New 50-State Scan on the Non-Licensed Substance Use Disorder (SUD) Workforce

Through HRSA’s cooperative agreement with National Organizations of State and Local Officials (NOSLO), the National Academy for State Health Policy (NASHP) conducted a comprehensive 50-state scan of how each state Medicaid program pays for and oversees non-licensed SUD staff. Learn how state Medicaid agencies are developing and deploying a growing workforce of peers, counselors, and other qualified staff to supplement licensed SUD provider capacity. The report can be accessed here.

Catalog of Value-Based Initiatives for Rural Providers

This catalog summarizes programs implemented by the U.S. Department of Health & Human Services that support the transition of payment models from fee-for-service to value-based care.  Updated in October 2019 by the Rural Health Value team, the catalog includes the rural impact and participation for such programs as the Medicare Diabetes Prevention Program, the Million Hearts Cardiovascular Disease Risk Reduction Model, and the Hospital Value-Based Purchasing Program. Recent catalog additions include: the Emergency Triage, Treat, and Transport Model; the Maryland Total Cost of Care Model; and Primary Cares Initiatives.

Access the catalog here:  Catalog of Value-Based Initiatives for Rural Providers.

Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally

The wide range of services involved in such programs requires substantial resources that are often limited.  Researchers from the Rural and Underserved Health Research Center at the University of Kentucky found that fewer than 5 percent of nonmetropolitan hospitals offer partial psychiatric hospitalization in-house.  Click here to view the report.

ARC POWER 2020 Request for Proposals (RFP) Now Available

The Appalachian Regional Commission (ARC) has issued a Request for Proposals (RFP) for the Partnerships for Opportunity and Workforce and Economic Revitalization (POWER) Initiative 2020 grant cycle. Pending final congressional appropriation, ARC is expected to invest up to $48 million in fiscal year 2020 to continue investing in the region’s coal-impacted communities by building a competitive workforce, fostering entrepreneurial activities, developing industry clusters in communities, and strengthening responses to substance abuse. The focus of ARC’s POWER 2020 Initiative will remain on investments that are regional, strategic, and transformational. Yesterday, nearly 150 people were in Champion, Pennsylvania for the first of three ARC POWER 2020 Application Workshops. Led by ARC staff, the workshop focused on the core elements of a strong POWER proposal: project development, budget planning, performance measurement, organizational structure, and partnership development. Two additional workshops are planned for January in Ashland, Kentucky and Johnson City, Tennessee. Workshop registration, the POWER 2020 RFP, a resource catalog for applicants, and more information is available at .

Since 2015, ARC has invested $190 million in 239 projects touching 326 counties via the POWER Initiative. These investment are projected to create/retain over 23,000 jobs and leverage more than $811 million in private investment into Appalachia’s economy. Most of these projects are multi-year with a long-term vision for economic sustainability. “While it is too early to measure the true impact of POWER funding and POWER projects, grantees described long-term vision for economic transformation driven, in part, by social change that includes the building of hope and the shifting of mindsets in areas that have seen severe economic distress,” noted Chamberlin/Dunn, a third party evaluator contracted by ARC to assess implementation of the POWER Initiative. “Reported early impacts include the power of POWER to set vision and build hope; progress toward potential long-term change; social change; and economic development.”

A 1st for Medicaid Work Requirements

CMS approved South Carolina’s request to implement Medicaid work requirements, marking the first time that CMS has approved work requirements in a state that has not expanded its Medicaid program under the Affordable Care Act. CMS also approved a separate request from South Carolina to increase its maximum income threshold for parents with minor children to qualify for Medicaid from 67% of the federal poverty level to 100%. (Source: Modern Healthcare, 12/12)

Pennsylvania Governor Wolf Administration Denounces Trump Administration Attacks on Food Assistance Programs

Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller has joined anti-hunger advocates to discuss the Wolf Administration’s opposition to the Trump Administration’s numerous attacks on the Supplemental Nutrition Access Program (SNAP), the most important anti-hunger program in the country, and the potential effects of these changes on people around Pennsylvania. More than 1.7 million Pennsylvanians rely on SNAP to access food, including about 700,000 children, about 690,000 people with disabilities, and about 300,000 older adults.

The Trump Administration has proposed two rules and has enacted a third that will jeopardize access to SNAP:

  • Last week, the United States Department of Agriculture (USDA) published a final rule that restricts states’ ability to determine which counties can be waived from work requirements for able-bodied adults without dependents, which are waived due to local unemployment rates.
  • In October, the USDA issued a proposed rule to alter the method Pennsylvania uses to determine the Heating/Cooling Standard Utility Allowance (SUA), which considers utility costs when calculating a person’s monthly SNAP benefit.
  • In July, the USDA announced a proposed rule that would eliminate Broad Based Categorical Eligibility (BBCE) for SNAP, which is a policy that gives states the flexibility to determine appropriate income thresholds and extend SNAP benefits to low-income families and individuals who would otherwise struggle to afford food.

“Every one of these rule changes forces people who are already in difficult positions to make the unconscionable choice of paying for food or paying for other necessities like utilities, rent, or medicine. Instead of modernizing and making SNAP more accessible for people who need it, the Trump Administration is enacting draconian rule changes that take away a state’s ability to meet the needs of its own citizens.” said Secretary Miller “The Wolf Administration is vehemently opposed to any and all attacks on this vital program, and we will always be committed to protecting SNAP and supporting the people who need it.”

The Trump Administration last week enacted changes to SNAP that limit states’ ability to determine which counties can be waived from work requirements for able-bodied adults without dependents. The ability to waive counties is now based on federally determined Labor Market Areas and on economic factors like excess labor and high unemployment. The new rule lowers the threshold for unemployment rates those areas must meet to qualify for a waiver and removes state flexibility to determine which counties should be waived, despite states being better positioned to determine the economic environment in the local economies. This rule change will jeopardize access to SNAP for more than 92,000 people, many of whom struggle with mental health, substance use disorder, and other long-term conditions that would be worsened by chronic hunger.

The Wolf Administration is committed to increasing employment opportunities for all Pennsylvanians. Work requirements, however, are a blunt instrument that do not get a person a job and do not address the social, educational, medical, and environmental barriers that keep people in a cycle of poverty.

The Trump Administration in July announced a proposal to eliminate BBCE for SNAP. BBCE is a policy that gives states, including Pennsylvania, the flexibility to determine appropriate income thresholds and extend SNAP benefits to low-income families and individuals who would otherwise struggle to afford food. With BBCE, a Pennsylvania family of four is eligible for SNAP if they earn no more than about $40,000 a year. If BBCE is eliminated, that family of four’s SNAP eligibility limit will drop from about $40,000 a year to no more than $32,000 a year. For elderly single-person households, the limit would change from approximately $24,000 a year to about $15,000.

Eliminating BBCE also impacts the ability for low-income children to receive free and reduced-price school lunches. Families whose children are eligible for SNAP receive direct certification for eligibility for free and reduced-price lunches. If fewer families qualify for SNAP, those children will not receive direct certification. Additionally, in districts where 40 percent or more children receive free and reduced-price lunches, the school qualifies for the Community Eligibility Provision, which allows schools and school districts in low-income areas to provide free school lunches to the entire school. Reduction in the number of children receiving direct certification may mean entire districts lose their ability to provide free meals for all students.

And in October, the Trump Administration announced a proposal to alter the method Pennsylvania uses to determine the Heating/Cooling SUA for SNAP recipients, which could negatively affect approximately 775,000 households in Pennsylvania. When DHS determines that a household is eligible for SNAP, to determine the value of the grant they will receive, the SUA is used as a factor; acknowledging that money needed to pay for shelter and utilities is not available to be used to purchase food. The Trump Administration’s rule would use a standard formula to determine each state’s SUA for the entire country, ignoring costs of living and utility rates that vary from state to state. The proposed rule impacts the Northeast states more significantly than the rest of the country due to the information used in the calculation. In Pennsylvania, each reduction in the SUA of $10 equates to a $2 to $3 reduction in SNAP benefits. If the Heating and Cooling SUA was reduced by $200, for example, most households would see a reduction in SNAP benefits of $40 to $60 per month.

“Every one of these rule changes hurts vulnerable people in Pennsylvania around the country. Food is a necessity, and ripping this basic need away will only make it more difficult for people to meet their basic needs, work to get ahead, and achieve a better life without public assistance,” said Secretary Miller. “If we truly want to reduce the shared cost of public assistance, we must invest in people and give them the ability to break the cycle of intergenerational poverty, and this means supporting programs like SNAP.”

In addition to SNAP helping 1.7 million Pennsylvanians avoid chronic hunger, SNAP helps local economies. More than 10,000 authorized retailers participate in SNAP across Pennsylvania, and these retailers redeemed about $2.6 billion in SNAP benefits in 2018 according to the USDA.

In May 2019, the USDA published a study on the influence of SNAP redemptions on the economy and county-level employment in the time leading up to, during, and after the Great Recession. This study found that SNAP redemptions could have a greater economic stimulus impact than many other forms of government spending per dollar spent, especially during a recession, because they are paid directly to low-income individuals. For instance, the grocery subsidies deliver food directly to tables along with a financial return into rural supermarkets and small businesses in those communities.

For more information on SNAP, visit

HRSA’s Shortage Designation Modernization Project Auto-HPSA National Update

The Health Resources and Services Administration (HRSA) has updated all automatically designated Health Professional Shortage Area (Auto-HPSA) scores. All Auto-HPSA organizations have received HPSA scores for primary care, dental, and mental health.

With the implementation of this update, for the first time Auto-HPSAs are now scored electronically, not manually, streamlining the process and ensuring that all HPSAs nationwide are in a single online system.

No Auto-HPSAs have lost their HPSA designations as a result of the national update.

Current National Health Service Corps (NHSC) participants and those awarded this year are not affected by the national update. Updated scores will be used for the FY 2020 NHSC Loan Repayment Program application cycle, which will open in February 2020.

Auto-HPSA scores are expected to change further. All Auto-HPSA organizations have the option to submit system and supplemental data rescore requests through the Auto-HPSA portal (via the BHW Customer Service Portal).

Visit the Shortage Designation Modernization Project for more information about the national update and technical assistance webinars.

For specific questions regarding HPSA scores, contact your State Primary Care Office (PCO) or HRSA’s Shortage Designation Branch at

New Brief: Behavioral Health In Rural America: Challenges and Opportunities

The prevalence 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

Catalog of Value-Based Initiatives for Rural Providers – 2019 Update

The Rural Health Value team recently updated its Catalog of Value-Based Initiatives for Rural Providers. See which HHS value-based programs are appropriate for rural participation.

Catalog of Value-Based Initiatives for Rural Providers. Summarizes rural-relevant, value-based programs to help rural leaders and communities identify Department of Health and Human Services (HHS) value-based programs appropriate for rural participation. It covers programs recently implemented by HHS, primarily by the Centers for Medicare & Medicaid Services and its Center for Medicare & Medicaid Innovation. Recent catalog additions include 1) the Emergency Triage, Treat, and Transport Model 2) the Maryland Total Cost of Care Model, and 3) Primary Cares Initiatives. (Updated 2019)


Top resources on the Rural Health Value website:

  • Value-Based Care Assessment – Assess capacity and capabilities to deliver value-based care. Receive an eight-category readiness report.
  • Physician Engagement – Score current engagement and build effective relationships to create a shared vision for a successful future.
  • Board and Community Engagement – Hold value-based care discussions as part of strategic planning and performance measurement.
  • Social Determinants of Health – Learn and encourage rural leaders/care teams to address issues to improve their community’s health.

 Contact information:

Keith J. Mueller, Ph.D.

Co-Principal Investigator

CMS Seeks Participants for Direct-Contracting Model

CMS released a request for applications seeking health care providers and other entities interested in participating in the direct contracting (DC) path under the agency’s new Primary Care First alternative payment model. CMS said early in December 2019, it will begin accepting applications to participate in the DC–Global or DC–Professional payment models for the initial implementation period, which will launch January 2020.