Rural Health Information Hub Latest News

Pennsylvania Takes More Steps to Reduce Prison Population

HARRISBURG — Pennsylvania enacted a new law in February 2020 designed to limit the stays of lower-risk offenders in prison in its latest effort to reduce the state’s prison population and to stop first-time offenders from becoming repeat offenders.

Gov. Tom Wolf, a Democrat, signed the two-bill package shortly after the Republican-controlled Senate approved the bills. The GOP-controlled House did the same Tuesday.  Key provisions involve getting shorter-sentence offenders onto parole faster and helping get more lower-risk offenders into programs that are shown to lower recidivism.

In some ways, the legislation was a continuing effort by the state to undo the effect of laws passed in the 1990s that substantially toughened criminal sentences and precipitated a ballooning state prison population. Pennsylvania’s incarceration rate is in the middle of the pack, according to federal data from 2016.

Several elements of the legislation, however, revisit a 2012 law that overhauled the parole system in an effort to shrink the state’s prison population.

Those changes were prompted by a spate of five parolees being arrested over the summer in homicides, most with connections to domestic violence. Victims included two children and Pittsburgh police Officer Calvin Hall.

The bill had broad support from law enforcement groups and criminal justice reform advocates. It’s goal of reducing the state prison population is expected to yield nearly $50 million in savings over five years, money that the state will earmark for use by county-based probation offices.

One key provision allows the automatic parole of certain non-violent offenders after they have served a minimum sentence of two years or less, a change designed to make parole more swift, consistent and efficient.

“I think that’s going to be really significant in reducing our (prison) population,” Secretary of Corrections John Wetzel said. “That presumptive parole is the No. 1 component of the population reduction.”

To help expand the use of the prison system’s intensive inpatient drug treatment program, the legislation streamlines the process through which inmates enter and makes more inmates automatically eligible.

The law also similarly is designed to smooth the path for offenders to enter the prison system’s “boot camp,” a discipline-focused facility that targets behavior modification for young adult offenders who have a higher propensity for violence and misconduct in prison. Research has shown that both the drug treatment program and the boot camp reduce the likelihood of recidivism, state officials say.

It also creates a state advisory committee for county-run probation systems in an effort to improve and standardize how they operate.

Several provisions emerged from the Department of Corrections’ review of cases where parolees were arrested for homicide.

One provision updates a 2012 law to add a trigger for an automatic six-month to one-year jail sentence for a parolee who continually ignores parole conditions, such as going to treatment or counseling.

The 2012 law already has five such triggers, including threatening behavior or possession of a weapon. The sixth provision is designed to address complaints by parole agents that changes over the past decade have stripped them of discretion to pull a potentially dangerous parolee off the street.

The bill also authorizes an annual review of homicides by parolees and provides an intermediate avenue to punish a parole violator, a short-term detention option of up to a week for parole violations that aren’t considered serious enough to warrant a return to prison.

ARC Seeks Partner & Community Input to Guide Investment Priorities

The Appalachian Regional Commission (ARC) has announced a series of public input sessions to identify critical opportunities and challenges facing Appalachia’s economic future. Envision Appalachia: Community Conversations for ARC’s Strategic Plan will gather insights from these public sessions, coupled with guidance from regional, state, and local partners, and will inform ARC’s strategic plan for fiscal years 2021-2025. ARC develops a new strategic plan every five years in accordance with the Office of Management and Budget (OMB). More than 3,000 Appalachians provided input to develop ARC’s current strategic plan, which expires on September 30, 2020.

“As we plan ARC’s investment strategy for the years to come, it is important that we be informed by the people we serve,” said ARC Federal Co-Chairman Tim Thomas. “These public input sessions for the next ARC Strategic Plan will provide Appalachian communities the opportunity to have a voice in this process, and I encourage the people of Appalachia to take part in one of these sessions.”

Each session, organized in conjunction with ARC’s state partner, runs from 9:30 am-3:00 pm, is open to the public and free to attend. Space is limited, so please register as soon as possible!

April 8 – Huntsville, AL
April 16 – Ashland, KY
April 22 – Youngstown, OH
April 30 – Abingdon, VA

If you cannot attend an event, ARC is also collecting input via this public survey.

Visit to join this important conversation.

HHS Appoints Former Kansas Governor Jeff Colyer Chair of the National Advisory Committee on Rural Health and Human Services

On February 27, 2020, the Secretary of the U.S. Department of Health & Human Services (HHS) announced new leadership for the National Advisory Committee on Rural Health and Human Services.  Former Kansas Governor Jeff Colyer will be the fifth chair in the 32-year history of the Committee.

Also known as the NACRHHS, the Committee was formed in 1987 as an independent advisory group focused on provision of health care in rural areas.  Joining the chair for two meetings each year are 20 committee members who include hospital CEOs, educators, experts on aging, physicians, certified registered nurse anesthetists, physician assistants, researchers, community health center directors and state office of rural health directors.  For each meeting, two areas of focus are selected; committee members conduct site visits and follow up with a policy brief and recommendations for the HHS Secretary.

Colyer, a surgeon by training, will be the fifth chair in the 32-year history of the Committee and the second chair from Kansas after Nancy Kassebaum Baker, who served during the Bush Administration. Colyer’s appointment coincides with a series of actions the Secretary has taken to bring more attention to rural health.

In late 2018, Secretary Azar created the HHS Rural Task Force to streamline efforts across HHS to be more focused on developing policy and program changes needed to transform health care in rural America.

“Improving healthcare in rural America is one of President Trump’s most important healthcare priorities, and addressing our rural health crisis is one of the key impactable health challenges the President has identified,” said Secretary Alex Azar. “President Trump’s administration has already put more attention on this challenge than it has seen for years, and we are delighted to welcome someone of Governor Colyer’s stature and experience to chair this Committee. The Committee will play an integral role in our ambitious ongoing efforts at HHS to transform rural healthcare, and Governor Colyer will work closely with me, Deputy Secretary Hargan, and the HHS Rural Health Task Force.”

The Committee was established by statute in 1987 to advise the Secretary on access to, delivery of, and financing for health care and human services in rural areas. The Committee produces policy briefs and reports on key rural issues, along with recommendations to address the challenges. The Committee is comprised of 21 members, including the chair, who represent the diversity of health and human service issues in rural America. In addition, the members represent an appropriate geographic representative mix from across the country, including the chair, selected by the Secretary from authorities knowledgeable in the fields of delivery, financing, research, development and administration of health care and human services in rural areas.

Members provide an array of expertise, including the range of rural-focused health programs under the purview of the Secretary, and are knowledgeable in the fields of rural human and social services. Examples include issues related to transportation, children and family services, social work, services for the elderly and rural economic development.

“As a Kansas doctor and a former governor, I know how important good medical care is to our rural communities,” said Governor Colyer. “President Trump’s and Secretary Azar’s insistence on improving rural health is a major step forward, and I want to thank the President and Secretary Azar for their push to improve the lives of rural Americans.”

Governor Jeff Colyer M.D. of Overland Park, Kansas finished his gubernatorial term in 2019. He is a fifth generation Kansan from Hays who practices craniofacial and reconstructive surgery. In addition to his medical practice, he is known for volunteering with International Medical Corps in war and conflict zones around the world including the Rwandan, Afghanistan, Iraq, South Sudan, and Libya.

Before becoming Governor, Colyer served in the House and Senate and was the longest serving Lt. Governor in Kansas history. He led Kansas’s Medicaid transformation into the first fully integrated managed care program in the United States and was noted for improving health outcomes, cutting waiting lists and saving over $2 billion through better care. As Governor he funded schools, saw more Kansans working than ever before, and left a $750 million budget surplus. He oversaw the first credit outlook upgrade in Kansas in more than a decade. He also emphasized improving rural health programs.

In addition to his service to the National Advisory Committee on Rural Health and Human Services, Governor Colyer also works with businesses in artificial intelligence, technology and healthcare. He was a White House Fellow to Presidents Reagan and Bush. He has degrees from Georgetown University (economics/premed), Cambridge University (Master’s in international relations), and the Kansas University School of Medicine with residency training in surgery and trauma, plastic surgery, and pediatric/craniofacial surgery. With his wife Ruth, they have three daughters.

The most recent meeting, in September of 2019, provided an opportunity for the Committee to identify topics aligned with HHS priorities.  Past meetings have covered topics such as Adverse Childhood Experiences, the impact of suicide, improving oral health care services, and modernizing Rural Health Clinic provisions.  Visit the NACRHHS for more details, including the Committee’s recommendations on each of these topics.  The Committee will host its first meeting of 2020 beginning Monday, March 2 and running through March 4 in Atlanta, Georgia.

DEA Announces Improvements to Medication Assisted Treatment

Improved access will benefit rural areas with limited treatment options

WASHINGTON – The Drug Enforcement Administration announced on February 26, 2020, an important step to improve access to medication assisted treatment, especially in rural areas where those suffering with opioid use disorder may have limited treatment options.

“Thankfully, prescription opioid overdose deaths have declined more than 13 percent, but thousands of Americans still suffer from addiction and opioid use disorder,” said DEA Acting Administrator Uttam Dhillon. “Today’s proposal is an important step to improve access to medication assisted therapy, a successful evidence-based practice to treat opioid dependence. DEA is committed to ensuring that these tools and resources are available to everyone, especially in rural areas where treatment options may be limited.”

Under the proposal published today, narcotic treatment program registrants authorized to dispense narcotic drugs approved to treat opioid dependence would be authorized to implement a “mobile component” to their registration, eliminating the need for a separate DEA registration. This streamlined registration process will make it easier for providers to offer needed services in remote or underserved areas.

In April 2000, DEA, in association with the American Methadone Treatment Association – now the American Association for the Treatment of Opioid Dependence – developed guidelines for NTPs to ensure more uniform standards throughout the United States. As the opioid crisis evolves, DEA and their partners seek to provide additional tools and resources to further increase accessibility for persons with opioid use disorder. Alternative methods, such as mobile components of NTPs, can be used to bring treatment to those in rural or other underserved areas where NTPs are not accessible, or to allow people who are unable to travel to an NTP to receive care.

According to the Centers for Disease Control and Prevention (CDC), more than 67,000 Americans lost their lives to drugs in 2018, and more than half of those deaths involved opioids. The demand for evidence-based medication-assisted treatment for substance use disorders, including opioid use disorder, has increased over the years, especially for services provided by NTPs. In some areas of the country, this has resulted in long waiting lists and high services fees, especially in rural communities.

The distance to the nearest NTP or the lack of consistent access to transportation in rural and underserved communities may prevent or substantially impede access to these critical services. There are more than 1,700 NTPs registered with DEA, including opioid treatment programs, detoxification treatment services that utilize methadone, and compounders. This proposed rule builds on existing experience and provides additional flexibility for NTPs in operating mobile components, subject to the regulatory restrictions put into place to prevent the diversion of controlled substances.

The proposed rule is available here

HHS Provides a Statement on the Coronavirus Supplemental Request

On February 25, 2020, HHS released the following statement on the coronavirus supplemental request.

“The Administration has been effectively utilizing all available resources to protect the American people from COVID-19. Today, the White House sent a supplemental request to Congress to make $2.5 billion available for COVID-19 response efforts, including an emergency supplemental appropriation of $1.25 billion. HHS will also use the Secretary’s transfer authority to provide needed resources to continue the Department’s robust and multi-layered public health preparedness and response efforts – including public health surveillance, epidemiology, laboratory testing, support for state and local governments and other key partners, advanced research and development of new vaccines, therapeutics and diagnostics, advanced manufacturing enhancements, and support for the Strategic National Stockpile.”

Read the letter here:

Behavioral Health in Rural America: Challenges and Opportunities

Behavioral Health In Rural America: Challenges and Opportunities

Principal authors: John Gale, MS; Jaclyn Janis, BSN, RN, MPH; Andrew Coburn, PhD; Hannah Rochford, MPH

Prepared by the RUPRI Health Panel: Keith Mueller, PhD; Andrew Coburn, PhD; Alana Knudson, PhD; Jennifer Lundblad, PhD, MBA; Timothy McBride, PhD

The prevelence mental health and substance use diagnoses and unmet treatment needs are not equally distributed, with rural residence being one factor associated with these differences. Moreover, the rural context has proven challenging for ensuring the availability of and access to prevention, diagnosis, treatment, and recovery services in rural areas. This paper reviews the prevalence of behavioral health disorders in rural populations, rural access to behavioral health services, promising program and policy strategies targeted to improving rural BH systems, and opportunities for policy and system changes to improve rural BH systems and outcomes.

Click to download a copy: Behavioral Health In Rural America: Challenges and Opportunities – Full document

ARC and NACo Partnership Focuses on Region’s Opioid Crisis

In 2017, the death rate for opioid overdoses in Appalachian counties was an astounding 72 percent higher than in non-Appalachian counties. “A good job can change a lot”, said Greg Puckett, Commissioner for Mercer County, West Virginia during a seminar event hosted this week by the National Association of Counties (NACo) and ARC focusing on the opioid crisis in Appalachia. The seminar, which included two panel discussions, focused on effective solutions and  how counties can best look toward the future to strengthen communities for long-term growth. It was a capstone event of on an ongoing partnership between partnership between NACo and ARC offering recommendations, best practices, and case studies to counties to help address the situation.

ARC Releases Year-in-Review Investments Summary, Announces Governor DeWine As States’ Co-Chair for 2020

A new fact sheets series is available recapping ARC’s regional and state specific investments showing that ARC invested nearly $177 million into the region, attracting nearly $247 million in matching funds and over $542.5 million in leveraged private investment during fiscal year 2019. These investments are projected to create or retain more than 17,300 jobs and train/educate over 51,000 students and workers. 70 percent of ARC’s FY 2019 investment dollars will benefit distressed counties and areas throughout the region.


340B Drug Discount Program: Increased Oversight Needed to Ensure Nongovernmental Hospitals Meet Eligibility Requirements

Provides an overview of the Government Accountability Office’s (GAO) review of 258 nongovernmental hospitals that participate in the 340B Drug Pricing Program and their contracts with state and local governments. Evaluates the contracts to determine if they meet the eligibility requirement to serve low-income individuals. Outlines weaknesses in the Health Resources and Services Administration’s review of the hospital contracts and offers six recommendations to improve the contract review process.

Challenges in Providing Substance Use Disorder Treatment to Child Welfare Clients in Rural Communities

Provides an overview of the unique challenges rural communities face serving parents with substance abuse issues, including provider shortages, limited access to health insurance, transportation and technological barriers, and lack of routine cross-systems collaboration with the child welfare system. Offers strategies to overcome these challenges in rural communities.