Federal Office of Rural Health Policy Announcement

April 25, 2019

What’s New

ARC on the State of Health Disparities in Appalachia. The Appalachian Regional Commission (ARC) is a federal agency created by Congress to partner with state and local governments and promote economic development for the region. This month, the ARC released three separate issue briefs on health disparities in the 13 states of the region – Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. The briefs describe the factors unique to the region that contribute to disparities related to obesity, opioid misuse, and smoking, and provide recommendations and practical strategies for communities.

ONC Brief on Electronic Capabilities of Hospitals. The Office of the National Coordinator (ONC) reports that nearly all hospitals provided patients with the ability to electronically view and download their personal information in 2017. However, Critical Access Hospitals (CAHs) and small rural hospitals were less likely than larger and urban hospitals to be able to transmit that data and to have view, download, and transmit (VDT) capabilities. Under the Promoting Interoperability Program (PI), hospitals are required to use electronic health records technology. Another aspect of the program is to promote patients’ ability to view and download their personal health information. The cost of electronic health record systems and limited access to broadband are two of the barriers to electronic capabilities in rural health care settings. See the Policy Updates section below for requests for comment on recent proposals on electronic health information networks.

Funding Opportunities

New Sites for National Health Service Corps – May 30. Facilities approved by the National Health Service Corps (NHSC) provide comprehensive, primary health care services to populations living in a designated Health Professional Shortage Area in urban, rural, and frontier areas. If approved as an NHSC site, the facility can be listed on the NHSC Health Workforce Connector and viewed by hundreds of clinicians seeking employment in underserved areas.

Rural PREP Micro-research Grants – June 3. The Collaborative for Rural Primary care, Research, Education, and Practice (Rural PREP) will provide small seed grants of up to $4000 each to conduct micro-research projects that seek local solutions to health problems in underserved rural communities. See the Learning Events section below for more information about the work of Rural PREP.

Environmental Workforce Development and Job Training – June 10. The Environmental Protection Agency (EPA) will invest $4 million to recruit, train, and place new workers in the environmental field. Eligible applicants include state and local governments, nonprofit organizations, and Land Clearance Authorities that can develop curricula and deliver comprehensive training in brownfield assessment and cleanup activities. Applicants are encouraged to assess their local labor market and focus training and recruitment on unemployed and underemployed residents. Environmental health and employment are social factors essential to staying healthy, yet challenges exist in rural areas. Between 2010 and 2017, EPA awarded 2 percent of all competitive brownfields grants to tribal recipients; 13 percent to recipients from communities under 10,000 people; 23 percent to recipients from communities under 20,000 people; and 56 percent to recipients from communities under 100,000 people.

USDA Local Food Promotion Program – June 18. The U.S. Department of Agriculture (USDA) will make 60 awards of up to $100,000 each to fund projects connecting agricultural producers to local consumers. The Local Food Promotion Program supports two project types: 1) planning projects that may be conducting a feasibility study, devising a business plan, or hiring experts; and 2) implementation projects used to establish or improve existing food business that support local agriculture.

Rural Health Research

Differences in Care Processes Between Community-Entry Versus Post-acute Home Health for Rural Medicare Beneficiaries. Medicare beneficiaries may be admitted to home health following an inpatient stay (post-acute) or directly from the community (community-entry). An analysis of Medicare data for rural, fee-for-service Medicare beneficiaries who utilized home health from 2011 to 2013 found significant differences in care processes between community-entry and post-acute home health. Compared to post-acute home health episodes, community-entry home health episodes on average were longer; less likely to include physical, occupational, and speech therapy visits; more likely to include medical social work visits; and less likely to be initiated on the physician-ordered start date or within two days of referral. Results suggest community-entry and post-acute home health are serving different needs for rural Medicare beneficiaries, which provides preliminary support for distinguishing between the two types of episodes in payment policy reform.

Policy Updates

Visit the FORHP Policy page to see all recent updates and send questions to ruralpolicy@hrsa.gov.

Comment Period Extended: Proposed Rules to Promote Interoperability of Health IT – June 3. In February of this year, the U.S. Department of Health & Human Services (HHS) announced two proposed rules to support the seamless and secure access, exchange, and use of health information among electronic heath information networks, a goal known as interoperability. Together, these proposals would address factors that create barriers to interoperability and limit access essential health information. Use of electronic health records can improve the quality of care by giving providers information about their patients and helping them find the best possible treatment. In a recent study, HHS found that 94 percent of hospitals used electronic health records to inform their clinical practice, but small, rural and Critical Access Hospitals had the lowest rates for using electronic records. In response to feedback from the public, HHS has extended the comment period by one month past its original deadline of May 3.

Comments Requested: Trusted Exchange Framework for Electronic Health Information – June 17. The Office of the National Coordinator for Health Information Technology (ONC) is seeking feedback from the public on their second draft of the Trusted Exchange Framework and Common Agreement. This document outlines a common set of principles, terms, and that would enable a nationwide exchange of electronic health information.

Comments Requested: Proposed Changes to Payment and Policy for Inpatient Psychiatric Facilities – June 17. On April 18, CMS displayed the Fiscal Year (FY) 2020 Inpatient Psychiatric Facilities Propose Rule (CMS-1712-P). CMS is proposing to increase the payment rates by $75 million this year. CMS is also proposing to continue the 17 percent payment adjustment for IPFs located in rural areas that has been in place since 2004.

Comments Requested: Proposed Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities – June 17. On April 17, the Centers for Medicare & Medicaid Services (CMS) proposed a rule that would update Medicare payment policies for facilities under the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the Inpatient Rehabilitation Quality Reporting Program (IRF QRP) for fiscal year (FY) 2020. CMS projects that rural IRF payments overall will increase by 4.3 percent for FY 2020, relative to payments in FY 2019.

Comments Requested: Proposed Update to Hospice Payment Rate – June 18. On April 19, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that rule would, among other things, update the hospice payment rates, wage index, and cap amount for fiscal year (FY) 2020. As proposed, rural hospice payment rates are updated by 2.1 percent overall for FY 2020.

Comments Requested: Proposed Payment and Policy Changes for Medicare Skilled Nursing Facilities – June 18. Last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for fiscal year (FY) 2020 that updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs). CMS’ Patient Driven Payment Model, focused on value rather than volume, will be effective October 1, 2019 under the SNF Prospective Payment System. CMS projects aggregate payments to rural SNFs will increase by 6.4 percent, for FY 2020 compared to FY 2019.

HHS and CMS Announce New Value-Based Care Initiatives. This week, the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced the CMS Primary Cares Initiative. Administered through the CMS Innovation Center, the new initiative will provide primary care practices and other providers with five new payment model options under two paths: Primary Care First (PCF) and Direct Contracting (DC). Both models provide incentives to reduce hospital utilization and total cost of care by adjusting payments to providers’ performance. While the PCF models focus on individual primary care practice sites, the three DC payment model options aim to engage a wider variety of organizations that have experience taking on financial risk and serving larger patient populations. Last year, the RUPRI Center for Rural Health Policy Analysis and Stratis Health published a policy brief on the priorities of rural health leaders about value-based payment models.

Final Rule for Health Insurance Benefit and Payment Parameters. Last week, the Centers for Medicare & Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters for the 2020 benefit year, a document that sets forth instructions to insurers participating in the Health Insurance Exchanges or “Marketplaces”. Among the changes for 2020 are flexibilities related to the duties and training requirements for the Navigator program and opportunities for innovations in the direct enrollment process. In 2018 and 2019, the percentage of enrollments in the federal exchange (healthcare.gov) by rural residents remained unchanged at 18 percent.

Learning Events and Technical Assistance

Rural PREP Grand Rounds: Live Where You Work – Thursday, April 25 at 1:00 pm ET. The Collaborative for Rural Primary care, Research, Education, and Practice (Rural PREP) hosts this one-hour web event to discuss the benefits and challenges of both living and working in underserved areas. Stories of physicians who do this in rural areas will be shared, as well as advice for residents considering living in the community where they are serving.

Help for Applying to USDA Broadband Program – Friday, April 26 at 1:00 pm ET. The U.S. Department of Agriculture (USDA) will hold a number of events to provide assistance to applicants to its ReConnect Loan and Grant program (due May 31). Through this program, the USDA is making available up to $600 million in grants and low-interest loans to help fund broadband infrastructure in rural communities. Friday’s technical assistance event is online and two regional events – in Auburn, Alabama and Alexandria, Minnesota – will take place in May.

Great Plains Telehealth Resource Conference – April 28-30. Registration is still open for the 2019 annual conference held in Bloomington, Minnesota by the Great Plains Telehealth Resource and Assistance Center (gpTRAC). The two-day event will feature a variety of exhibitors and presenters covering topics such as telehealth in substance use treatment programs and developing a curriculum for nurse training programs. The gpTRAC is one of 12 regional and two national Telehealth Resource Centers supported by the Office for the Advancement of Telehealth in HRSA’s Federal Office of Rural Health Policy.

The Changing Burden of Diabetes in Rural and Urban U.S. – Monday, April 29 at 12:00 pm ET. Though diabetes is one of the leading causes of the death in the U.S., research suggests that the burden of disease varies considerably between residents in rural and urban settings. This hour-long webinar hosted by the Rural Health Research Gateway will provide an in-depth look at how the burden of diabetes has changed over time.

NAM: Collaborative for Countering the Opioid Epidemic – Tuesday, April 30 at 9:00 am ET. The National Academy of Medicine (NAM) will hold a public meeting to discuss its collaboration with more than 55 organizations. The four-hour event will take place at the National Academies building in Washington, DC, and will be viewable online.

Assistance for Applicants to RMOMS Funding – Tuesday, April 30 at 2:00 pm ET. The Health Resources and Services Administration (HRSA) will hold a webinar to assist applicants to the Rural Maternity and Obstetrics Management Strategies (RMOMS) Program. This new grant program will be an investment of $1.8 million in three health networks to test models that improve obstetrics services in rural areas. Call-in number: 888-603-9810; participant code: 9971486. For more information, email RMOMS@hrsa.gov.

HRSA Telehealth Learning Series: Teledentistry – Thursday, May 2 at 1:00 pm ET. The Health Resources and Services Administration (HRSA) will host this 60-minute webinar on the Use of Telehealth to Increase Access to Dental Care. Speakers from Children’s Dental Services and the University of the Pacific will discuss best practices in reducing oral health disparities in rural communities through dental therapy and telehealth innovations as well as the methodology and results of the Virtual Dental Home system developed in California and now deployed in multiple states. Contact Nancy Rios at NRios@hrsa.gov for more information about the session. Archived sessions of the HRSA Telehealth Learning Series can be found online.