- In the Columbia River Gorge, a Local Program Adapts to Serve the Community Through COVID-19
- Nine out of 10 Rural Counties Are in the COVID-19 Red Zone
- COVID in North Dakota: One Day Inside a Rural US Hospital's Fight
- The 4 Lessons I Learned While Striving to Preserve and Increase Access to Care in Rural Communities
- HHS Administrator Seema Verma's Rural Open Door Forum Speech
- Report: 20% of COVID-19 Patients Develop Mental Health Issues
- Celebrating State Innovations on National Rural Health Day 2020
- States Are Getting Ready to Distribute COVID-19 Vaccines. What Do Their Plans Tell Us So Far?
- Five Ways VA Supports Rural Veterans During COVID-19
- New Rural COVID Infections Top 195,000 in One Week
- Improving Access to Maternal Care in Rural Communities
- Colleges Probably Stoked Pandemic in the Upper Midwest, Epidemiologists Say
- Supporting Rural Health and Human Services: Celebrating National Rural Health Day November 19, 2020
- Rural Faith Leaders Workshop Series: Empowering Faith Leaders to Help Persons with Substance Use Disorder
- Rural Hospitals Brace for Increased Coronavirus Cases
A new publication targeting our provider community, “Stay Protected – Get a Flu Shot” will be available for order on December 1. And best of all, there is no charge! In order to request your copies, simply set up an account on the CMS Product Ordering page here: https://productordering.cms.hhs.gov/pow/?id=pow_login; and once approved, you can order the publication by either searching by the title (above), or entering pub. no. 12115. General delivery time is approximately one week.
The U.S. Department of Agriculture (USDA) announced the official launch of the AskUSDA Contact Center program. The AskUSDA Contact Center will serve as the “one front door” for phone, chat, and web inquires, transforming how the public interacts with USDA and providing an enhanced experience for the public.
Prior to the creation and implementation of AskUSDA, members of the public had to navigate dozens of phone numbers and had no chat function or online platform for self-service, creating frustrations and inefficiencies. AskUSDA was created to make USDA more responsive to the public by providing a single destination for phone, chat, and web inquiries. Whether it’s talking to a USDA representative via phone, chatting with a live agent on our website, or communicating with USDA via e-mail, the public will have streamlined access.
The launch of AskUSDA delivers a centralized contact center that offers customer service and consistent information for the public. With over 29 agencies and offices, USDA’s mission impacts every single person in the U.S. and hundreds of millions around the globe. AskUSDA assures that farmers, researchers, travelers, parents, and more have efficient access to the information and resources they need.
AskUSDA is set up to handle common questions across programs that service a variety of audiences. For example, customers who may have basic questions about USDA’s nutrition services can be assisted across phone, e-mail, and web chat by trained AskUSDA representatives, and customers who may have complicated questions about loan programs can be quickly connected to agency experts. AskUSDA also hosts over five thousand articles for a self-service option to help with more common questions such as food safety inquiries or pet-travel guidance.
Over the course of its pilot program, AskUSDA successfully assisted with over 93,000 citizen inquiries, and the AskUSDA website resulted in over 1.4 million knowledge article page views. USDA looks forward to continuing to implement this enhanced best in class contact center across the Department.
The public can contact AskUSDA by phone at (833) ONE-USDA with representatives available 9:00am-5:30pm EST weekdays. The website (https://ask.usda.gov/) is available 24/7 and includes live chat agents available 10:00am-6:00pm EST on weekdays. Inquiries can also be sent via email at any time to email@example.com.
Advancing Cancer Prevention Practice Facilitation Work in Rural Primary Care During COVID-19, Dannell Boatman, Susan Eason, Mary E. Conn, Summer Miller, & Stephenie Kennedy-Rea
COVID-19 and Opioid Use in Appalachian Kentucky: Challenges and Silver Linings, Rachel Vickers-Smith, Hannah L.F. Cooper, & April M. Young
Improving Access to Treatment for Opioid Use Disorder in High-Need Areas: The Role of HRSA Health Centers, Michael Topmiller, Jennifer Rankin, Jessica L. McCann, Jene Grandmont, David Grolling, Mark Carrozza, Hank Hoang, Josh Bolton, & Alek Sripipatana
In Their Own Words: How Opioids Have Impacted the Lives of “Everyday” People Living in Appalachia , Patricia Nola Eugene Roberson, Gina Cortez, Laura H. Trull, & Katherine Allison Lenger
Qualitative Analysis of Maternal Barriers and Perceptions to Participation in a Federal Supplemental Nutrition Program in Rural Appalachian North Carolina , Sydeena E. Isaacs, Lenka H. Shriver, & Lauren Haldeman
Leveraging Electronic Health Records Data for Enhanced Colorectal Cancer Screening Efforts, Adam D. Baus, Lauren E. Wright, Stephenie Kennedy-Rea, Mary E. Conn, Susan Eason, Dannell Boatman, Cecil Pollard, Andrea Calkins, & Divya Gadde
Review & Special Articles
The Landscape of Connected Cancer Symptom Management in Rural America: A Narrative Review of Opportunities for Launching Connected Health Interventions , Ming-Yuan Chih, Anna McCowan, Sadie Whittaker, Melinda Krakow, David K. Ahern, Eliah Aronoff-Spencer, Bradford W. Hesse, Timothy W. Mullett, & Robin C. Vanderpool
Media Reviews & Reports
Notes from the Field
Rural Appalachia Battling the Intersection of Two Crises: COVID-19 and Substance Use Disorders, Margaret Miller, Rebekah Rollston, Kate E. Beatty, & Michael Melt
The Centers for Medicare & Medicaid Services (CMS) finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from sending a patient for many types of services to a provider that the physician owns, is employed by, or otherwise receives payment from—regardless of what that payment is for. The old federal regulations that interpret and implement this law were designed for a health care system that reimburses providers on a fee-for-service basis, where the financial incentives are to deliver more services. However, the 21st century American health care system is increasingly moving toward financial arrangements that reward providers who are successful at keeping patients healthy and out of the hospital, where payment is tied to value rather than volume.
The Trump Administration has taken enormous steps towards lowering the cost of prescription drug prices in America, reflecting the historic commitments by both President Trump and Secretary Azar to put American patients first. In three different actions, the Administration has worked towards implementing President Trump’s July 24, 2020 Executive Order on “Lowering Prices for Patients by Eliminating Kickbacks to Middlemen;” cutting down on foreign freeriding through the Most Favored Nation Model; and announced the end of the Food and Drug Administration’s Unapproved Drugs Initiative (UDI), a program that drug companies had used to jack up prices on older drugs.
The Trump Administration finalized a rule to bring drug discounts directly to seniors at the pharmacy counter and eliminate the current system of drug rebates to middlemen.
- HHS Finalizes Rule to Bring Drug Discounts Directly to Seniors at the Pharmacy Counter
- Fact Sheet: Trump Administration Finalizes Proposal to Lower Drug Costs by Targeting Backdoor Rebates and Encouraging Direct Discounts to Patients
- Secretary Azar Confirmation In Response to Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen
The Trump Administration also announced the Most Favored Nation Model, a prescription drug payment model to put American patients first.
- Trump Administration Announces Prescription Drug Payment Model to Put American Patients First
- FACT SHEET: Most Favored Nation Model for Medicare Part B Drugs and Biologicals Interim Final Rule with Comment Period
Additionally, HHS announced a notice published in the Federal Register announced the withdrawal of guidance documents issued as part of the Unapproved Drugs Initiative.
- Statement from HHS Chief of Staff Brian Harrison on Unapproved Drugs Initiative
- Read the Frequently Asked Questions Regarding the Department of Health and Human Services’ Announcement on the Unapproved Drugs Initiative – PDF*
Here is a fact sheet on all of the actions the Administration has taken to lower prescription drug prices.
CMS will retire the original Compare Tools on December 1. Use Medicare.gov’s Care Compare to find and compare health care providers.
In early September, the Centers for Medicare & Medicaid Services (CMS) released Care Compare on Medicare.gov, which streamlines our eight original health care compare tools. Since then, you’ve had the opportunity to use and familiarize yourself with Care Compare while having the option to use the original compare tools, too. You’ve also been able to share feedback from a survey directly on Care Compare and we’ve received lots of great feedback so far.
The eight original compare tools – like Nursing Home Compare, Hospital Compare, Physician Compare – will be retired on December 1st, ending this transition period. If you haven’t been using Care Compare, we urge you to:
- Use Care Compare on Medicare.gov and encourage people with Medicare and their caregivers to start using it, too. Go to Medicare.gov and choose “Find care”.
- Update any links to the eight original care tools on your public-facing websites so they’ll direct your audiences to Care Compare.
Care Compare offers a new design that makes it easier to find the same information that’s on the original compare tools. It gives you, patients, and caregivers one user-friendly place to find cost, quality of care, service volume, and other CMS quality data to help make informed health care decisions.
Now, instead of having to search through many compare tools, with just one click on Care Compare, you’ll find easy-to-understand information about nursing homes, hospitals, doctors, and other health care providers.
Please remember that when we retire the 8 original compare tools, you will still be able to find information about health care providers and CMS quality data on Care Compare, as well as download CMS publicly reported data from the Provider Data Catalog on CMS.gov. Fully transitioning to these tools does not change how CMS measures quality. In addition, we’ll continue to make improvements to Care Compare and the Provider Data Catalog based on stakeholder and consumer feedback now and in the future.
Direct links to the tools & additional resources:
- Care Compare on Medicare.gov – https://www.medicare.gov/care-compare/
- Provider Data Catalog on CMS.gov – https://data.cms.gov/provider-data/
- Care Compare resources for consumers and partners – Medicare blog, Promotional video, Conference card
As Pennsylvania experiences a resurgence of COVID-19 cases with significantly higher daily case counts than in the spring and hospitalizations on the rise, the Pennsylvania Governor Wolf’s Administration has identified four new mitigation efforts, which Secretary of Health Dr. Rachel Levine announced on November 17, 2020.
“It is our collective responsibility to protect our communities and our most vulnerable Pennsylvanians from COVID-19 and to continue to work together to get through this pandemic. These targeted mitigation efforts, combined with existing ones, are paramount to saving lives and protecting our economy,” Gov. Wolf said. “The administration will continue to monitor the risks posed by COVID-19 across the commonwealth and will reinstate or institute new targeted mitigation tactics as necessary.”
The efforts announced include:
Protecting Our Health Care System
Dr. Levine issued a memorandum to acute care hospitals outlining expectations to care for Pennsylvanians who need care during the pandemic.
Hospitals are to work through the established health care coalitions and other partnerships to prepare for how they will support one another in the event that a hospital becomes overwhelmed during the pandemic. Hospitals should also be working to move up elective procedures necessary to protect a person’s health and prepare to suspend them if our health care system becomes strained.
Restrictions on elective surgeries put into effect in March and lifted in April were to help with both PPE and bed capacity and were considered successful.
Hospitalizations are increasing, as are ICU patients, and according to modeling from the Institute of Health Metrics and Evaluation, which does not take into account hospitalizations from influenza, Pennsylvania will run out of intensive care beds in December if ICU admissions continue at the current rate.
The same modeling indicates we will have sufficient medical-surgical beds with some uncertainty as to capacity from region to region.
Dr. Levine issued an order requiring anyone who visits from another state to have a negative COVID-19 test within 72 hours prior to entering the commonwealth.
If someone cannot get a test or chooses not to, they must quarantine for 14 days upon arrival in Pennsylvania.
Pennsylvanians visiting other states are required to have a negative COVID-19 test within 72 hours prior to their return to the commonwealth or to quarantine for 14 days upon return to Pennsylvania.
This order, which takes effect on Friday, November 20, does not apply to people who commute to and from another state for work or medical treatment.
Strengthened Masking Order
Dr. Levine first issued a masking order on April 15. The order signed today strengthens this initial order with these inclusions:
- Masks are required to be worn indoors and outdoors if you are away from your home.
- When outdoors, a mask must be worn if you are not able to remain physically distant (at least 6 feet away) from someone not in your household the entire time you are outdoors.
- When indoors, masks will now be required even if you are physically distant from members not in your household. This means that even if you are able to be 6 feet apart, you will need to wear a mask while inside if with people other than members of your household.
- This order applies to every indoor facility, including homes, retail establishments, gyms, doctors’ offices, public transportation, and anywhere food is prepared, packaged or served.
Colleges and Universities
The departments of Health and Education issued recommendations for colleges and universities to implement a testing plan for when students return to campus following the holidays.
These recommendations include establishing routine protocols for testing.
Colleges and universities should have adequate capacity for isolation and quarantine and should be prepared to enforce violations of established policies such as mask wearing and physical distancing.
Every college and university should test all students at the beginning of each term, when returning to campus after a break and to have regular screening testing throughout the semester/term.
“We must remain united in stopping COVID-19,” Dr. Levine said. “Wear a mask, wash your hands, stay apart and download the COVID Alert PA app. If you test positive, please answer the call of the case reviewer and provide information that can help protect others. It’s the selfless, right thing to do.”
From the American Hospital Association (AHA)
The U.S. Department of Health and Human Services (HHS) issued two important clarifications related to Provider Relief Fund (PRF) reporting.
First, HHS had previously stated that providers could claim only the value of depreciation for COVID-19-related capital purchases with useful lives of more than 12 months. However, at the AHA’s urging, the agency today stated that expenses for capital equipment, facilities projects and inventory may be fully expensed in cases where the purchase was directly related to the prevention, preparation for and response to the SARS-CoV-2 coronavirus. HHS provides several examples of such purchases, including:
- upgrading heating, ventilation and air conditioning systems to support negative pressure units;
- retrofitting COVID-19 units;
- enhancing or reconfiguring intensive care unit capabilities;
- leasing or purchasing temporary structures to screen and/or treat patients; and
- leasing permanent facilities to increase hospital capacity.
Second, HHS clarified that providers’ reporting of net patient revenue should NOT include any payments received from, or any payments made to, third parties that relate to care not provided in 2019 or 2020. The AHA had raised concerns with HHS about including in hospital reporting any Medicaid payments that have been made to settle years-old legal disputes over the program’s construction.
The AHA sent an alert to the field today on these, and other PRF advocacy issues. We will continue to encourage Congress to address our outstanding concerns.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act and Paycheck Protection Program and Health Care Enhancement Act included $175 billion in the Public Health and Social Services Emergency Fund to reimburse health care providers for health care-related expenses or lost revenues not otherwise reimbursed that are attributable to COVID-19. In order to accept these funds, recipients agreed to Terms & Conditions, which require compliance with reporting requirements as specified by HHS.
If you have questions, please contact AHA at 800-424-4301.
As part of its ongoing work to explore sustainable transportation options, the Pennsylvania Department of Transportation (PennDOT) is requesting public feedback for the PennDOT Pathways Program. Information is accessible at www.penndot.gov/funding and feedback will be accepted through December 17, 2020.
“A safe and reliable transportation network is critical to quality of life for those who travel throughout our state,” said PennDOT Secretary Yassmin Gramian. “We take our responsibility as stewards of mobility very seriously, which is why we must explore our options.”
The department faces an $8.1 billion gap in its annual highway and bridge transportation funding to keep the network in a state of good repair. Federal funding has remained essentially flat for several years despite rising inflation. Gas taxes, which comprise 74 percent of PennDOT’s funding, have become increasingly unreliable.
Through the PennDOT Pathways program, the department is launching an extensive initiative to examine possible near- and long-term funding solutions – and how they could potentially work in Pennsylvania. As part of this program, PennDOT recently launched an alternative funding Planning and Environmental Linkages (PEL) Study as part of the PennDOT Pathways program to explore options for funding the maintenance and improvement of Pennsylvania’s highways and bridges.
PennDOT encourages the public to review the information presented on its online engagement platform and to provide comments. Online comments can be submitted directly from the website, or through the below methods:
- Email: PennDOTPathways@pa.gov
- Hotline: 717-325-6129
- Mail: PA Department of Transportation, Keystone Building, 400 North St., Fifth Floor, Harrisburg, PA 17120
For more information about PennDOT Pathways, visit www.penndot.gov/funding.
Pennsylvania State Veterinarian Dr. Kevin Brightbill urged Pennsylvania’s poultry industry, including backyard bird owners, to step up their biosecurity practices as East Asia and Europe report cases of Highly-Pathogenic Avian Influenza.
“Written biosecurity plans are good, but they are only effective when deliberately acted upon day in and day out by you and every farm-hand,” said Brightbill. “When practical biosecurity practices are implemented, they not only safeguard your farm and your flock from high consequence disease, but may enhance the productivity and long-term sustainability of your farm.”
Highly Pathogenic Avian Influenza (HPAI) is reported to be circulating in East Asia and Europe including the countries of Bulgaria, Cambodia, China, Czech Republic, Denmark, Germany, Hungary, Ireland, Japan, Kazakhstan, Laos, Netherlands, Poland, Slovakia, Romania, Russia, South Korea, Taiwan, United Kingdom, Ukraine, and Vietnam. HPAI is known to spread rapidly and be fatal for chickens and turkeys. The last outbreak of HPAI in Pennsylvania, H5N2 in 1983, resulted in the loss of more than 17 million chickens, turkeys, and guinea fowl to contain and eradicate the disease.
Pennsylvania poultry producers should limit exposure of poultry to wild birds through confinement rearing and other biosecurity measures to reduce the risk of introduction of avian influenza virus from wild birds. Such practices are key to decreasing the risk of circulating strains of Avian Influenza from evolving into highly pathogenic forms. Recent detection by USDA Wildlife Services during routine wild bird surveillance of migratory waterfowl in Washington County detected H4N8 Low Pathogenic North American wild bird lineage virus in a mallard duck, which confirms avian influenza is circulating in Pennsylvania and producers should be on-guard to protect their flocks.
Biosecurity basics for poultry producers include:
- Allow only essential personnel to access your property and your birds. Disinfect any vehicles that enter your farm.
- Don’t lend or borrow equipment from other farms. Bring only cleaned and disinfected items into your bird area.
- Avoid contact with other poultry. If you cannot avoid contact, change clothes and shoes before working with your own birds.
- Wash your hands thoroughly with soap and water before entering your bird area.
- Use footbaths when entering or leaving your bird housing (change disinfectant frequently), or wear disposable boot covers.
- Keep poultry separate from wild birds. Don’t let them share water sources or have access to common areas frequented by wild birds.
- Eliminate standing water on your farm and clean up feed spills to avoid attracting wild birds.
For more information about good biosecurity practices visit healthybirds.aphis.usda.gov.
Watch for these signs of illness and immediately report sick or dying birds:
- Sudden increase in bird deaths in your flock
- Sneezing, gasping for air, coughing, and nasal discharge
- Watery and green diarrhea
- Lack of energy and poor appetite
- Drop in egg production or soft- or thin-shelled, misshapen eggs
- Swelling around the eyes, neck, and head
- Purple discoloration of the wattles, comb, and legs
- Ruffled feathers, listlessness, lethargy
Poultry producers with sick or dying birds should immediately report them to Pennsylvania’s state veterinarian by calling 717-772-2852 and press option 1.
“Don’t wait for tomorrow – take steps today to prevent catastrophic loss of flock and your livelihood,” said Brightbill. “Review your biosecurity plans, strengthen them, and retrain your farm hands by working with your herd or flock veterinarian.”
Producers with questions about biosecurity planning are encouraged to contact Pennsylvania’s
Center for Poultry and Livestock Excellence, a result of Governor Tom Wolf’s 2019 Pennsylvania Farm Bill, for resources.