The Rural Health Value team has released the annual update of the Catalog of Value Based Initiatives for Rural Providers.  This is your “go to” resource for staying current on CMMI payment demos that are germane for rural health care organizations and clinicians. Please share this resource as appropriate with your networks and stakeholders:

Catalog of Value Based Initiatives for Rural Providers
One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).

Link:https://ruralhealthvalue.org/files/Catalog%20Value%20Based%20Initiatives%20for%20Rural%20Providers.pdf

On March 9, the U.S. House and Senate released the long-awaited compromise for the fiscal year (FY) 2022 appropriations package. The National Rural Health Association (NRHA) is pleased with the attention lawmakers have placed on rural providers throughout the pandemic. This week’s package continued that focus with significant provisions for supporting the rural health safety net the following provisions of note.

Support for Rural Hospitals  

• $3.45 billion for the Rural Community Facilities Program and $2 million for the Rural Hospital Technical Assistance Program thru the United States Department of Agriculture Rural Development (RD) programs. NRHA is happy to see maintained funding for these critical programs and will continue advocating for additional TA funds in FY 2023. 
• $62 million for the Medicare Rural Hospital Flexibility Grants Program, an increase of nearly $7 million over FY 2021 funding levels. The $62 million includes $21 million for the Small Rural Hospital Improvement Grant Program and $5 million to establish a Rural Emergency Hospital (REH) Technical Assistance Program. Since the REH designation was established in December 2020, NRHA has been advocating lawmakers explaining that technical assistance is needed to support providers interested in transitioning to this designation.  

Continuation of Core Rural Health Care Programs 

• $12.5 million for State Offices of Rural Health 
• $135 million for the Rural Communities Opioid Response Program  
• $10.5 million for the Rural Residency Development Program 
• $122 million for the National Health Service Corps  
• $6 million for the Rural Maternity and Obstetrics Management Strategies (RMOMS) program, including an increase of $1 million over FY 2021 included in this package.  

Supplemental Public Health Provisions  

As an omnibus package, non-appropriations related provisions will pass along with it, including several that NRHA advocated for.  

• Legislative text to ensure providers maintain their 340B status by waiving the DSH percentage qualification requirement during COVID-19 cost report years. We have heard tremendous concerns from providers on this issue. Congress taking this action is a tremendous victory to upholding the integrity of the program. In February, NRHA sent this letter to HHS Secretary Becerra outlining our concerns with attacks on the 340B program, and the need for this fix.  
• Substantive maternal health legislative language. This includes training grants for health care providers in the maternal health lens, support for pregnant women to understand the true benefit of the COVID-19 vaccine, and additional support for post-partum care. Also included is the NRHA developed Rural Maternal and Obstetric Modernization of Services (Rural MOMS) Act to:  
  • Improve rural maternal and obstetric care data;  
  • Create rural obstetric network grants (authorization of FORHP’s current program); 
  • Adds rural obstetric care to the telehealth programs at HRSA; 
  • Creates a rural maternal and obstetric care training demonstration on workforce specific to rural communities.  
• Extension of telehealth flexibilities beyond the duration of the public health emergency (PHE), including allowance for rural health clinics (RHC) and Federally Qualified Health Centers (FQHC) at their current reimbursement methodology and furnishment of audio-only telehealth services. The bill continues current Coronavirus Aid, Relief, and Economic Security (CARES) Act telehealth provisions as currently written for 151 days beyond the duration of the PHE, which is anticipated to end in July 2022. This timeframe will allow for telehealth to be continued until mid-December, where they will have another opportunity to address this issue.  

NRHA is thrilled with the number of our advocacy priorities included in this package as outlined above. They will continue advocating for delay reinstatement of Medicare sequestration, tools rural providers need to combat the remainder of the pandemic, and creation of a quality reporting program for provider-based RHCs in exchange for cost-based reimbursement moving forward.  

NRHA expects consideration of this package in the House and Senate before the deadline of March 11, with the President expected to sign it into law soon after. They will keep members apprised of developments on this important package and work we’re doing to continue improving the rural health safety net.  

In a significant step toward changing how federal funds are distributed, the Biden administration has preliminarily identified nearly a third of the nation’s census tracts as “disadvantaged” and in line for more help from the federal government.

A week after taking office last year, Biden said he wanted to address historic inequities that have left disadvantaged communities around the country behind in receiving federal funding.

Federal agencies are still working through exactly how to do this. But in the meantime, the White House Council on Environmental Quality has provided a preliminary glimpse at which communities might benefit from Biden’s vision.

The first draft of the database identified 23,410 census tracts, or nearly a third of the nation, as disadvantaged. They represent a sweeping list of communities that could see more federal funds headed their way for climate change, clean energy and energy efficiency, clean transit, affordable and sustainable housing, training and workforce development, the remediation and reduction of legacy pollution, and the development of critical clean water infrastructure.

Among the communities described as “distressed” in the draft Climate and Economic Justice Screening Tool are big cities like Newark, New Jersey, but also rural areas like Mason County, Washington, which has seen a decline in the timber industry after protections were put in place decades ago to preserve the spotted owl.

To identify the areas, the administration considered a wide range of factors, from the expected loss of agriculture and population due to climate change, to traffic volume and diesel particulate exposure, to the cost of housing, to the rate of asthma, diabetes and heart disease in the community.

A solace for areas initially not considered distressed is that the database is a work in progress. Saying it wants to make sure it is not missing any communities in need, the environmental council posted a notice in the Federal Register, asking local and state government officials, academics and members of the public to examine the database and suggest ways to refine it by April 25.

“The hope is that the tool reflects the realities on the ground and we are properly identifying disadvantaged communities,” the council official said.

Particularly valuable will be national datasets that allow the government to compare communities around the country, the official said. But the council would also welcome local studies and data to further refine the tool.

Monica Lewis-Patrick, a member of a White House advisory committee and president and CEO of a Michigan water justice organization, We the People of Detroit, said she hoped relevant data not usually considered in federal funding decisions, like data gathered by community activists, will be included.

Read more.

In the State of the Union Address, President Biden proposed his solutions to the biggest concerns we are currently facing as a nation, including those facing rural health.

The National Rural Health Association (NRHA) has been pleased to see a focus on rural communities early in the President’s term, recognizing that for too long rural communities have faced underinvestment and persistent poverty. Significant investments in rural through the American Rescue Plan and Bipartisan Infrastructure Package include addressing rural health coverage gaps, keeping rural hospitals open, addressing rural healthcare workforce shortages, as well as maintaining and expanding telehealth. These are in line with NRHA’s advocacy focus since the onset of the Biden Presidency.

Of note, the President used the speech to launch a new Strategy to Address our National Mental Health Crisis. Rural America suffers from the effects of long-standing shortages of specialty mental health services, long travel distances to obtain treatment, and stigma and cultural/ societal attitudes toward receiving behavioral health services. Last fall, NRHA provided comments to a Senate Finance Committee request for information on mental health care. Upon initial review of the President’s proposed mental health strategy, NRHA is pleased to see many of our recommendations reflected in this new initiative, especially around investing in a strong behavioral health workforce, integration of behavioral health and primary care, and addressing the opioid crisis. HHS Secretary Becerra will kick off the National Tour to Strengthen Mental Health to hear directly from Americans across the country about the behavioral health challenges they are facing and engage with local elected officials and leaders to strengthen the mental health and crisis care system in our communities.

Last night President Biden announced his proposals to address several issues important to rural areas, including:

• COVID-19 “test to treat” program which will allow individuals to receive antiviral pills on the spot when doing in person testing at local pharmacies and locations like community health centers and long-term care facilities.
• Addressing the cost of prescription drugs including Medicare drug negotiation.
• Continuing to advance maternal health care in America.
• Veterans health and addressing toxic exposure.
• Creating of ARPA-H, the Advance Research Projects Agency for Health.

Of potential concern, the President announced measures to improve nursing home quality, including minimum staffing levels and increased inspections.  Given historic under-reimbursement by public payers and recent staffing shortages associated with COVID-19, NRHA is concerned about implications for rural nursing home facilities ability to meet the potentially burdensome new standards. NRHA will closely monitor developments and advocate on behalf of rural long-term care providers across the country.

NRHA supports the Administration’s Unity Agenda to bring together all parts of our country to address disparities among our citizens. NRHA looks forward to continuing work with the Administration and Congress to ensure that rural communities have access to critical health care they need and deserve.

Funding continues to be available for eligible individuals and families in Pennsylvania experiencing financial hardship due to the COVID-19 pandemic through the Low-Income Household Water Assistance Program (LIHWAP). This assistance can aid in maintaining households’ access to drinking and wastewater services essential to ongoing health and overall wellbeing.

Program funds are issued directly to the service providers in the form of grants, or crisis grants depending on situation severity. To qualify for the program, participants must either rent or own their home, have overdue water bills, and meet program income guidelines.

The Department of Human Services (DHS) developed a media toolkit to assist in the awareness of the Water Assistance program within the commonwealth. Below are example social media posts. Additional social media images, newsletter text, and flyer text are available on the DHS website.  Click here to apply!

March is #Colorectal Cancer (CRC) Awareness Month. CRC is the second leading cause of cancer death for both men and women. Overall, the most effective way to reduce your risk of colorectal cancer is to get screened for colorectal cancer routinely, beginning at age 45. Go to the Pennsylvania Cancer Control News for colorectal cancer information and resources.

Black persons have the highest CRC rates of any racial/ethnic group in the United States. CRC is expected to be the third leading cause of cancer death in this group according to the American Cancer Society. These disparities may be partially attributed to differences in exposure to risk factors (i.e., smoking, obesity) and health care access (ACS, 2020). However, Blacks are less likely to receive follow-up after a positive screening test in a timely manner.  To learn more about screening barriers and key messages designed for this population and others check out these George Washington University (GW) tools:  GW Cancer Control TAP CRC Awareness Month Campaign Resources.

Last night, President Biden announced an ambitious strategy to address our national mental health crisis. At the Health Resources and Services Administration, we stand with the President in his call for unity in our national response and know that for the millions of Americans living with a mental health condition or caring for a loved one with a mental health condition, the time for action is now.

The trauma and loss of COVID-19 has heightened long-standing needs and inequities in our mental health system, and the President’s strategy charts a path forward to address these gaps to help all Americans thrive.

At HRSA, our work to implement the President’s strategy means taking action to dramatically expand the supply, diversity, and cultural competence of the mental health and substance use disorder workforce through our health professions training, scholarship and loan repayment programs; increasing the number of community health workers and peers providing behavioral health services; launching new programs to support the mental health and well-being of our heroic health care workers to reduce burnout; expanding access to substance use disorder treatment in rural communities, and bolstering the work of HRSA-funded community health centers, which provide health care to nearly 29 million Americans, to address the mental health needs of children and families in underserved communities across the country. We will continue to pull all available levers to help meet this critical moment for the nation’s mental health.

Read Administrator Johnson’s statement and more about the President’s plan.