Federal Office of Rural Health Policy Announcements

November 1, 2018

What’s New

Open Enrollment for Health Insurance Begins November 1. The six-week period during which consumers may enroll in the Federal Health Insurance Exchange begins today and ends on Saturday, December 15. Those without an employer-based plan may visit HealthCare.gov and CuidadodeSalud.gov to shop for plans that will begin coverage on January 1, 2019. Eleven states and the District of Columbia have their own state-based websites for enrollment in individual/family or small business health coverage, or both. Some states have expanded their Medicaid programs to cover more people. Choose your state and household size to learn if your state has expanded and if you may qualify.

Updated State Fact Sheets from the USDA Economic Research Service. The Economic Research Service (ERS) at the U.S. Department of Agriculture (USDA) conducts research to inform public and private decision-making on economic and policy issues involving food, farming, natural resources and rural development. The ERS State Fact Sheets provide information on population, income, poverty, food security, education, employment, organic agriculture, farm characteristics, farm financial indicators, top commodities, and agricultural exports. Data are available for all States, and for metro/nonmetro breakouts within States. Links to county-level data are provided where available. This release provides the latest available (2017) U.S. and State-level agricultural exports and poverty estimates.

Funding Opportunities

CDC Cooperative Agreement for Public Health Crisis Response – November 30. The Centers for Disease Control and Prevention (CDC) will make 69 awards of up to $5 million each to strengthen administrative preparedness and capacity for managing public health emergency. The eligible entities are limited to the 50 state public health departments (including Washington D.C.), and local public health departments with current alignment to the CDC’s Public Health Emergency Preparedness or Epidemiology and Laboratory Capacity for Infectious Diseases. Eligibility extends to territorial governments in the mostly rural U.S. territories of the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. In addition, tribal governments meeting the requirements laid out in this NOFO and serving a population of at least 50,000 members are eligible to compete.

AHRQ Dissemination of Research for Unhealthy Alcohol Use – Letter of Intent December 5. The Agency for Healthcare Research and Quality (AHRQ) invests in research on the nation’s health care delivery and ways to train and teach professionals to put that research into practice. For this funding opportunity, the AHRQ seeks applicants who will disseminate findings from Patient-Centered Outcomes Research on alcohol use into primary care practices. The target audience for dissemination includes patients, families, providers and health care teams, healthcare systems, and payers with the intent that they will implement research findings and evidence-based interventions in day-to-day practice. AHRQ considers rural and frontier populations a priority for this and all research and interventions. The deadline for application is January 4, 2019.

EPA Design Competition for People, Prosperity and the Planet – December 11. The U.S. Environmental Protection Agency (EPA) is seeking applications proposing to research, develop, design, and demonstrate solutions to real world challenges with a focus on small, rural, tribal and disadvantaged communities. Public and private institutions of higher education (limited to degree-granting institutions of higher education) located in the U.S. (includes eligible institutions of higher education located in U.S. territories and possessions) are eligible to apply to be the recipient of a grant to support teams of undergraduate and/or graduate students who will design innovative projects addressing environmental challenges in one of four areas: 1) air quality, 2) safe and sustainable water resources, 3) sustainable and healthy communities, 4) chemical safety. Environmental quality is a social determinant of health; in rural areas, it is challenged by industry-related toxins and pollutants that have long-term impact on population health.

Rural Health Research

Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Among Rural US Residents. In a study published this week in the Journal of Rural Health, researchers from the HRSA/FORHP-supported University of Minnesota Rural Health Research Center found that diagnosis of maternal opioid use disorder (OUD) and neonatal abstinence syndrome are steadily increasing among rural residents. Despite the fact that hospital discharge data from the all‐payer National Inpatient Sample shows that rural women with OUD and other clinical complications were more likely to give birth in urban teaching hospitals findings from the Minnesota study show that more than 60 percent of rural moms with opioid use disorder give birth locally. “Rural hospitals may have more limited capacity to care for them and their babies,” said Center Director Katy Kozhimannil.

Policy Updates

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

Comments Requested: Implementing Provisions of the Bipartisan Budget Act (BBA) of 2018 – December 31. The Centers for Medicare & Medicaid Services (CMS) seeks comments on several proposals to improve quality and access to care in the Medicare Advantage (MA) and Prescription Drug Programs by implementing provisions from the BBA of 2018. For example, the BBA allows MA plans to offer “additional telehealth benefits” not otherwise available in Original Medicare starting in 2020. CMS proposes to give MA plans more flexibility in how they pay for “additional telehealth benefits” to satisfy this provision. By allowing services such as such as live-interactive videoconferencing and remote monitoring, telehealth connects rural providers and their patients to services at a distant site. CMS also solicits comment on how to implement the statutory provision that if an MA plan covers a Part B service as an “additional telehealth benefit,” then the MA plan must also provide the enrollee access to such service through an in-person visit. Comments can be submitted through regulations.gov by December 31.

Comments Requested: Medicare Part B Drug Pricing – December 31 Last week, CMS issued an Advanced Notice of Proposed Rulemaking (ANPRM) seeking comment on potential options for testing changes to payment for certain separately payable Part B drugs and biologicals. Among the questions CMS is seeking feedback on is the potential approach to selecting geographic areas for the intervention and comparison groups in the model, and whether particular regions of the country would need adjustments or exclusions from the model (for example, rural areas).

Resources, Learning Events and Technical Assistance

Rural Hospital Mergers and Acquisitions – Thursday, November 1 at 1:30 pm ET. Hospital mergers and acquisitions are changing the face of healthcare in both rural and urban communities across the country. This has been a common phenomenon among rural hospitals: approximately 12% of all rural hospitals merged from 2005 through 2016. The Rural Health Research Gateway will host this hour-long webinar with the North Carolina Rural Health Research and Policy Analysis Center to explain the findings of their recent policy brief.

AgriSafe: Wildfire Associated Health Risks – Friday, November 2 at 1:00 pm ET. The AgriSafe Network hosts this one-hour session to explore various health concerns related to wildfires in rural areas, including respiratory health, mental health, heat illness, deterioration of water quality, and injuries due to relocating livestock.

BHW Workforce Forum on Opioids – Wednesday, November 7. HRSA’s Bureau of Health Workforce (BHW) is holding a series of regional forums across the country to share strategies for connecting skilled health care professionals to communities facing the opioid crisis. The objective for the full-day November 7 meeting in Atlanta, GA is to build collaboration with federal, state, local, and tribal partners in the mostly rural states of Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.

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.

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 and the Centers for Medicare & Medicaid Services. A Twitter Chat hosted by @HRSAgov will have an open Q&A on the benefits and barriers to implementing telehealth in rural areas.

Resource of the Week

Resource: Updated Medicare Market Saturation and Utilization Tool. The CMS Market Saturation and Utilization Data Tool provides interactive maps and a dataset to analyze national-, state-, and county-level provider density and Medicare utilization data for selected health service areas. Data is not available on all measures for all rural counties; however, the tool permits comparisons across states and across time. New to this data release are three metrics for dual eligibility including Number of Dual Eligible Users, Percentage of Dual Eligible Users out of Total Users, and Percentage of Dual Eligible Users out of Dual Eligible FFS Beneficiaries.