- Traveling Nurses Help Rural Hospital Staffing Issues, But at a Cost
- Rural Americans Share Personal Stories to Inspire Confidence in COVID-19 Vaccines in Local Communities and Nationwide
- Study Finds Family Physicians Deliver Babies in Majority of Rural Hospitals
- State of Decay: Rural Areas in America Are at a Tooth Loss
- Rural Covid Infections Decline for Third Straight Week
- Rural U.S. Hospitals Stretched Thin After Nurse Shortage Exacerbated by the Pandemic
- New Vaccinations in Rural Counties Decline for Second Week
- CMS Clarifies Medicare Recognition of Interstate Licensure Compacts
- Making History, Despite History: The First Tribally Affiliated Med School Takes Flight in Oklahoma
- COVID-19 Cases and Deaths by Race/Ethnicity: Current Data and Changes Over Time
- The Surge of Telehealth During the Pandemic is Exacerbating Urban-Rural Disparities in Access to Mental Health Care
- Rural Infections Decline by 20%; Number of Covid Deaths Falls Slightly
- Rate of New Vaccinations Falls by 20%
- Telehealth has Rapidly Expanded. But Companies are Still Struggling to Reach Rural Populations
- Covid Is Killing Rural Americans at Twice the Rate of Urbanites
The Pennsylvania Departments of Agriculture and Health announced today a new partnership to make Pennsylvania’s six medical marijuana testing laboratories available to the agriculture industry for testing hemp crops for tetrahydrocannabinol (THC) levels.
“Secretary of Health Dr. Rachel Levine has been a great friend to Pennsylvania agriculture, as we’ve worked to keep the industry healthy and moving and comply with federal law throughout 2020,” said Agriculture Secretary Russell Redding. “This partnership is just one more example, and we’re grateful to the Department of Health for helping to make these labs available to Pennsylvania’s new and growing hemp industry as they work to meet testing requirements during a very tight, critical harvest window.”
For the 2020 growing season, Pennsylvania has 510 farms growing approximately 3,000 acres of hemp across the commonwealth. Every hemp lot in Pennsylvania is required to be sampled and tested to show a THC level at or below 0.3 percent. Anything above that level is considered marijuana. Prior to the availability of medical marijuana laboratories for hemp growers, 13 in-state and out-of-state labs were available to hemp growers for required potency testing. As growers are nearing harvest season, the Department of Health’s medical marijuana laboratories add capacity during a critical, short window of time.
“The Department of Health is pleased to collaborate with the Department of Agriculture as part of their hemp program,” Dr. Levine said. “We are committed to ensuring that Pennsylvanians have access to medicine that is regulated and approved. The laboratories that are part of the medical marijuana program have been key partners in our program, and we believe they will play a key role in assisting the Department of Agriculture as well.”
In 2017 and 2018, the Department of Agriculture administered the Industrial Hemp Pilot Research Program, legitimized by the 2014 federal Farm Bill and authorized in Pennsylvania statute by the Industrial Hemp Research Act. As of 2019, the research program’s 100-acre cap was lifted for the inaugural year of the commercial program which was made possible through the 2018 Farm Bill. The 2019 program permitted 324 growers who grew just over 4,000 acres of hemp in 55 Pennsylvania counties.
Under the historic 2019 Pennsylvania Farm Bill, the state made funding available to hemp farmers through the creation of a state Specialty Crop Block grant. The Department of Agriculture also encouraged the USDA to make federal specialty crop funds available to hemp farmers.
Hemp was grown in Pennsylvania and throughout the United States until after World War II but became regulated along with marijuana and its cultivation was prohibited by federal law. Hemp and marijuana are different varieties of the same plant species. Unlike marijuana, hemp is also grown for fiber and seed, in addition to floral extracts, and must maintain a much lower concentration of the psychoactive chemical THC below the 0.3 percent legal threshold.
In recognition of National Recovery Month, the Appalachian Regional Commission (ARC) has issued a Request for Proposals (RFP) for Investments Supporting Partnerships In Recovery Ecosystems (INSPIRE), a $10 million initiative to address the Region’s substance abuse crisis by creating or expanding a recovery ecosystem leading to workforce entry or re-entry. Awards made via the INSPIRE Initiative will support the post-treatment to employment continuum, which could include investments in healthcare networks that support substance abuse recovery professionals, recovery-focused job training programs, as well as initiatives designed to coordinate, or link, recovery services and training that support the recovery ecosystem, among others.
INSPIRE draws on the work and recommendations developed by ARC’s Substance Abuse Advisory Council (SAAC) to address the disproportionate impact substance abuse continues to have on the Region’s workforce in comparison to the rest of the country. More information about the SAAC and their findings is available at www.arc.gov/SUD.
“Confronting the substance abuse crisis in the Appalachian Region has been a priority of President Trump and his administration, and I was encouraged when he signed into law legislation providing for these critical investments in the Region,” said ARC Federal Co-Chairman Tim Thomas. “The INSPIRE Initiative seeks to elevate the best ideas in the region to address the most critical needs communities face in creating recovery ecosystems, ideas that build a bridge to employment and encourage successful long-term recovery outcomes.”
The application process for INSPIRE begins with a Letter of Intent, which is due October 16. Read more at www.arc.gov/SUD.
On August 3, President Trump signed an executive order requesting that the Department of Health and Human Services produce a report on existing and upcoming efforts to improve rural healthcare. Today, HHS released the Rural Action Plan, the first HHS-wide assessment of rural healthcare efforts in more than 18 years and the product of HHS’s Rural Task Force, a group of experts and leaders across the department first put together by Secretary Azar in 2019.
This action plan provides a roadmap for HHS to strengthen departmental coordination to better serve the millions of Americans who live in rural communities across the United States. Eighteen HHS agencies and offices took part in developing the plan, which includes 71 new or expanded activities for FY 2020 and beyond. Efforts that will be undertaken in FY 2020 include nine new rural-focused administrative or regulatory actions, three new rural-focused technical assistance efforts, 14 new rural research efforts, and five new rural program efforts. These efforts build on 94 new rural-focused projects the HHS Rural Task Force identified as having launched over the past three years.
“Growing up in rural Maryland, I saw firsthand some of the challenges faced by rural healthcare providers and patients,” said HHS Secretary Alex Azar. “Under President Trump, we have invested unprecedented time and resources transforming healthcare for the forgotten men and women of rural America. The Rural Action Plan identifies key, tangible areas where HHS agencies can soon make a real difference in the health outcomes of millions of Americans. We cannot just tinker around the edges of a rural healthcare system that has struggled for too long, which is why the Rural Action Plan lays out a bold vision for transforming how healthcare works in rural America.”
“The Rural Action Plan continues HHS and the Administration’s continued focus on rural communities,” said former Kansas Governor Jeff Colyer, chair of the National Advisory Committee on Rural Health and Human Services. “It provides an important reminder of the key steps HHS has already taken to support rural communities as well as a number of new initiatives for this year and beyond. HHS and the Committee will continue to strengthen rural health care to improve patients’ lives.”
Following up on the President’s Executive Order, the Rural Action Plan – PDF* examines the key challenges facing rural communities related to issues such as emerging health disparities, chronic disease burden, high rates of maternal mortality and limited access to mental health services. The plan lays out a four-point strategy to transform rural health and human services, with a number of actions that can be launched within weeks or months. The four points of the strategy are:
- Building a sustainable health and human services model for rural communities, including actions such as:
- Funding the Rural Healthcare Providers Transition Project, a new program to provide support for hospitals and rural health clinics transitioning to value-based models.
- Expanding the Community Health Aide Program, which provides education and training of tribal community health providers to increase access to quality health care, health promotion and disease prevention services.
- Funding the Integrated Rural Community Care project to connect federally qualified health centers with rural hospitals to better coordinate preventive, primary and emergency health care.
- Leveraging technology and innovation, including:
- Supporting a new HHS Health Challenge to leverage technology to improve screening and management of post-partum depression for rural women.
- Providing more than $8 million in grant funding for the Telehealth Network Grant Program to provide emergency care consults via telehealth to rural providers without emergency care specialists.
- Developing new flexibility for Medicare Advantage (MA) plans to improve access to managed care options in rural areas through changes in network adequacy assessments for MA plans and to take into account the impact of telehealth providers in contracted networks.
- Focusing on preventing disease and mortality, including:
- Creating the Healthy Rural Hometown Initiative, a new initiative to identify strategies to address the growing rural disparities related to the five leading causes of avoidable death, including stroke, heart disease, cancer, respiratory disease and injury/substance use.
- Investing over $2 million in additional funding for rural cancer control grants with a focus on geographically underserved rural areas with deep and/or persistent poverty, building on a multi-year research effort to increase prevention efforts and enhance cancer treatment efforts in rural communities.
- Investing more than $2 million in funding in 2020 as part of a four-year $8 million project to identify evidence-based interventions that can reduce health risks faced by rural Americans.
- Increasing rural access to care, including:
- Issuing a new policy brief examining the workforce shortage challenges state-based licensure restrictions create for rural residents by failing to let health care clinicians practice to the full extent of their training.
- Investing $5 million in FY 2020 to recruit and train EMS personnel in rural areas.
- Awarding $8.25 million to 11 communities who develop new rural residency programs through the Rural Residency Planning and Development Program.
Read the action plan here: https://www.hhs.gov/sites/default/files/hhs-rural-action-plan.pdf – PDF*
The Rural Action Plan builds on the work throughout the Trump Administration to improve rural healthcare, including:
- The Centers for Medicare & Medicaid Services (CMS) finalized wage index reform to increase payment to hospitals in low wage areas, including many rural hospitals, allowing them to invest more to improve quality, put them on a more level playing field with their higher wage counterparts, and attract more talent.
- CMS created two new ways for Medicare to pay providers specifically for forms of “virtual care,” delivered remotely. Health care providers can now be paid for remote patient monitoring, virtual assessments and review of electronically transmitted images.
- HRSA launched the Rural Communities Opioid Response program, funding multi-sector consortia in rural areas to enhance their ability to implement and sustain prevention, treatment, and recovery services in underserved rural areas, with more than $157 million in 47 states awarded to date.
- Through the Rural Tribal COVID-19 Response Program, HRSA awarded $15 million to 52 Tribes, Tribal organizations, urban Indian health organizations, and other health services providers to Tribes across 20 states to prepare, prevent, and respond to COVID-19 in rural tribal communities.
- Through the CARES Act, HRSA invested $150 million to over 1,700 rural hospitals to prepare, prevent, and respond to COVID-19. Of this amount, approximately $1 million was allocated to 12 tribal hospitals across 3 states to build up their capacity for fighting COVID-19 in their communities, including through further expansions of telehealth, purchases of PPE, and boosting testing capacity.
As the Rural Action Plan was developed, the HHS Rural Task Force also played a key role in the COVID-19 pandemic response, ensuring that HHS accounted for the unique challenges faced by rural communities. In April, the Centers for Disease Control and Prevention created a Minority Health/Rural Health Team as part of its pandemic response, ensuring a targeted focus on the needs rural communities were facing in dealing with COVID-19. The Task Force also worked with the Provider Relief Fund created in the CARES Act to develop a targeted allocation to rural providers of more than $10 billion to support rural hospitals, rural health clinics, community health centers and tribal providers.
From the Pennsylvania Health Action Network and the Pennsylvania Developmental Disabilities Council
Navigating the Pennsylvania health care system is frequently challenging. Long wait lists, unexpected costs, and lack of coverage for needed services affect many health care consumers in Pennsylvania. These issues are especially acute in the rural parts of the state where many live in poverty, distances are longer, transportation infrastructure is limited, and there may be fewer options for treatment.
People with disabilities living in rural areas encounter all of these problems as well as prejudice, ignorance, and various barriers that impact their ability to access health care services, facilities, and equipment. This report features stories from people with disabilities, their family members and caregivers about barriers to health care access. We collected these stories through surveys, face-to-face meetings, phone conversations, and public listening sessions during 2019 and 2020.
The goal of this report is to document barriers, better understand the perspectives and needs of those facing them, and raise awareness of the need for improved accessibility.
The report can be accessed at https://pahealthaccess.org/wp-content/uploads/2020/09/rural-access-report.pdf
September is Hunger Action Month and the Pennsylvania Department of Human Services (DHS) is drawing awareness to the charitable food organizations that work tirelessly to fill the hunger gaps in our communities that the Supplemental Nutrition Assistance Program (SNAP) cannot do on its own. Food insecurity is at an all time high in Pennsylvania. In 2020, as a result of the coronavirus pandemic, Feeding America estimates the number of Pennsylvanians facing food insecurity will grow to 15.9 percent – an increase of 45.2 percent in just two years.
DHS administers SNAP, the nation’s most important anti-hunger program. SNAP helps more than 1.8 million Pennsylvanians expand their purchasing power and put food on their tables. On average, children whose families utilize SNAP are healthier than kids whose families qualify for SNAP but are not enrolled in the program. These kids go on to have higher graduation rates, increased earnings in adulthood, and improved health outcomes throughout their life. Older adults who are enrolled in SNAP are healthier, hospitalized less often, and are less likely to go into a nursing home. More than 1.8 million people use SNAP, but SNAP’s positive impact has an even broader reach. The food bought from local grocery stores and farmers markets supports our local economies to the tune of over $25 billion respectively.
Feeding Pennsylvania oversees member food banks which serve nearly 2 million people annually by distributing more than 164 million pounds of food throughout Pennsylvania to more than 2,700 agencies and feeding programs.
On average, Feeding Pennsylvania’s food banks serve nearly 2.2 million Pennsylvanians annually. During the first three months of their COVID-19 response, these food banks have had 5.5 million visitors.
Organizations like Feeding Pennsylvania rely on support to operate and help those in need. You can find out how you can support their mission on the Feeding Pennsylvania website.
Find Food Assistance
Pennsylvanians can get help with food costs through the Supplemental Nutrition Assistance Program (SNAP.) If you’re new to the program, applying is easy and can be done online via COMPASS.
If you are in need of local food resources, Feeding Pennsylvania has a Find Assistance page that can connect you to help.
For a list of local food banks and pantries visit Ending Hunger in PA.
Finalized policy changes expand new technology add-on payment pathway for certain antimicrobials
On September 2, CMS issued the FY 2021 Medicare Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital (LTCH) final rule, which includes important provisions designed to ensure access to potentially life-saving diagnostics and therapies for hospitalized Medicare beneficiaries. The changes will affect approximately 3,200 acute care hospitals and approximately 360 LTCHs. CMS estimates that total Medicare spending on acute care inpatient hospital services will increase by about $3.5 billion in FY 2021, or 2.7 percent.
“President Trump is committed to ensuring that seniors on Medicare have access to the latest life-saving diagnostics and therapies,” said CMS Administrator Seema Verma. “This rule is another critical step in our effort to modernize the program and strip away bureaucratic barriers between our seniors and the latest innovative treatments.”
CMS’ rule creates a new Medicare Severity Diagnostic Related Group (MS-DRG) that provides a predictable payment to help adequately compensate hospitals for administering Chimeric Antigen Receptor (CAR) T-cell therapies. The current FDA-approved CAR-T-cell cancer therapies use a patient’s genetically modified immune cells to treat specific types of cancer.
Also in the final rule, CMS approved a record number of 24 New Technology Add-on Payments (NTAPs), which is an additional payment to hospitals for cases involving eligible new and relatively high cost technologies. Last year, to remove barriers to innovation, CMS established alternative streamlined pathways for FDA Breakthrough Devices and FDA Qualified Infectious Disease Products (QIDPs) to qualify for NTAPs. Among CMS’ approval of these 24 additional NTAPs are two technologies for new medical devices that are part of the FDA’s Breakthrough Devices Program and six technologies that received FDA QIDP designation. This will provide additional Medicare payment for these technologies while real-world evidence is emerging, giving Medicare beneficiaries timely access to the latest innovations.
CMS is also expanding the add-on payment alternative pathway for antimicrobial products approved under FDA’s Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD pathway), which encourages the development of safe and effective drug products that address unmet needs of patients with serious bacterial and fungal infections. Specifically, an antibacterial or antifungal drug approved under the LPAD pathway is used to treat a serious or life-threatening infection in a limited population of patients with unmet needs.
CMS is also taking steps to ensure that the Medicare Fee-for-Service (FFS) program adopts pricing strategies based on real world market forces. Medicare generally pays hospitals a rate that is weighted by the relative cost of providing certain services based on a patient’s diagnosis. These weights are currently based in large part on the charges that hospitals report to the federal government, which often have little relevancy to the actual rates paid by insurance companies. Hospitals are already required to report these negotiated rates as part of the Trump Administration’s efforts to promote price transparency, and CMS is now finalizing a requirement for hospitals to report to CMS the median rate negotiated with Medicare Advantage Organizations for inpatient services to use instead of the charge based data. CMS will begin to collect this data in 2021 and will use it in the methodology for calculating inpatient hospital payments beginning in 2024. These provisions will introduce the influences of market competition into hospital payment and help advance CMS’s goal of utilizing market- based pricing strategies in the Medicare FFS program.
For More Information:
During the current pandemic, school nurses may be the only avenue for assuring that children receive dental screenings/referrals. The Association and State and Territorial Dental Directors (ASTDD) and the National Association of School Nurses have collaborated to develop a resource to assist with doing so. Please share the below resource with any school nurses you may work with or know.
The National Maternal and Child Oral Health Resource Center (OHRC) produced a report that provides information about the “Networks for Oral Health Integration Within the Maternal and Child Health Safety Net” projects funded by the Maternal and Child Health Bureau (MCHB). The goal of the 5-year initiative is to improve access to and utilization of comprehensive, high-quality oral health care in community health centers for target populations (i.e., pregnant women, infants and children from birth to age 40 months, children ages 6–11) at high risk for oral disease.
Hospitals that received COVID-19 relief loans from Medicare expected that CMS would cut off their fee-for-service reimbursement after four months, but as deadlines have passed the agency apparently hasn’t started garnishing payments. State and national hospital associations, providers and consultants that work with providers said their reimbursements remain the same although CMS said it would begin recouping Medicare Accelerated and Advance Payment Program funds. In March and April, hospitals received more than 80% of the $100.3 billion in relief loans from CMS.
Pennsylvania Governor Tom Wolf announced on September 1 that he has renewed a 90-day disaster declaration, now for a second time, after he originally signed it in early March following the confirmation of the first positive cases of the coronavirus in Pennsylvania.
The original declaration was set to expire Tuesday, and the new declaration will last through late November, unless Wolf ends it.
“We are going to continue to combat the health and economic effects of COVID-19, and the renewal of my disaster declaration will provide us with resources and support needed for this effort,” Wolf said in a statement.
Under state law, an emergency disaster declaration gives governors the authority to issue or rescind executive orders and regulations, access stockpiles of emergency supplies and equipment and suspend laws or regulations that govern state agencies.
Executive orders have the force of law, under emergency disaster law. As part of it, the Pennsylvania Emergency Management Agency has been able to assign missions to the National Guard, and it could in the future allow PEMA to rapidly deploy a vaccine, Wolf’s office said.