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Announcements from the Federal Office of Rural Health Policy

December 21, 2017

What’s New

FCC Proposals for the Rural Health Care ProgramOn December 14, leadership at the Federal Communications Commission (FCC) met to discuss changes to the Rural Health Care Program (RHC), which provides up to $400 million every year to support telecommunications for health care delivery in rural and underserved areas of the country. Among issues that were up for consideration in last Thursday’s discussion and in the resulting Notice of Proposed Rulemaking (NPRM) are changes that could become a turning point in the way Americans living in rural areas get access to health care.  Each of the statements released by FCC Commissioners referenced the potential for rural telehealth to dramatically change outcomes in areas where residents are typically older, sicker and lacking basic care.  The Telecom Program, a component of the RHC Program that subsidizes rates for rural telecommunications services, has not seen any significant changes since it was mandated by Congress in 1997.  At this time, the FCC seeks to make the program more effective and put in place measures to guard against waste, fraud and abuse.  Once the NPRM is published in the Federal Register, the FCC will open a 30-day window for public comment.  Watch this space for more information about these changes and how rural stakeholders can provide input in the coming days.

Contact the Marketplace Call Center for a Special Enrollment PeriodWhile enrollment for health insurance through the Federal Marketplace has ended, consumers affected by natural disasters in Georgia, South Carolina, Florida, Alabama, Mississippi, Texas, and Maine may qualify for an extended enrollment period.  Also, as the number of insurers offering health plans, especially in rural areas, has decreased, consumers who lost coverage because their insurer no longer offers coverage in their area may qualify for a special enrollment period.  Contact the Marketplace call center to find out if you qualify for an extended, or special, enrollment period.  Consumers in DC, Connecticut, Maryland, Rhode Island, Colorado, Minnesota, Washington, Massachusetts, California, and New York should contact their state-based exchange to determine the end of their enrollment period.  

Forecast: Rate of Alzheimer’s Expected to Increase. A new study published in The Journal of the Alzheimer’s Association calculates that approximately 6 million adults in the U.S. currently have the disease or mild cognitive impairment that can be a precursor.  With funding from the National Institutes of Health, scientists discovered that, when accounting for numbers of people with biomarkers or other evidence of possible preclinical disease, they can predict that the number of people living with Alzheimer’s will double to 15 million by 2060.  Previous research from the Alzheimer’s Association has shown that three socioeconomic factors – low income, low education attainment, and having lived in a rural area as a child – are associated with greater risk of developing Alzheimer’s and other dementias.  Search for dementia and/or Alzheimer’s on the Rural Health Information Hub for evidence-based projects, toolkits and other resources on these subjects.  For health care providers and health professions educators, HRSA’s Bureau of Health Workforce recently published a training curriculum for Alzheimer’s disease and related dementias, with 16 learning modules for effective disease management and care.

Funding Opportunities

Pro Bono Legal Services – Letters of Intent – January 8. The U.S. Congress provided the nonprofit Legal Services Corporation (LSC) with nearly $4 million for the 2018 Pro Bono Innovation Fund (PBIF) to be awarded to existing grantees with new, innovative projects to increase free legal aid services for lower-income clients.  LSC funds more than 130 legal services organizations around the country, including several PBIF awards in 2017 for legal aid in rural communities.  To apply for 2018 funding, applicants must submit a Letter of intent by January 8, 2018.  Medical-legal partnerships integrate legal assistance into health care settings with the goal of eliminating social and economic barriers to health care and improving the health of vulnerable, underserved populations. Health care providers may consider encouraging their local legal service organization to submit a letter of intent to apply for PBIF funding that can be used to fund a rural medical-legal partnership.  Learn more about how rural health networks integrate medical-legal partnerships into chronic care and see the events section below for a HRSA webinar on January 9th.

Policy Updates

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

Comments Requested: Revised Head Start Quality Measures – February 6. The U.S. Department of Health and Human Services (HHS) has proposed changing the thresholds for observed emotional support, classroom organization, and instructional support in Head Start and Early Head Start classrooms.   Agencies failing to meet these and other established standards of high-quality, comprehensive services must reapply for further funding.  Studies show that Head Start children display fewer behavioral problems and experience better overall health but early childhood programs in rural areas face continuing challenges meeting performance standards.  Rural health care providers should be aware of their high-quality local Head Start and Early Head Start programs as well as other child care and early education options.  Rural health leaders may also consider collaborating with early childhood educators to help address childhood obesity, as in Kansas, Maine, and New York.

Comments Requested: USDA Child Nutrition Programs – February 12.  The U.S. Department of Agriculture (USDA) invites public stakeholders to submit ideas on what foods are allowed in the Child and Adult Care Food Program, National School Lunch Program, and other child nutrition programs.  Program meals must conform to the most recent Dietary Guidelines for Americans and current nutrition research as well as specific program standards that encourage children to build balanced, nutritious meals.  Improving rural children’s access to nutritious foods may help reverse higher rates of overweight and obesity relative to their urban peers.  USDA asks commenters to respond to questions such as (1) Are certain nutrients more important than others when determining if a food is allowed? or (2) What other factors should UDSA consider to determine which foods are allowed?  Rural health care providers may also consider additional strategies and efforts to help increase access to healthful foods in their communities.

Comments Requested: FDA Opioid Prescribing Guidelines – March 16.  The Food and Drug Administration (FDA) established the Opioid Policy Steering Committee (OPSC) to explore and develop strategies to combat the opioid crisis.  OPSC will hold a public meeting on January 30 to collect stakeholder input on new approaches FDA might adopt to promote the safe use of opioid painkillers and reduce overprescribing that may contribute to new addiction.  New ideas may benefit rural communities where CDC research shows rates of prescription opioid misuse and overdose death are highest.  Comments will be accepted through March 16.  Rural health care providers may also consider implementing promising strategies and models for preventing and treating opioid misuse.

CMS Seeks Hospitals to Test Patient Safety Measures. CMS has developed multiple measures of adverse patient safety events that can be improved with high-quality care, on including hypoglycemia, hospital-acquired pressure injury, opioid-related adverse events, and acute kidney injury.  Participating hospitals will submit patient data extracted from electronic health records (EHR) and will receive feedback reports on data verification and rates of patient harm.  Testing these measures may inform future rulemaking about their implementation.  Greater rural participation can help ensure the measures are feasible and relevant in rural settings.  Interested hospitals should contact Shari Glickman or Kirsten Barrett for more information.

Resources, Learning Events and Technical Assistance

Register for NOSORH Grant Writing Institute – Deadline is January 3, 2018.  The National Organization of State Offices of Rural Health will host a series of online learning sessions that inform grant writing for rural health funding.  The series is intended for novice grant writers who will learn how to research and draft winning proposals from a variety of agencies.  Class size is limited so register before the January 3rd deadline.

Medical-Legal Partnership in Action – Tuesday, January 9 at 2:00 pm.  This 90-minute HRSA webinar will help participants understand medical-legal partnerships and discuss opportunities for engagement between health providers and civil legal aid offices.  Presenters will include subject experts from HRSA, The National Center for Medical-Legal Partnership, and the Montana Primary Care Association with a presentation on how they provided legal assistance despite the rural location of health providers.  See the Funding Opportunities section above for more information and resources for medical-legal partnership in rural communities.

Strategies to Combat Opioid Use in Rural Communities – Thursday, January 18 at 2:00 pm ET.  This one-hour webinar hosted by the FORHP-funded Rural Health Research Gateway will  discuss cost-effective, evidence-based prevention, treatment, and recovery programs that have been successfully implemented in rural communities. It will conclude by describing community organizing strategies to engage a wide range of local stakeholders to reduce the burden of opioid use.

National Drug and Alcohol Facts Week – January 22-28, 2018.  Start planning now for this week-long event aimed at raising teenagers’ awareness and knowledge of facts about drug and alcohol. Launched in 2010 by scientists at the National Institute on Drug Abuse (NIDA), the annual observance relies on locally-planned school and community events that present scientific facts about drug and alcohol use, what causes addiction, and evidence-based strategies for helping friends or family.  NIDA provides an online guide for planning and promoting events, as well as free booklets and other resources for teens.  Recent research has shown that roughly 10% of rural teens meet criteria for alcohol use disorder, and that rural areas have a higher rate of drug overdose deaths.

Approaching Deadlines

Deadline to submit Essential Community Provider (ECP) Petition – December 22
Comments Requested: USDA Revises Telemedicine Grant Program – December 27
New Geographic Service Areas for HIV Intervention – January 2
Register for NOSORH Grant Writing Institute – January 3
Nominations: HHS Advisory Committee on Minority Health – January 3
Researching Health Behavior for Young People – January 7
Pro Bono Legal Services – Letters of Intent – January 8
Treasury Loans for Rural Economic Development – January 9
Nominations: Experts for Improving MIPS – January 12
Public Health Leadership Academy – January 12
Comments Requested: Changes to Medicare Advantage/Part D Plans – January 16
Preventing Intimate Partner Violence – January 16
Preventive Medicine Residency Program – January 26
Comments Requested: Rules for School Lunches – January 29
Training Nurses for Primary Care – January 29
Comments Requested: DOL Updates Senior Employment Program – January 30
Training and Enhancement – Primary Care Physicians and PAs – January 30
PCORI  Engagement Awards – February 1
Understanding Vaccination Coverage in Rural Areas – February 13
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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