Rural Health Information Hub Latest News

Fentanyl and COVID-19 Pandemic Reshaped Racial Profile of Overdose Deaths in U.S.

For as long as statistics about opioid overdose deaths have been collected in the United States, white individuals have been much more likely to die than Black individuals of the same age. With the rapidly increasing rate of fentanyl overdoses in the late 2010s, that trend began to reverse — by the start of the COVID-19 pandemic in 2020, more Black Americans began to die of opioid overdoses and from drug overdoses of any kind, according to researchers at Penn State.

New research from the Penn State College of Health and Human Development examined racial and regional differences in overdose fatalities from 2012-21, capturing the periods preceding and during the COVID-19 pandemic. In most of the nation, the researchers found that younger Black individuals died of overdose at lower rates than their white counterparts, but older Black individuals — especially men in Midwestern cities — became several times more likely to die of drug overdose than their white counterparts as the COVID-19 pandemic emerged.

The study was published in The American Journal on Addictions.

Read more.

Rural Prosperity Roundtable Signals A New Era for Our Planet, People in Rural Pennsylvania

On April 23, more than 70 academics, public officials, economic development, and agriculture stakeholders met at Pennsylvania State University’s Behrend Campus in Erie, Pa. The roundtable discussion – Investing in America Rural Prosperity Roundtable –highlighted the U.S. Department of Agriculture’s (USDA) efforts to create additional income opportunities for producers and entrepreneurs.

Agriculture Deputy Secretary Xochitl Torres Small also highlighted other Biden-Harris Administration efforts to build a stronger, more prosperous rural America through historic investments including the American Rescue Plan Act, Bipartisan Infrastructure Law, and Inflation Reduction Act. These investments are about rebuilding our economy from the middle out and the bottom up and creating new opportunities that ensure families, small businesses and family farmers throughout rural America have the opportunities and tools they need to build a good life in the communities that they love.

Among USDA’s local representatives at the event were Bob Morgan, State Director for Rural Development (RD), Heidi Secord, State Executive Director for the Farm Service Agency (FSA), and Denise Coleman, Natural Resources Conservation Service (NRCS) State Conservationist.

Last week was Earth Week and people everywhere are looking for ways to make our world a better place. This includes rural Americans, who thanks to programs like those in President Biden’s historic Inflation Reduction Act, are leading the fight against climate change, while making their communities healthier and reducing their energy costs. USDA is highlighting our partnership with rural communities to sustainably cultivate the future here in Pennsylvania and around the country.

Just like the President, we at USDA believe that every person, no matter where you call home, has a right to breathe clean air, drink clean water, and live in a healthy community—now and into the future. Every single day, we work to ensure these things. And with historic investments like the Inflation Reduction Act, we’ve also created new programs to transform rural power production and create good jobs for people in rural areas across the country.

The President’s Investing in America agenda is creating good-paying clean energy jobs, lowering costs, meeting our climate goals, advancing environmental justice and conservation, and strengthening communities that for too long were left behind or left out. The President has given Native Americans a stronger voice in federal affairs, and USDA has built new land stewardship and food harvesting programs based on the knowledge and traditions indigenous people have passed down through generations.

Here in Pennsylvania and throughout the country, USDA will continue to play an important role in all these goals. The investments we’re making will bring wealth and resources to people in rural areas and ensure they have every opportunity to succeed right in their own communities.

USDA is proud to celebrate Earth Week to show how we are investing in locally driven solutions to expand access to renewable energy, clean water and wastewater systems, and essential services that create jobs, build critical infrastructure, and create sustainable futures for rural America. We are committed to unleashing the potential of all rural and Tribal communities to build a secure and successful future for all.

For more information and to contact your local USDA office.

FSA in Pennsylvania: https://offices.sc.egov.usda.gov/locator/app?state=pa&agency=fsa

NRCS in Pennsylvania: https://www.nrcs.usda.gov/contact/find-a-service-center

RD in Pennsylvania:  https://www.rd.usda.gov/pa/pennsylvania-contacts

To learn more about biobased products, go to www.biopreferred.gov. For more information on how the Inflation Reduction Act is enhancing USDA investments in clean energy, visit https://www.rd.usda.gov/inflation-reduction-act.

Federal Agencies Release New Resource to Connect People Returning to the Community to Health Care Services

The Office of Justice Programs and the Centers for Medicare & Medicaid Services Office of Minority Health have joined together to release a new Coverage to Care (C2C) resource to support individuals upon release and re-entering the community to connect to health coverage and health services.

Click here to view: Returning to the Community: Health Care After Incarceration

This guide, Returning to the Community: Health Care After Incarceration, will assist individuals upon release and re-entering the community to better understand their health care needs, including physical and behavioral health, to learn key information, terms, people, and titles to help connect to health care services pre- and post-release, learn about insurance coverage types and how to apply, and tips to get started using health coverage to receive needed services to support a successful reentry and healthy life.

Based on community and peer feedback, OJP and CMS worked together to create this resource to help  fill a gap  and give people returning to the community information that can support their ability to advocate for needed services and coverage.  Many people returning to the community may not have health coverage right away or know how to obtain health coverage, and caring for physical or behavioral health needs may have been deferred.  While the immediate needs of  housing or employment will be a priority, it is still important to consider immediate health care needs, including prescriptions, care management, or behavioral health – needs that should not wait. Connecting people to health coverage and to services is essential. This resource is specifically tailored to consider the unique considerations, concerns, and needs of individuals that are incarcerated, soon to be released, or recently released.

Returning to the community can be overwhelming. OJP and CMS encourage family members, community partners, peer support services, and justice-related programs and other stakeholders to use this resource to help start conversations about and support individuals in seeking health care coverage, services, and how to get started. Coverage to Care (C2C) is a CMS initiative meant to assist consumers in understanding their health coverage and using it to receive needed health care services.

Returning to the Community: Health Care After Incarceration is currently available in English and Spanish. Additional languages will be made available. This resource can be used alongside other Coverage to Care resources like the Roadmap to Better Care or the Roadmap to Behavioral Health.

To learn more about Coverage to Care, sign up for our listserv, visit https://go.cms.gov/c2c or email CoveragetoCare@cms.hhs.gov.

To learn more about the Office of Justice Programs, sign up for our listserv, visit https://www.ojp.gov/subscribe.

20 States With the Most Rural Hospital Closures

From Becker’s Financial Management

Nearly 200 rural hospitals have closed since 2005, and some states bear the brunt of this reduction to healthcare access more than others.

Since 2005, 192 hospitals in rural America have shut down, and the COVID-19 pandemic only accelerated rural hospitals’ risk of closure. Eight rural hospitals closed in 2023, as many as in 2022 and 2021 combined, according to the report. This followed a landmark 18 rural hospital closures in 2020, more than any year in the previous decade.

The counts come from the Center for Healthcare Quality and Payment Reform’s latest report, “Rural Hospitals at Risk of Closing.” CHQPR tracks rural hospital closures on an annual basis and, using the latest hospital financial information released by CMS in April 2024, analyzes rural hospitals’ risk of closure.

Below is a listing of the states that have seen the greatest number of rural hospital closures over the past 19 years. For a forward-looking way of looking at the risks of rural hospital closures, here are 25 states ranked by the percentage of their rural hospitals at risk of closure in the next two to three years maximum. The report from CHQPR assessing each state’s rural hospital health and risks can be found in full here.

  • Texas: 25
  • Tennessee: 15
  • North Carolina: 12
  • Kansas: 10
  • Missouri: 10
  • California: 9
  • Georgia: 9
  • Florida: 8
  • Oklahoma: 8
  • Alabama: 7
  • Minnesota: 6
  • Mississippi: 6
  • New York: 6
  • Pennsylvania: 6
  • West Virginia: 5
  • Arizona: 4
  • Illinois: 4
  • Indiana: 4
  • Kentucky: 4
  • South Carolina: 4

HHS Issues New Rule to Strengthen Nondiscrimination Protections and Advance Civil Rights in Health Care

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. By taking bold action to strengthen protections against discrimination on the basis of race, color, national origin, sex, age, and disability, this rule reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.

“Today’s rule is a giant step forward for this country toward a more equitable and inclusive health care system, and means that Americans across the country now have a clear way to act on their rights against discrimination when they go to the doctor, talk with their health plan, or engage with health programs run by HHS,” said Secretary Xavier Becerra. “I am very proud that our Office for Civil Rights is standing up against discrimination, no matter who you are, who you love, your faith or where you live.  Once again, we are reminding Americans we have your back.”

“Section 1557 is critical to making sure that people in all communities have a right to access health care free from discrimination.  Today’s rule exemplifies the Biden-Harris Administration’s ongoing commitment to health equity and patient rights,” said OCR Director Melanie Fontes Rainer. “Traveling across the country, I have heard too many stories of people facing discrimination in their health care. The robust protections of 1557 are needed now more than ever. Whether it’s standing up for LGBTQI+ Americans nationwide, making sure that care is more accessible for people with disabilities or immigrant communities, or protecting patients when using AI in health care, OCR protects Americans’ rights.”

“CMS is steadfast in our commitment to providing access to high-quality, affordable health care coverage for millions of people who represent the vibrant diversity that makes America strong,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s rule is another important step toward our goal of health equity – toward the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health.”

The rule will restore protections gutted by the prior administration and help increase meaningful access to health care for communities across the country. The 1557 final rule draws on extensive stakeholder engagement, review of over 85,000 comments from the public, the Department’s enforcement experience, and developments in civil rights law. Among other things, the rule:

  • Holds HHS’ health programs and activities to the same nondiscrimination standards as recipients of Federal financial assistance.
  • For the first time, the Department will consider Medicare Part B payments as a form of Federal financial assistance for purposes of triggering civil rights laws enforced by the Department, ensuring that health care providers and suppliers receiving Part B funds are prohibited from discriminating on the basis of race, color, national origin, age, sex and disability.
  • Requires covered health care providers, insurers, grantees, and others, to proactively let people know that language assistance services are available at no cost to patients.
  • Requires covered health care providers, insurers, grantees, and others to let people know that accessibility services are available to patients at no cost.
  • Clarifies that covered health programs and activities offered via telehealth must also be accessible to individuals with limited English proficiency, and individuals with disabilities.
  • Protects against discrimination by codifying that Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients.
  • Respects federal protections for religious freedom and conscience and makes clear that recipients may simply rely on those protections or seek assurance of them from HHS.
  • Respects the clinical judgement of health care providers.
  • Protects patients from discriminatory health insurance benefit designs made by insurers.
  • Clarifies the application of Section 1557 nondiscrimination requirements to health insurance plans.

Given the increasing use of artificial intelligence (AI) in health programs and activities, the rule clarifies that nondiscrimination in health programs and activities continues to apply to the use of AI, clinical algorithms, predictive analytics, and other tools. This clarification serves as one of the key pillars of HHS’ response to the President’s Executive Order on Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence. Specifically, the rule:

  • Applies the nondiscrimination principles under Section 1557 to the use of patient care decision support tools in clinical care.
  • Requires those covered by the rule to take steps to identify and mitigate discrimination when they use AI and other forms of decision support tools for care.

Through partnership and enforcement, HHS OCR helps protect access to health care, because all people deserve health care that is safe, culturally competent, and free from discrimination. Learn more about the robust protections of Section 1557 of the ACA at www.HHS.gov/1557 .

This press release provides a summary, not any independent interpretation of Section 1557.  The Final Rule may be viewed or downloaded at: https://www.federalregister.gov/public-inspection/2024-08711/nondiscrimination-in-health-programs-and-activities

25 States at Most Risk of Rural Hospital Closures

From Becker’s Financial Management

Rural hospital closures picked up in 2023 and nearly 700 rural hospitals face continued risk of closing due to serious financial challenges, with some states facing critical conditions in the short term.

The finding comes from the Center for Healthcare Quality and Payment Reform’s latest report, “Rural Hospitals at Risk of Closing.” Eight rural hospitals closed in 2023, as many as in 2022 and 2021 combined, according to the report. This followed a landmark 18 rural hospital closures in 2020, more than any year in the previous decade.

Based on the latest hospital financial information released by CMS in April 2024, CHQPR analyzes rural hospitals’ financial vulnerability in two ways: risk of closure and immediate risk of closure.

For the first category, there are hospitals at risk of closure in nearly every state. This is partly measured by financial reserve limitations that cannot offset hospital losses on patient services for more than six to seven years. In more than half of states, 25% or more of the rural hospitals are at risk of closing; in eight states, the majority of rural hospitals are at risk.

Immediate risk of closure is partly measured by tougher financial reserve limitations: those that could offset hospital losses on patient services two to three years at most. Over 300 rural hospitals are at immediate risk of closing because of the severity of their financial problems, with nearly half of rural hospitals in New York and Alabama facing such an outlook.

Given that immediate risk of closure is the more urgent of the two categories, Becker’s has ranked 25 states by the percentage of their rural hospitals at risk of closure in the next two to three years maximum. The listing for each state also contains broader information about the number of hospitals at risk of closure over the next six to seven years. The report from CHQPR assessing each state’s rural hospital health and risks can be found in full here.

New York
45% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
57% of rural hospitals — 29 — are at risk of closure in the next 6-7 years

Alabama
44% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
58% of rural hospitals — 30 — are at risk of closure in the next 6-7 years

Mississippi
34% of rural hospitals — 25 — are at immediate risk of closure in the next 2-3 years
52% of rural hospitals — 38 — are at risk of closure in the next 6-7 years

Connecticut
33% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years
67% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Tennessee
31% of rural hospitals — 17 — are at immediate risk of closure in the next 2-3 years
35% of rural hospitals — 19 — are at risk of closure in the next 6-7 years

Vermont
31% of rural hospitals — 4 — are at immediate risk of closure in the next 2-3 years
62% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Oklahoma
29% of rural hospitals — 23 — are at immediate risk of closure in the next 2-3 years
43% of rural hospitals — 34 — are at risk of closure in the next 6-7 years

Arkansas
29% of rural hospitals — 14 — are at immediate risk of closure in the next 2-3 years
53% of rural hospitals — 26 — are at risk of closure in the next 6-7 years

Maine
28% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years
44% of rural hospitals — 11 — are at risk of closure in the next 6-7 years

Virginia
27% of rural hospitals — 8 — are at immediate risk of closure in the next 2-3 years
30% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Kansas
26% of rural hospitals — 26 — are at immediate risk of closure in the next 2-3 years
56% of rural hospitals — 57 — are at risk of closure in the next 6-7 years

Florida
24% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 8 — are at risk of closure in the next 6-7 years

Nevada
23% of rural hospitals — 3 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 5 — are at risk of closure in the next 6-7 years

New Mexico
21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years
25% of rural hospitals — 7 — are at risk of closure in the next 6-7 years

West Virginia
21% of rural hospitals — 6 — are at immediate risk of closure in the next 2-3 years
36% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

South Carolina
20% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
40% of rural hospitals — 10 — are at risk of closure in the next 6-7 years

Massachusetts
20% of rural hospitals — 1 — are at immediate risk of closure in the next 2-3 years
40% of rural hospitals — 2 — are at risk of closure in the next 6-7 years

Texas
18% of rural hospitals — 29 — are at immediate risk of closure in the next 2-3 years
48% of rural hospitals — 77 — are at risk of closure in the next 6-7 years

California
18% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 18 — are at risk of closure in the next 6-7 years

Louisiana
17% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years
44% of rural hospitals — 23 — are at risk of closure in the next 6-7 years

Pennsylvania
17% of rural hospitals — 7 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 13 — are at risk of closure in the next 6-7 years

Missouri
16% of rural hospitals — 9 — are at immediate risk of closure in the next 2-3 years
38% of rural hospitals — 21 — are at risk of closure in the next 6-7 years

Georgia
15% of rural hospitals — 10 — are at immediate risk of closure in the next 2-3 years
32% of rural hospitals — 22 — are at risk of closure in the next 6-7 years

Colorado
12% of rural hospitals — 5 — are at immediate risk of closure in the next 2-3 years
21% of rural hospitals — 9 — are at risk of closure in the next 6-7 years

Alaska
12% of rural hospitals — 2 — are at immediate risk of closure in the next 2-3 years
18% of rural hospitals — 3 — are at risk of closure in the next 6-7 years

Meet the 90 New ARC READY Local Governments Communities

Congratulations to the 90 local government groups selected to receive training and funding through our READY Local Governments capacity-building program!  Fifteen are in Pennsylvania!

Each of the 90 participating local governments will receive nine-weeks of no-cost training designed to help them identify, manage and implement federally-funded projects. 🛠️ Many of the participant entities serve economically distressed or historically marginalized areas.

READY Local Governments is one learning track in our READY Appalachia initiative, which aims to increase the region’s capacity to solve its most pressing issues. ⏱️ Stay tuned to apply to our next READY learning track — READY Foundations!

New Brief: Rural Hospitals’  Perspectives On Health System Affiliation

This brief explores the current trend in hospital affiliation from a rural perspective and offers guidance to rural hospital leaders in navigating a potential affiliation. With an understanding of the rural context and challenges facing rural hospitals, risks and opportunities across key areas for consideration are presented, including costs, quality, service delivery and system finances. The brief offers an overview of the affiliation process and how to assess success.

Rural hospitals are anchor institutions in their communities and are the hubs for a host of healthcare services such as emergency care, outpatient care, long term care, and primary care in provider-based rural health clinics. However, rural hospitals are affected by an amalgam of factors which may lead them to consider alternative organizational structures such as participating in local rural health networks and affiliating with large regional health systems.

Read the full report.

Principal Authors: Joel M. James, MPH, Guest Author and Keith J. Mueller, PhD, Chair
Contributing Author: Dan M. Shane, PhD
Prepared by the RUPRI Health Panel: Alva O. Ferdinand, DrPh, JD; Alana D. Knudson, PhD; Jennifer P, Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; and Timothy D. McBride, PhD

This work was supported by the Leona M. and Harry B. Helmsley Charitable Trust.

Pennsylvania Broadband Authority BEAD Challenge Portal Is Open!

The Pennsylvania Broadband Development Authority (PBDA) opened its BEAD Challenge Submission Window this morning. The Challenge Portal is available online. If you are an eligible participant for the challenge process and have not registered, you will need to complete a registration before you can submit challenges.

The PBDA strongly encourages that all Internet Service Providers (ISPs) register for the challenge portal so they may be notified of challenges they may receive through the portal.

Please visit the BEAD Challenge webpage for additional details to include registering for the BEAD Challenge portal, review the public map that identifies those areas deemed unserved, underserved, served, funded and statewide Community Anchor Institutions (CAIs). You can also watch the recording of the BEAD Challenge webinar that was held on March 29, 2024 and download the PowerPoint presentation used during the webinar.

The PBDA would like to remind eligible entities interested in submitting bulk challenges to consider requesting a license from CostQuest Associates. Tier D licenses are available here. Tier E licenses are available here. While a license is not required to participate and access the BEAD Challenge portal, it will help to simplify the submission of bulk challenges.

The timeline for the BEAD Challenge process is broken down into 3, 30-day windows which are as follows:

  1. Challenge Submission Period: Eligible entities will be able to submit challenge for 30 days. (April 24 – May 23)
  2. Rebuttal of Challenges: Entities that have been challenged will have 30 days to respond (May 24 – June 22)
  3. Final Determinations: The PBDA will decided if challenges and rebuttals are valid or not within 30 days (June 23 – July 22)

Lastly, as a reminder, the PBDA will be holding the last of three Office Hour Sessions tomorrow, please click on the link below to obtain additional details and to register.