Recently, Congress created the Affordable Connectivity Program, a $14 billion program that may help people in rural communities get the internet connections they need for work, school, health care, and more. Eligible households can enroll through a participating broadband provider or directly with the Universal Service Administrative Company (USAC) using an online or mail-in application. This benefit provides a discount of up to $30 per month toward broadband service for eligible households and up to $75 per month for households on qualifying Tribal lands. Eligible households can also receive a one-time discount of up to $100 to purchase a laptop, desktop computer, or tablet from participating providers. To apply or ask questions, visit affordableconnectivity.gov or call the ACP Support Center at (877) 384-2575.

On July 7, HRSA published the complete lists of all geographic areas, population groups, and facilities designated as primary medical care, dental health, and mental health professional shortage areas (HPSAs) as of April 29, 2022.  In this notice, HRSA also indicated that the agency will be providing a longer transition time for jurisdictions and facilities to prepare for potential changes to HPSA designations given the impact of the COVID-19 pandemic.  Specifically, HPSA designations that are currently proposed for withdrawal will remain designated in “proposed for withdrawal” status until they are reevaluated in preparation for the publication of the 2023 HPSA notice. This additional time will allow jurisdictions to re-evaluate their HPSAs against the designation criteria, and plan for potential changes in staffing.

CMS is proposing actions to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral health services furnished via communications technology. Additionally, in line with President Biden’s Executive Order on Promoting Competition in the American Economy, the calendar year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule includes proposed enhanced payments under the OPPS and the Inpatient Prospective Payment System for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators and a comment solicitation on competition and transparency in our nation’s health care system.

More Information:

• Press release
• Proposed rule fact sheet
• REH fact sheet
• Proposed rule

On July 7, CMS published a proposed rule updating payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule. Included in this rule are updates to Accountable Care Organization (ACO) policies under the Medicare Shared Savings Program designed to increase participation among rural and underserved communities, including proposals to provide Advance Investment Payments building on lessons learned from CMS’s ACO Investment Model and to smooth the transition to performance-based risk. Additionally, CMS is extending telehealth regulatory flexibilities beyond the pandemic in line with the Consolidated Appropriations Act of 2022 and incorporating new chronic pain management and behavioral health integration services to the Rural Health Clinic and Federally Qualified Health Center codes– Comment by September 6.

Rural residents who are Black, Indigenous, and People of Color (BIPOC) experience even poorer pregnancy-related health outcomes. Racial disparities in rural maternal and infant health outcomes may be related to limited accessibility of clinical care and pregnancy/postnatal support programs and services in rural communities. This policy brief from the University of Minnesota Rural Health Research Center describes these differences between majority-BIPOC versus majority-white rural counties’ available maternal and infant health evidence-based supports.

Researchers looked at survey responses from women of reproductive age across eight rural U.S. regions to determine the association between contraceptive use and SUD treatment, healthcare utilization, and substance use.  They found that less than 40 percent of respondents to the Rural Opioid Initiative (ROI) survey reported contraceptive use, compared to 66 percent responding to a more general survey on families, fertility, and health from the Centers for Disease Control and Prevention.  Odds of contraceptive use increased, however, for ROI women who had received treatment for substance use disorder within the last 30 days.

On Monday, HHS announced new guidance on the Emergency Medical Treatment and Active Labor Act that protects providers when offering life- or health-saving abortion services in emergency situations.  The statute requires Medicare hospitals to provide all patients an appropriate medical screening, examination, stabilizing treatment, and transfer, if necessary, irrespective of any state laws or mandates that apply to specific procedures.

The U.S. Department of Health & Human Services (HHS) seeks input from individuals; paid and unpaid caregivers; community-based organizations; health care providers; professional societies; community health centers and Rural Health Clinics; state, local, tribal, and territorial governments, and public health departments; educators; academic researchers; global partners; health insurance payers and purchasers; health technology developers; and policy experts.  Respondents are asked to provide information on successful models or innovations that improve primary health care and successful strategies to engage communities.

Comments Requested by August 1

Using data from the Centers for Disease Control and Prevention, the national nonprofit Kaiser Family Foundation reports that suicide death rates in 2020 were highest among American Indian and Alaska Native people, males, and people who live in rural areas.  While women are more likely to report mental illness and are more likely to attempt suicide, suicide death rates for men are four times higher.  The report comes ahead of the launch of a new crisis line, 988, that goes live this Saturday.  The Bipartisan Policy Center provides details on the funding and policy steps taken to implement 988 and identifies three areas – federal interagency collaboration, the behavioral health workforce, and financing – essential to its success.

Starting July 16, 2022, Pennsylvanians will have a new, easier way to connect to behavioral or mental health crisis services. Dialing 988 will connect callers directly to the National Suicide Prevention Lifeline.

76,000 calls were received by the the National Suicide Prevention Lifeline  from Pennsylvania residents in 2020.

In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. The Substance Abuse and Mental Health Services Administration (SAMHSA) sees 988 as a first step towards a transformed crisis care system in America.

People who contact 988 via phone, text, or chat will be directly connected to trained counselors located at 13 PA crisis call centers who can immediately provide phone-based support and connections to local resources, if necessary. Between 80-90 percent of calls are resolved through conversations with call center staff, without further intervention. By directing cases to 988 when a mental or behavioral health crisis isn’t life threatening, the response provided by public services, such as law enforcement and EMS, can be reserved for situations when there is a risk to public safety.

If you’re in crisis, reach out now.

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7.

• CALL: Dial 988
• TEXT– By texting 988, individuals will be asked to complete a short survey to let 988 trained crisis counselors know more about their current situation. After finishing the survey, texters will be connected to crisis counselors.
• CHAT – Lifeline Chat connects individuals with trained counselors for emotional support and other services via web chat.

The current Lifeline phone number (1-800-273-8255) will remain available to people in emotional distress or suicidal crisis, even after 988 is launched.

Who Can Use the New Number?

988 can be used by anyone who needs support for a suicidal, mental or behavioral health, and/or substance use crisis — no matter where they are or where they live.

988 can also be called on behalf of someone else. Counselors can offer guidance on helping a friend or loved one navigating a mental health emergency, and experts advise that people reach out particularly if a loved one reveals a plan to hurt themselves.

Lifeline services are available 24 hours a day, seven days a week at no cost to the caller.

What Happens When You Call 988?

• Back to Basics: How Our Calls Are Routed — 988 Suicide & Crisis Lifeline

When calling 988, the caller will hear the following recording:

“You have reached the National Suicide Prevention Lifeline, also serving the Veterans Crisis Line. Para español, oprima numero dos. If you are in emotional distress or suicidal crisis, or are concerned about someone who might be, we are here to help. If you are a U.S. military veteran or current service member, or calling about one, please press 1 now. Otherwise, please hold while we route your call to the nearest crisis center in our network.”

The following steps will follow depending on the callers needs and call center availability:

• The caller will be routed to a local PA 988 crisis call center.
• If the call is not answered within 60 seconds at the local level, the call is routed to one of PA’s three regional 988 crisis call centers.
• If a regional call center is unavailable, the call is routed to the national backup network.
• Note: Veterans and Spanish-speaking callers are given options to connect to resources specific to their needs.

Trained, compassionate counselors located at 13 crisis call centers across Pennsylvania are ready to provide phone-based support and connections to local resources. Counselors may be able to provide referrals for treatment for mental health, substance abuse, or other behavioral health needs if to local service providers are available. Also, if the counselor recognizes the caller is in need of an in-person response, they are able to dispatch emergency personnel from EMS or law enforcement, or a mobile mental health crisis team if one is available in the caller’s area.

Additional 988 Resources

• 988 Fact Sheet — Pennsylvania Department of Human Services
• 988 Frequently Asked Questions — Substance Abuse and Mental Health Services Administration
• The History of 988 — Vibrant Emotional Health
• Suicide Prevention by the Numbers — 988 Suicide & Crisis Lifeline
• Veterans Crisis Line — 988 Suicide & Crisis Lifeline
• Mental Health in PA — Pennsylvania Department of Human Services