telephone or webcast. To obtain the call-in number, submit comments, or request special accommodations, email ismicc@samhsa.hhs.gov.
Resource of the Week
North Carolina – Rurally Engaging and Assisting Clients Who Are HIV Positive (REACH). Earlier this year, the National Rural Health Association recognized NC REACH as its Outstanding Rural Health Program winner for 2017. The organization focuses its efforts on HIV-positive individuals with mental health and/or substance abuse disorders who are homeless or unstably housed. In this three-minute video, organization leaders explain how they help people in their rural community get to medical appointments, make sure their treatment is up to date, and navigate their way through the complexities of the health care system.
Approaching Deadlines
Comments Requested: PACE Quality Measures – November 30
Support for Rural Financial Institutions – November 30
Revitalize Rural Rental Housing – December 1
MIPS Virtual Group Election – December 1
USDA Community Food Projects – December 4
Recertify in 340B Drug Pricing Program – December 6
Rural Health Care Services Outreach Program – December 6
Enrollment for 2018 Medicare Advantage and Prescription Drug Plans – December 7
Comments Requested: CMS Letter to Insurers – December 11
Public Health Crisis Response – December 11
Improve Tribal Road Safety – December 11
Rural Utilities Service Assistance for Communities – December 11
Deadline for Health Insurance Enrollment – December 15
Assessment for Preventing Medical Errors – December 15
Improving Rural Community Airports – December 15
New Geographic Service Areas for HIV Intervention – January 2
Nominations: HHS Advisory Committee on Minority Health – January 3
Researching Health Behavior for Young People – January 7
Treasury Loans for Rural Economic Development – January 9
Comments Requested: Changes to Medicare Advantage/Part D Plans – January 16
Preventing Intimate Partner Violence – January 16
Training Nurses for Primary Care – January 29
Training and Enhancement – Primary Care Physicians and PAs – January 30
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