- Miles for Milk: How Student-Run Grocery Store Reshaped Rural Community's Food Access
- Native Americans Have Shorter Life Spans, and It's Not Just Due to Lack of Health Care
- Promotoras Play Essential Role in Connecting Farmworkers with Health Care in Rural NorCal
- Using Medicaid to Address Young People's Mental Health Needs in School Settings
- Across the Country, Amish Populations Are on the Rise
- Sunsets, Wildlife and Limited Care: Challenges of Aging in Place in Rural America
- City-Country Mortality Gap Widens amid Persistent Holes in Rural Health Care Access
- Tribal Environmental Impact Network
- Minnesota's Rural Ambulance Providers Look to State Capitol for Their Own Lifeline
- Biden-Harris Administration Takes Action to Support the Primary Care Workforce
- Over 3,000 Homes on the Navajo Nation Receive Accurate Addresses for the First Time
- Rural Population Grows for Second Consecutive Year
- Rapides Library Offers Telehealth to a Town Without Doctors
- Rural Infection Preventionists Need Community Support
- New Federal Health IT Strategy Sets Sights on a Heathier, More Innovative, and More Equitable Health Care Experience
Pennsylvania Transitions Jan. 1 to Single Statewide Preferred Drug List
Pennsylvania’s Medicaid program will have a single statewide Preferred Drug List (PDL) effective Jan. 1, 2020. The statewide PDL was developed by the Department of Human Services (DHS) Pharmacy and Therapeutics (P&T) Committee and published via an Oct. 10, 2019 MA Bulletin. Officials with the Department of Human Services (DHS) report that requiring the Medicaid managed care plans to use a single medication formulary will result in substantial cost savings for the Medicaid program and improve consistency for providers and recipients.
- Under the statewide PDL, all Medicaid HealthChoices and Community HealthChoices plans as well as MA Fee-for-Service (FFS) will use the same list of preferred medications and the same prior authorization guidelines
- The DHS pharmacy director reported at a public meeting in late October that 149,741 consumers would be impacted by the transition, meaning they would need to change medications or get prior authorization to continue taking their current medication
- Of those impacted, about 39,000 would have more than one medication impacted
- Both FFS MA and the Medicaid managed care plans are scheduled to mail letters to impacted consumers by Nov. 1, 60 days prior to the effective date
- Medicaid consumers who get a letter about the new PDL should talk to their doctors about the preferred medication listed and will need prior authorization to have their current medication covered once the new PDL goes into effect in January
- The Medicaid MCOs are required to decide prior authorization requests within 24 hours
- Any Medicaid consumer who has a script denied at the pharmacy because the medication they have been taking now requires prior authorization can request a 15-day emergency supply, which is reimbursed by the MCO but provided at the discretion of the pharmacist
- Consumers who are denied a medication can contact the PHLP Helpline at 1-800-274-3258
More information on the Medicaid program PDL and the P&T Committee
Prepare for National Children’s Dental Health Month
National Children’s Dental Health Month is in February. This year’s theme is “Fluoride in water prevents cavities! Get it from the tap!” and celebrates the 75th anniversary of community water fluoridation. Free resources are available.
Centers For Disease Control and Prevention Finds Excess Deaths Occurring in Rural Areas
Abstract
Problem/Condition: A 2017 report quantified the higher percentage of potentially excess (or preventable) deaths in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas. In that report, CDC compared national, regional, and state estimates of potentially excess deaths among the five leading causes of death in nonmetropolitan and metropolitan counties for 2010 and 2014. This report enhances the geographic detail by using the six levels of the 2013 National Center for Health Statistics (NCHS) urban-rural classification scheme for counties and extending estimates of potentially excess deaths by annual percent change (APC) and for additional years (2010–2017). Trends were tested both with linear and quadratic terms.
Period Covered: 2010–2017.
Description of System: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate potentially excess deaths from the five leading causes of death among persons aged <80 years. CDC’s NCHS urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent’s county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Potentially excess deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Potentially excess deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and District of Columbia.
Results: The number of potentially excess deaths among persons aged <80 years in the United States increased during 2010–2017 for unintentional injuries (APC: 11.2%), decreased for cancer (APC: −9.1%), and remained stable for heart disease (APC: 1.1%), chronic lower respiratory disease (CLRD) (APC: 1.7%), and stroke (APC: 0.3). Across the United States, percentages of potentially excess deaths from the five leading causes were higher in nonmetropolitan counties in all years during 2010–2017. When assessed by the six urban-rural county classifications, percentages of potentially excess deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan) for the study period. Potentially excess deaths from heart disease increased most in micropolitan counties (APC: 2.5%) and decreased most in large fringe metropolitan counties (APC: −1.1%). Potentially excess deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan (APC: −16.1%) and large fringe metropolitan (APC: −15.1%) counties. In all county categories, potentially excess deaths from the five leading causes increased, with the largest increases occurring in large central metropolitan (APC: 18.3%), large fringe metropolitan (APC: 17.1%), and medium metropolitan (APC: 11.1%) counties. Potentially excess deaths from CLRD decreased most in large central metropolitan counties (APC: −5.6%) and increased most in micropolitan (APC: 3.7%) and noncore (APC: 3.6%) counties. In all county categories, potentially excess deaths from stroke exhibited a quadratic trend (i.e., decreased then increased), except in micropolitan counties, where no change occurred. Percentages of potentially excess deaths also differed among and within public health regions and across states by urban-rural county classification during 2010–2017.
Interpretation: Nonmetropolitan counties had higher percentages of potentially excess deaths from the five leading causes than metropolitan counties during 2010–2017 nationwide, across public health regions, and in the majority of states. The gap between the most rural and most urban counties for potentially excess deaths increased during 2010–2017 for three causes of death (cancer, heart disease, and CLRD), decreased for unintentional injury, and remained relatively stable for stroke. Urban and suburban counties (large central metropolitan and large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in potentially excess deaths from unintentional injury during 2010–2017, leading to a narrower gap between the already high (approximately 55%) percentage of excess deaths in noncore and micropolitan counties.
Public Health Action: Routine tracking of potentially excess deaths by urban-rural county classification might help public health departments and decision-makers identify and monitor public health problems and focus interventions to reduce potentially excess deaths in these areas.
Read the full report here: https://www.cdc.gov/mmwr/volumes/68/ss/ss6810a1.htm
Sex Trafficking Summit Warns of Epidemic
STATE COLLEGE — When Kendra Aucker, CEO of Lewisburg’s Evangelical Community Hospital, first learned about the pervasiveness of sex trafficking along the Route 15 corridor where her hospital is located, she was shocked enough to order all 2,000 hospital employees to undergo training so they could recognize trafficking victims when they encountered them and deal with them properly.
The Rural MOMS Act in the Spotlight
The maternal death rate is 60% higher in rural areas as compared to central parts of metropolitan areas. The important legislation aims to attract more health providers to rural areas and identify the root causes of pregnancy-related deaths in rural communities. As rural hospitals continue to close, distance to obstetric care continues to increase. Fewer than half of rural women live within a 30-minute drive to a hospital with obstetric services. Experts have said that long distances and shortages of obstetric care has contributed to the maternal deaths being experienced in rural areas.
National Rural Health Association’s Appropriations Watch
Top Congressional leaders met to discuss the delayed spending bills for the current fiscal year. Reporting shows that talks have shifted from partisan sniping to guarded optimism through options for the next stopgap bill. Following this week’s negotiations, Senate Appropriations Chairman Richard Shelby (R-Ala) has said the next stopgap is more likely to run only until next month, instead of the previously reported longer-term resolution. The top four appropriators from both chambers will meet during the week of November 11 to discuss the spending allocations for the bills need for FY2020, which are already overdue.
Prioritizing Rural Health and Rural Hospital Closures
During the week of November 4, the Texas Observer published an article detailing the impact of a rural hospital closure in Clarksville, Texas. The reporting highlights stories from Clarksville community members that have been negatively impacted by the loss of local health care access, and it claims that the closure may have contributed to at least 10 deaths since the hospital’s closure in 2014.
TIME published an article that emphasizes why Democratic presidential candidates should prioritize rural health care issues in their campaign platforms: according to former Sen. Heidi Heitkamp, “You cannot, certainly, win the Senate back, but probably not even win the presidency, without increasing the margin of Democratic votes in rural America.”
The Effects of Childhood Trauma
Traumatic childhood experiences are associated with higher odds of developing some of the leading causes of death later in life, according to a CDC report published this week. Overall, CDC estimated that eliminating childhood trauma could prevent 1.9 million cases of coronary heart disease, 2.5 million cases of obesity, and 21 million cases of depression. (Source: Associated Press, 11/5)
Health in the United States
The United States has seen decreases in life expectancy and increases in obesity and drug overdose rates, as well as steadily increasing overall health care costs, according to a recent report from CDC’s National Center for Health Statistics that spotlights the state of health in the country. For example, the report found that average life expectancy at birth decreased to 78.6 years in 2017, from 78.7 years in 2016. (Source: Axios‘ “Vitals,” 10/30)
Human Trafficking and Public Health – New SOAR Online Training Module
SOAR Online is a series of training modules launched in 2018 by the National Human Trafficking Training and Technical Assistance Center and Postgraduate Institute, in collaboration with federal partners. A new SOAR for School-Based Professionals Module equips those serving middle and high school students to better understand how human trafficking-related issues impact youth. Visit the SOAR Online page for full CE/CME information and register for SOAR Online.