By Donna Kallner September 27, 2024

People who travel overseas are usually advised to do a bit of research beforehand about how to behave there. Closer to home, though, they may be unintentionally obtuse about the etiquette of rural places they visit.

n the hospitality business it’s common knowledge that doctors and lawyers, judges and business executives like to cut loose where their professional colleagues, customers and constituents are unlikely to notice. And rural places, whether they’re across the country or across the county, are just the ticket.

My theory, for what it’s worth, is that people who’ve been trained to never take no for an answer in their day jobs forget that negotiation isn’t part of every interpersonal exchange.

Some people raise misbehaving to an art form worthy of lyrics in country songs. But mostly, it’s not worthy. Manners matter, even when you’re around people you think you’ll never see again. So here are things you might wish to know about how to behave in rural areas.

There’s a reason. For every sign posted in a rural area, there’s a reason. Sadly, though, there are always people who think they only apply to other people. Often, as they disregard a sign, they declare, “I’m only going to be here a minute.” And somehow they always seem to have missed childhood lessons about how long a minute is. So here’s one of the simplest rules of behavior in rural areas: Don’t block driveways, mailboxes, gates, dry hydrants or anything else marked by a sign.

People pay attention. Where there are fewer people and fewer vehicles on the roads, there’s not much anonymity. So you can assume folks note the make and model of unfamiliar vehicles. Recently, I stopped to visit with someone who told me about a pickup truck that’s been racing past his place. I’ve seen that truck and think it might belong to someone working a construction project nearby.

When a project is expected to take several months, an out-of-town work crew might find rental housing (good luck) or park a trailer somewhere. They might never actually meet the people who live on that narrow, curvy, hilly road – people who may be reluctant to flag down an unfamiliar vehicle to ask the driver to slow down. So visitors might want to know that rural populations skew older, and behave as if behind every window there’s someone with all the time in the world to take down license plate numbers, note patterns of activity, and call the sheriff.

Word gets around. I have to assume that misunderstood manners are why, in the city, Uber drivers get to review guests like guests review drivers. VRBO and AirBnB short-term rental hosts also get to review guests. But even when there’s no formal mechanism to record bad behavior, word gets around. When we hear a business owner mutter, “That guy’s as welcome as a fart in church,” we take note. It’s best to assume that people in a rural area all know each other, and the person behind the bar is texting her cousins about the unruly patron who might be headed their way after she invites the bad boy to leave. As a rule, it’s best to treat rural bartenders like tough mothers, regardless of gender.

Patience is a virtue. I know people with years of experience in the hospitality industry who will not work on Friday nights. Here in Wisconsin, that’s when people go out for fish fry. Here in the Northwoods, that’s also when people with cottages head north to relax after leaving more populated places with more restaurant options. I don’t know why some reality show doesn’t drop celebrities and CEOs into Northwoods taverns to work Friday fish fries (or maybe they have but I don’t watch those shows).

People skilled in other lines of work might not fully appreciate the careful preparation, teamwork and timing it takes to get fried fish orders through the line and out of the kitchen. People who know and love this culinary tradition just order a brandy old fashioned (sweet) and wait patiently for their food. Unless they see a large party with fussy children arguing with the wait staff about making 20 or 30 minor substitutions: Then locals take our orders to-go.

Planning is appreciated. In rural areas, it’s safe to assume that there are no simple solutions to supply problems nearby. So we try to plan ahead as much as possible. That includes not just restaurants but also volunteer fundraisers like fish boils and pancake breakfasts. An order of 50 meals to-go is most appreciated when we know in advance it’s coming. Then we can have sufficient containers on hand not just for that one order but for all the other folks who want carryout, and set up for food prep that doesn’t extend the wait time for people standing in line. The volunteers flipping flapjacks can’t make their griddles larger, or shorten the distance to town to send someone for more to-go boxes.

Make eye contact. This may be difficult to comprehend for people who spend most of their time trying to avoid making eye contact with strangers. But in rural areas, we actually look at each other when we talk. Pair that with a smile and folks will be treating you like family in no time. Add a friendly wave if you’re driving by. But don’t slow down unless there’s a deer in the ditch or you may seem creepy.

Language matters. In general, in rural places you can’t go wrong with please, thank you, and “may I ask…” Respectful questions are generally appreciated in both private homes (would you prefer I take off my shoes?) and in businesses (is it too close to closing time to order food?). Even respectful questions may not yield the hoped-for answer. Back when my husband and I owned a paddling school on a whitewater river, we said no to a lot of people who thought they should be able to rent a canoe or kayak – whether or not they knew how to paddle in whitewater rapids. Some of them seemed to think no meant talk louder using coarse language. The first time it happened to me, I asked the guy, “Would you speak that way if your mother was standing behind you?” He actually looked over his shoulder.

To avoid any misunderstanding, cussing at the person behind the counter is not good manners. Cussing where families are present (and by that I mean people of every age) – not good manners. Anybody on a ladder helping a neighbor get a fallen tree off a roof gets a free pass on language. But otherwise, watch your mouth. Anything else I might have to add can be best expressed by Wisconsin musicians Pete and Lou Berryman in their song, A Chat With Your Mother:

I can’t control how you young people 

Talk to one another,

But I don’t want to hear you use 

That F word with your mother.

Once you hear that sung to the accordion, it’ll be with you forever.

In June 2023, Pennsylvania was awarded over $1.16 billion in funding through the National Telecommunications and Information Administration’s (NTIA) Broadband Equity, Access, and Deployment (BEAD) Program. As a next step in implementing this historic investment, the PBDA Board of Directors recently approved guidelines that detail the requirements to participate in the program.

Pennsylvania’s BEAD Program Guidelines will be posted for at least 30 days prior to PBDA beginning to accept applications. Additionally, the PBDA is aware that other states have, or will, implement a pre-qualification process for potential applicants interested in applying for BEAD funding. However, the PBDA has determined that it will not require pre-qualification in advance of accepting applications.

Lastly, the PBDA has updated the Pennsylvania Broadband Map to include Broadband Serviceable Areas (BSAs) eligible under the PBDA BEAD Program.  You can find a CSV file and other pertinent information, to include Program Webinars and upcoming Office Hours details, on the PBDA BEAD Program website.

There’s a new morning ritual in Pinedale, Wyoming, a town of about 2,000 nestled against the Wind River Mountains.

Friends and neighbors in the oil- and gas-rich community “take their morning coffee and pull up” to watch workers building the county’s first hospital, said Kari DeWitt, the project’s public relations director.

“I think it’s just gratitude,” DeWitt said.

Sublette County is the only one in Wyoming — where counties span thousands of square miles — without a hospital. The 10-bed, 40,000-square-foot hospital, with a similarly sized attached long-term care facility, is slated to open by the summer of 2025.

DeWitt, who also is executive director of the Sublette County Health Foundation, has an office at the town’s health clinic with a window view of the construction.

Pinedale’s residents have good reason to be excited. New full-service hospitals with inpatient beds are rare in rural America, where declining population has spurred decades of downsizing and closures. Yet, a few communities in Wyoming and others in Kansas and Georgia are defying the trend.

“To be honest with you, it even seems strange to me,” said Wyoming Hospital Association President Eric Boley. Small rural “hospitals are really struggling all across the country,” he said.

Read more.

The Centers for Medicare & Medicaid Services (CMS) released comprehensive guidance to support states in ensuring the 38 million children with Medicaid and the Children’s Health Insurance Program (CHIP) coverage – nearly half of the children in this country – receive the full range of health care services they need.

Under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, eligible children and youth are entitled to a comprehensive array of prevention, diagnostic, and treatment services — including well-child visits, mental health services, dental, vision, and hearing services. These requirements are designed to ensure that children receive medically necessary health care services early, so that health problems are averted, or diagnosed and treated as early as possible. Because of the EPSDT requirements, Medicaid provides some of the most comprehensive health coverage in the country for children and youth.

The guidance issued today reinforces the EPSDT requirements and highlights strategies and best practices for states in implementing those requirements. This guidance, which was required by section 11004 of Title I of Division A of Bipartisan Safer Communities Act (BSCA) (P.L. 117–159), is the most comprehensive EPSDT guidance that CMS has released in a decade and is a critical step to ensuring the health of children.

“We need to make sure our children have what they need to stay well. Medicaid makes that possible,” said HHS Secretary Xavier Becerra. “This guidance to our states today will help millions of kids get the services that are crucial to their health and development, no matter where they live.”

“Our children are the future. They deserve the very best care possible and CMS is committed to ensuring that our nation’s children and youth get the right care, at the right time, in the right setting,” said CMS Administrator Chiquita Brooks-LaSure. “The implementation of the EPSDT requirements, in partnership with states, is vital to the tens of millions of children in the nation who are covered by Medicaid and CHIP. We’ll keep working until every child can get the care they need, when they need it.”

Today’s guidance is a critical step in CMS’ efforts to strengthen the Medicaid and CHIP programs across the country. The guidance clearly explains the statutory and regulatory EPSDT requirements, and suggests best practices across key areas, including increasing access to services through transportation and care coordination, expanding the children-focused workforce, improving care for children with specialized needs (including children in the child welfare system and children with disabilities), and expanding awareness among families of their children’s rights under the EPSDT requirements.

The EPSDT guidance also includes information to help address the needs of children with behavioral health conditions. Youth in the United States are experiencing a mental health crisis, research shows. The EPSDT guidance includes a series of strategies and best practices that states can use to meet children’s and youth’s behavioral health needs. For example, it suggests that states create a children’s behavioral health benefit package and support the management of children and youth with mild to moderate behavioral health needs in primary care settings. States must provide coverage for an array of medically necessary mental health and SUD services along the care continuum – including in children’s own homes, schools and communities — in order to meet their EPSDT obligation. This work builds on the HHS Roadmap to Behavioral Health Integration, which outlines the Department’s commitment to providing the full spectrum of integrated, equitable, evidence-based, culturally appropriate, and person-centered behavioral health care to the populations it serves, and builds on the President’s Unity Agenda to advance mental health.

The EPSDT requirements play a crucial role in the long road to achieving health equity by helping to provide access to essential care for children enrolled in Medicaid and CHIP. The guidance released today is one important step in the Biden-Harris Administration’s commitment to child health and access to affordable, quality health coverage for all, and is part of CMS’ broader strategy to ensure that children have the comprehensive and high-quality care they need. Beyond the importance of the EPSDT requirements, Medicaid more broadly is vital for ensuring the health of America’s youth. A new HHS report, Medicaid: The Health and Economic Benefits of Expanding Eligibility, by researchers in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) examines the impact of Medicaid throughout its six decades and highlights the importance of Medicaid coverage for low-income children. Studies show that access to Medicaid coverage is associated with a significant improvement in health and mortality that continues beyond childhood. In addition to improved health outcomes, children with Medicaid have improved educational and economic outcomes.

Congresswoman Carol Miller (R-WV)  introduced the Rural Communities Opioid Response Program (RCORP) Authorization Act with Representatives Terri Sewell (D-AL), Buddy Carter (R-GA), and Ann Kuster (D-NH). The RCORP Authorization Act will establish and expand prevention, treatment, and recovery services in rural areas for opioid users.

“Ensuring there are enough resources for those who are suffering from addiction is a top priority for me. As a representative for a rural district, I have seen firsthand how important it is for my constituents to have access to quality health care. The Rural Communities Opioid Response Program provides funding to rural communities that are in need of recovery facilities, and the program should be authorized to provide certainty for communities and providers. I thank my colleagues for partnering with me on this bipartisan issue to establish addiction prevention services in the most rural areas of the United States,” said Congresswoman Miller.

“The opioid epidemic doesn’t discriminate. As we see in Alabama, it affects people of every background and every zip code, urban and rural. By authorizing the Rural Communities Opioid Response Program, we can take critical steps toward expanding prevention, treatment, and recovery services for opioid users in rural communities. I’m grateful to be part of the bipartisan group of lawmakers working to make that happen,” said Congresswoman Sewell.

“The opioid epidemic is a nationwide crisis that especially impacts rural communities. As a pharmacist and representative for a rural district, I understand the importance of ensuring that all Americans have access to prevention, treatment, and recovery services. Formally authorizing the Rural Communities Opioid Response Program will save lives in districts like mine. I am proud to work in a bipartisan manner to ensure continued access to these vital health care resources,” said Congressman Carter.

“From health care workforce shortages to limited access to treatment and recovery services, rural communities in New Hampshire and across the country have been hit particularly hard by the addiction and overdose crisis. Ending the substance use disorder epidemic calls for an all-of-the-above government response, and the Rural Communities Opioid Response Program will help ensure that even our most rural communities have access to the resources and support they need to save lives,” said Congresswoman Kuster.

“Substance use, including opioid use, is exacerbated in rural America by a lack of access to care and treatment. The Rural Communities Opioid Response Program (RCORP) is a grant program aimed at alleviating this gap by establishing and expanding prevention, treatment, and recovery services. NRHA applauds the efforts of Representatives Miller, Sewell, Carter, and Kuster for their introduction of the RCORP Authorization Act and their continual leadership on rural issues,” said Alan Morgan, CEO of the National Rural Health Association.

“Rural communities have been uniquely tested by the opioid epidemic. Limited care options, transportation issues, and incomplete support systems along with barriers to reintegration into the workforce have created unique barriers on the road to recovery. The RCORP program has been critical in deploying needed resources to these communities while promoting unique collaborations that provide patient-centered care. As such, we enthusiastically support the continuation of this vital program,” said David Gozal, M.D., M.B.A., Ph.D. (Hon), Vice President for Health Affairs and Dean of the Joan C. Edwards School of Medicine at Marshall University.

​​”On behalf of the 50 State Offices of Rural Health, we are thrilled to see Reps. Carol Miller, Ann Kuster, and Buddy Carter introduce the RCORP Authorization Bill of 2024.  The RCORP grant program has been a lifeline for Rural population in West Virginia, New Hampshire, Georgia and all 50 states.  If passed into law this bill solidifies the standing of the program in the eyes of Congress – we look forward to working with our rural champions to ensure Congress passes this bipartisan bill into law,” said Tammy Norville, CEO of the National Organization of State Offices of Rural Health.

PHC4 has released a new resource on its website, intended to support informing interested Pennsylvanians on current topics that impact health care in the Commonwealth. This first occurrence aims to offer insight into non-compete agreements in health care and includes an extensive summary of the events on both state and federal levels.

PHC4 believes this coincides with its mission to empower Pennsylvanians through transparency, providing access to data, research, analysis, and reporting focused on the cost, utilization, and quality of health care delivery in the Commonwealth. Barry D. Buckingham, Executive Director at PHC4, stated, “I’m proud to be a part of expanding the reach of PHC4’s value by offering additional resources in support of every person in the Commonwealth making informed decisions.” He went on to say offering key insights and support to Pennsylvania’s stakeholders is paramount in assessing the relevance of this new requirement through Act 74 of 2024, as well as in the development of additional resources.

Announced alongside this is a public comment period in response to the Fair Contracting for Health Care Practitioners Act, Act 74 of 2024. This recent legislation requires PHC4 to perform a study on the effects of the Act, and to report its findings. In support of this study PHC4 will be collecting public comment for analysis and inclusion within the final report. To ensure comments are included for analysis, the comment must be received by October 21, 2024. Those interested in commenting on Act 74 of 2024, may do so by sending an email or letter by mail to PHC4.

Email: publiccomment@phc4.org

Letter by Mail: PA Health Care Cost Containment Council, 225 Market St, Suite 400, Harrisburg, PA 17101

PHC4 is an independent council formed under Pennsylvania statute (Act 89 of 1986, as amended by Act 15 of 2020) to address rapidly growing health care costs. PHC4 continues to produce comparative information about the most efficient and effective health care to individual consumers and group purchasers of health services. In addition, PHC4 produces information used to identify opportunities to contain costs and improve the quality of care delivered.

For more information, visit phc4.org.

READY Grants to Grow is making $9 million available for projects that will build individual, organizational and/or community capacity to help the region’s most underserved areas and populations create positive change.

The Appalachian Regional Commission (ARC) announced the launch of READY Grants to Grow, a new, $9 million funding opportunity that will award grants of up to $500,000 to organizations seeking to build individual, organizational and/or community capacity across Appalachia. Any organization that is eligible to apply for an ARC grant can apply for READY Grants to Grow, though certain requirements apply.

READY Grants to Grow is the latest offering from READY Appalachia, ARC’s capacity-building initiative offering no-cost training and funding access to nonprofits, local development districts (LDDs), local governments and community foundations serving the region. This new funding opportunity aims to make even more resources available to a wider range of community and economic development organizations.

“Many of our Appalachian communities do not have the staff to fully take advantage of valuable opportunities for growth,” said ARC Federal Co-Chair Gayle Manchin. “Through the READY Grants to Grow initiative, ARC is working to help these communities to address these economic inequalities, so they can increase their grant success potential and create long-lasting, transformative change for their residents and the region.”

To be selected, organizations must propose projects that strengthen underserved communities and economies in the Appalachian Region, and/or demonstrate low capacity themselves. Proposed projects must address one or more of the following:

• Individual capacity building, including skill training for organization staff or professional development for leaders.
• Organizational capacity building, including hiring new staff for expanded services, developing internal strategic plans, or purchasing goods and services that will improve operation.
• Community capacity building, including creating and expanding partnership networks, hiring a contractor for a community economic development plan, or launching a community-led planning process.

Successful projects will draw a clear connection between their capacity building proposal and the broader community’s economic development and improved services to underserved populations and areas.

A pre-application webinar will be held on October 10, 2024 at 11:00 a.m. ET. Interested applicants must submit a letter of intent to apply by November 1, 2024 to access application portal. Grant applications are due February 14, 2025.

READY Appalachia was launched in July 2022 using Bipartisan Infrastructure Law funds. To date, ARC has provided no-cost training to 75 nonprofits, 90 local government entities, 41 LDDs and 30 community foundations to help them build internal capacity and better serve their communities. Nearly $4 million in funding (no match required) was awarded through READY LDDs and more than $1.6 million was awarded through READY Nonprofits, with more awards on the horizon through READY Local Governments and READY Community Foundations.

Across all READY Appalachia opportunities, special emphasis is placed on serving Appalachia’s most underrepresented communities, including economically distressed areas, organizations located within the Rural Partners Network’s Community Networks, counties prioritized by the Interagency Working Group on Coal and Power Plant Communities, and marginalized populations.

About READY Appalachia
READY Appalachia is an ARC initiative building individual, organizational and community capacity in the Appalachian Region. Offerings include no-cost, cohort-based training and funding access (no match required) for nonprofit organizations, Local Development Districts (LDDs), local governments and community foundations serving the Appalachian Region. Additionally, READY Grants to Grow offers capacity building grant awards of up to $500,000, available to entities that are currently eligible to apply for ARC grants. Across all READY Appalachia offerings, special emphasis is placed on helping the region’s most under resourced and economically distressed communities increase their ability to solve pressing issues and create lasting, positive change.

About the Appalachian Regional Commission
The Appalachian Regional Commission is an economic development entity of the federal government and 13 state governments focusing on 423 counties across the Appalachian Region. ARC’s mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the region achieve socioeconomic parity with the nation.