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Federal Office of Rural Health Policy Announcements

November 8, 2018

What’s New

Federal Resource Guide for Substance Use Disorder in Rural Communities. This comprehensive guide was created specifically for rural communities facing substance use disorder and opioid misuse.  It organizes federal grant programs and resources by 26 categories that include prevention, treatment and recovery, but also include social services, employment, economic development, transportation and justice.  The guide was created by the Rural Opioid Federal Interagency Working Group to help address the opioid crisis by improving coordination of and reducing potential overlap among the Federal responses in the nation’s rural communities.  Last year, the Centers for Disease Control and Prevention (CDC) issued data showing that the rate of drug overdose deaths in rural areas surpassed the rate in urban areas

Funding Opportunities

Grants for Early Head Start Child Care in Low-Income Communities – November 30.  The Administration for Children and Families (ACF) will award $140 million to expand access to high-quality, comprehensive services to families of low-income infants and toddlers through Early Head Start-Child Care (EHS-CC) Partnerships, or through the expansion of Early Head Start services. Eligible applicants include public entities, private non-profit organizations, including community-based or faith-based organizations, and for-profit agencies.  Separate funding opportunities are available for specific minority populations in rural areas: Head Start Child Care in Migrant and Seasonal Communities, and  Head Start Child Care for American Indian/Alaska Native Communities, both with November 30 deadlines.  According to the Economic Research Service at the U.S. Department of Agriculture, more than 1 in 4 rural children are living in families that are poor.

NHSC: Students to Service Loan Repayment Program – December 20.  The National Health Service Corps (NHSC) awards up to $120,000 to medical and dental students in their final year of school in exchange for a three-year commitment to providing primary care services at NHSC-approved sites in rural and underserved areas.  Review the 2019 Application and Program Guidance for more information on how to apply. In FY 2018, nearly 80 students were placed and are providing primary care services in rural areas through the NHSC Student to Service Loan Repayment Program.

Policy Updates

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

Comments Requested: Expanding Telehealth for Substance Use Disorder Treatment – December 31. As part of the Medicare Physician Fee Schedule and Quality Payment Program final rule, CMS incorporated an Interim Final Rule to implement part of the SUPPORT of Patients and Communities Act addressing Medicare telehealth provisions. This includes removing the originating site geographic requirements and adds the home as an originating site for the treatment of a substance use disorder or co-occurring mental health disorder on or after July 1, 2019. Additionally, the SUPPORT for Patients and Communities Act establishes a new Medicare benefit category for opioid use disorder treatment services furnished by opioid treatment programs (OTP) under Medicare Part B, beginning on or after January 1, 2020.

Medicare Clinician Payment Policies Finalized. On November 1, CMS finalized updates to Medicare’s payment of clinicians for calendar year 2019 under the Physician Fee Schedule (PFS) and the Quality Payment Program (QPP). Highlights under the PFS for rural providers include new virtual communication services billable by clinicians and RHCs/FQHCs, the addition of two new telehealth codes for prolonged preventive services, telehealth updates for ESRD and acute stroke, practice flexibility for radiologist assistants, and updates to evaluation and management payment in 2021 and documentation in 2019. Updates to the QPP’s Merit-Based Incentive Payment System (MIPS) include an expansion of eligible clinician types (physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists, and registered dieticians or nutrition professionals), a new element added to the low-volume threshold (200 covered professional services under the PFS), an opportunity for eligible clinicians to opt-in to MIPS, updates to health IT policies to promote interoperability, and an increased contribution of cost to the overall MIPS score (15 points). The final rule also covers some provisions related to the Medicare Shared Savings Program including a reduction in the number of quality measures and a six-month extension for existing ACOs with participation agreements expiring on December 31.

CMS Delays Finalizing Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health AgenciesOn November 3, 2015, CMS published a proposed rule, “Medicare and Medicaid Program; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals (CAHs), and Home Health Agencies (HHAs)” that would update the discharge planning requirements for hospitals, CAHs, and HHAs and implement the discharge planning requirements of the IMPACT Act of 2014 (Pub. L. 113-185).  In general, CMS must finalize Medicare rules within 3 years; however, CMS needs more time to address issues raised by public comments in the proposed rule.  Therefore, CMS is extending the timeline for publication of the final rule until November 3, 2019.

Medicare Outpatient Payment Policies FinalizedOn November 2, CMS finalized updates to the Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Care Center (ASC) Payment System for 2019.  In addition to updating payment rates, the rule continues the 7.1 percent adjustment to OPPS payments for certain rural Sole Community Hospitals (SCHs), including Essential Access Community Hospitals (EACHs). It finalizes a method to control increases in hospital outpatient department services by applying a Physician Fee Schedule (PFS)-equivalent payment rate for the clinic visit service when provided at an off-campus provider-based department (PBD) that is paid under the OPPS.  It also removes nine quality measures from the ASC and hospital outpatient department quality reporting programs.

CMS Updates Home Health Payments and Policy –  CMS displayed its final rule for calendar year (CY) 2019 updates to payment rates and rules for home health agencies.  Over 1,100 comments were received on the proposed rule. In addition to a payment rate increase of 2.2 percent ($420 million), which rural areas will experience as 2.4, the final rule makes changes to the methodology for rural add-on payments mandated by statute, proposes case-mix methodology refinements to be implemented for home health services beginning January 1, 2020, and changes the unit of payment from 60-day episodes of care to 30-day periods of care. Also of interest for rural areas, CMS updated the definition of remote patient monitoring which can now be included as an allowable operation expense; changed requirements for accrediting organizations to ensure access to and burden reduction for small or rural non-certified providers and suppliers; and established health safety standards and transitional payment for qualified home infusion therapy suppliers.

CMS Updates Dialysis and Durable Medical Equipment Payments and Policy – CMS displayed its final rule for calendar year (CY) 2019 updates to payment rates and rules for providers of dialysis services and durable medical equipment. Over 150 comments were received on the proposed rule. In addition to a payment rate increase of 1.3 percent for providers of dialysis, the final rule also makes updates to the competitive bidding program (CBP) for Durable Medical Equipment, Prosthetics, and Oxygen Suppliers (DMEPOS). CMS finalized an increase in DMEPOS fee schedule rates using a blend of adjusted and unadjusted fee amounts to protect access to needed durable medical equipment in rural areas that are not subject to the DMEPOS CBP. Rural providers of dialysis for end-stage renal disease will experience the payment increase as the full 1.3 percent, and rural providers of dialysis for acute kidney injury will experience the payment increase as 1.0 percent.

Resources, Learning Events and Technical Assistance

Rural America at a Glance – Thursday, November 8 at 1:00 pm ET.  In this hour-long webinar, experts from the Economic Research Service (ERS) at the U.S. Department of Agriculture (USDA) will highlight the most recent indicators of social and economic conditions in rural areas, focusing on how population change, employment growth, and poverty levels vary by race/ethnicity, as well as trends in rural aging. The ERS releases the Rural America at a Glance report annually, to summarize the status of conditions and trends in rural areas.

The Health and Economic Concerns of Rural Americans – Friday, November 9 at 12:00 pm ET.  In October, the Robert Wood Johnson Foundation (RWJF) teamed with National Public Radio to issue their report on economic and health issues in rural communities.  In this hour-long webcast, a panel of experts will explore the public health and policy implications of these findings within the broader context of life in rural America.

DOJ Rural and Tribal Justice Elder Summit – November 14-15, Des Moines, Iowa.  The U.S. Department of Justice (DOJ) will hold this two-day summit with a focus on combatting elder abuse, neglect, and financial exploitation in rural and tribal communities.  The initiative aims to connect tribal, state and federal efforts by identifying promising practices and opportunities for public/private partnership.

Combating the Opioid Crisis: Addressing Stigma – Thursday, November 15 at 9:00 am ET.  In this hour-long webinar, experts from the New York State Department of Health and the Peer Network of New York will provide an overview of how stigma negatively affects people who use drugs and provide strategies for reducing stigma as key strategy for addressing the opioid crisis.  Earlier this year, a report commissioned by the Appalachian Regional Commission identified stigma as one of the key barriers to addressing the crisis in rural areas.

FORHP Celebrates National Rural Health Day – Thursday, November 15.  As it does every year, the Federal Office of Rural Health Policy (FORHP) will join the National Organization of State Offices of Rural Health (NOSORH) in recognizing the challenges and accomplishments of delivering health care to rural communities.  FORHP activities this year include online events with federal partners at the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS).  A Twitter Chat hosted by @HRSAgov will have an open Q&A on the benefits and barriers to implementing telehealth in rural areas.

Addressing Reproductive and Sexual Health – Thursday, November 15 at 12:00 pm ET.  Healthy People 2020 Reproductive and Sexual Health Leading Indicators provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans, including those living in rural areas. The Leading Health Indicators (LHIs) represent a smaller set of Healthy People 2020 objectives selected to communicate high-priority health issues and actions to help address them. Services for reproductive and sexual health improve overall health and reduce costs by providing pregnancy prevention, HIV and STD testing and treatment and prenatal care.  They also create an opportunity to screen for intimate partner violence and reproductive cancers, refer people to substance abuse treatment, and offer counseling on nutrition and physical activity.  At this webinar, attendees will hear how the Texas Department of State Health Services is working to increase people’s knowledge of their HIV status by supporting HIV testing as a standard of care.

NRHA on the All of Us Research Program – Tuesday, November 27 at 2:00 pm ET.  The All of Us Research Program is a long-term initiative conducted by the National Institutes of Health that aims to enroll one million or more participants who will share information about their family health histories, lifestyles, and personal medical histories. The goal is to help improve researchers’ baseline understanding of what it means to be healthy and sick, ultimately to develop more precise and effective methods to keep people healthy and treat those who get sick. In this one-hour webinar, the National Rural Health Association (NRHA) will share information about the effort and provide context on how and why rural communities can participate.  Read more about the program on NRHA’s blog.

Rural Virtual Job Fair – Wednesday, November 28 at 6:45 pm ET.  HRSA’s Bureau of Health Workforce will host a Rural Focused Virtual Job Fair a free, interactive event held online to allow primary care providers a chance to talk about their sites approved for the National Health Service Corps or NURSE Corps.  Recruiters will discuss their organization’s benefits, their clinical environments (including approaches to integrated care), the populations they serve, and the rewards of providing care in their rural communities.

Approaching Deadlines

CDC Capacity Building for HIV Prevention – November 12

Improving Transit Access to Health Care – November 13

FTA Access and Mobility Partnership Grants – November 13

Comments Requested: Impact of Socioeconomic Status on Medicare Programs – November 16

Instructor Training Grants for Physical Activity Programs – November 19

Comments Requested: Reducing Regulations for Healthcare Providers – November 19

MCHB Challenge: Addressing Opioid Use in Pregnant Women – November 19

USDA Delta Health Care Services Grant Program – November 26

MCHB Challenge:  Remote Pregnancy Monitoring – November 27

Nurse Faculty Loan Program – November 28

Responding to Opioid Use Disorder in Tribal Communities – November 29

Grants for Early Head Start Child Care in Low-Income Communities – November 30

Head Start Child Care in Migrant and Seasonal Communities – November 30

Head Start Child Care for American Indian/Alaska Native Communities – November 30

CDC Cooperative Agreement for Public Health Crisis Response – November 30

Rural Health Network Development Planning Program – November 30

Farm to School Grant Program – December 4

Health Disparities Research with Tribal Epidemiology Centers – December 4

AHRQ Dissemination of Research for Unhealthy Alcohol Use – Letter of Intent December 5

EPA Design Competition for People, Prosperity and the Planet – December 11

Research to Address Opioid Crisis (Clinical Trial Required) – December 11

Research to Address Opioid Crisis (Clinical Trial Not Allowed) – December 11

NBCC Minority Fellowship for Addictions Counselors – December 15

NBCC Minority Fellowship for Mental Health Counselors – December 15

AHRQ Dissemination of Research for Unhealthy Alcohol Use – January 4

Advanced Nursing Education Workforce (ANEW) – January 8

Rural Primary Care SBIRT for Maternal Opioid Use – March 29

Indian Health Service Loan Repayment Program – Ongoing through August 2019

Guaranteed Loans for Rural Rental Housing – Ongoing through 2021

Telecommunications Infrastructure Loans – Ongoing

Funding for Rural Water and Waste Disposal Projects –  Ongoing

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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