Rural Health Information Hub Latest News

Understanding Barriers to COVID-19 Testing

Researchers used funding from the NIH-supported RADx-UP program to better understand barriers in underserved communities – rural and urban, as well as racial and ethnic minority populations – in Kansas.   The most commonly reported barrier was fear of lost income or employment resulting from quarantine.  Common barriers reported in both rural and urban communities were access issues, such as lack of transportation and lack of support for languages other than English.  Three subthemes appeared to be dominant in rural counties. Under the theme of “political beliefs,” the subtheme “politicization of COVID-19 mitigation and response efforts” was an identified barrier for most rural counties.  See Approaching Deadlines below for a RADx-UP opportunity that closes in January.

HRSA Announces New $350 Million Initiative to Increase COVID-19 Vaccinations

HRSA will distribute funding to health centers to support community-based vaccination events and outreach focused on underserved populations

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced a new $350 million initiative for HRSA-supported health centers to increase COVID-19 vaccines in their communities, with a specific focus on underserved populations. This funding will support health centers administering updated COVID-19 vaccines through mobile, drive-up, walk-up, or community-based vaccination events, including working with community-based organizations, and other efforts to increase the administration of COVID-19 vaccines.

“Community health centers save lives,” said HHS Secretary Xavier Becerra. “We will continue to reach, vaccinate, and protect our most vulnerable people across the country working together with community health centers and community-based organizations. We have seen COVID infections increase in prior winters, and it does not have to be that way this year. We now have updated COVID-19 vaccines to protect communities against the Omicron strain. Our message is simple: Don’t wait. Get an updated COVID-19 vaccine this fall. It’s safe and effective.”

“As community-based organizations that have built deep relationships with their patients and neighborhoods, health centers are uniquely positioned to increase COVID-19 vaccinations,” said HRSA Administrator Carole Johnson. “These funds will ensure that people who live in underserved communities have access to updated COVID-19 vaccines this winter through community-based vaccination events hosted by health care providers and organizations they trust.”

The Expanding COVID-19 Vaccination initiative will provide resources directly to health centers throughout the country to increase COVID-19 vaccinations this winter by addressing the unique access barriers experienced by the underserved populations that health centers serve. HRSA anticipates these efforts will also increase flu and childhood vaccinations through combined vaccination events. All HRSA-funded health centers, as well as health center look-alikes that received American Rescue Plan funding, will be eligible. These funds build on the previous investments made to HRSA-funded health centers to combat COVID-19 and will help even more Americans have access to updated COVID-19 vaccines. To date, health centers have administered more than 22 million vaccines in underserved communities across the country, of which 70 percent to patients of racial and ethnic minorities.

To facilitate access to COVID-19 vaccination, the initiative will foster new and strengthened coordination, with community-based organizations that provide childcare, early childhood development, housing, food, employment, education, older adult, or behavioral health services. Health centers will be encouraged to support mobile, drive-up, walk-up, or community-based vaccination events; extend operating hours, outreach, and off-site vaccination locations to expand opportunities for COVID-19 vaccination; and support  access to COVID-19 vaccination by expanding transportation, translation, education, and interpretation services.

The nearly 1,400 HRSA-funded community health centers serve as a national source of primary care in underserved communities, providing services through more than 14,000 sites across the country. They are community-based and patient-directed organizations that deliver affordable, accessible, and high-quality medical, dental, and behavioral health services to more than 30 million patients each year, with specific initiatives intended to reach people experiencing homelessness, agricultural workers, and residents of public housing.

In 2021, HRSA-funded health centers provided care for one-in-five residents in rural areas and one-in-eleven people nationwide. One-in-three health center patients are living in poverty, and nearly two-thirds are racial/ethnic minorities.

Learn more about the Health Center Program: https://bphc.hrsa.gov/about-health-centers/health-center-program-impact-growth

Read the White House FACT SHEET: Biden Administration Announces Six-Week Campaign to Get More Americans their Updated COVID-⁠19 Vaccine Before End of the Year.

Rural Pennsylvania: Building Healthier Communities for the People Who Power America

By Bob Morgan, Pennsylvania State Director USDA Rural Development

As we celebrate National Rural Health Day this year, we are reminded that a strong community is rooted in its people. The Biden-Harris Administration is committed to serving those who live in the rural areas of this country, like the small towns and communities right here in Pennsylvania.

At the United States Department of Agriculture, we are hard at work offering the resources to the rural and agricultural communities that feed and fuel our nation and provide the everyday essentials upon which America depends.

As I’ve traveled across Pennsylvania, I’ve seen firsthand the unique challenges people in rural communities and remote parts of the state have in accessing the health resources they need and deserve.

“More than 130 rural hospitals have closed over the past decade, and over 600 additional rural hospitals — more than 30% of all rural hospitals in the country — are at risk of closing in the near future,” according to a report from the Center for Healthcare Quality and Payment Reform.

It is part of my job to see what we can do as an agency to address problems such as this.

At USDA Rural Development, we are committed to making sure that people, no matter where they live, have access to high-quality and reliable health care services like urgent care, primary care, and dental care. That’s why I’ve been a proud champion of programs like the Emergency Rural Health Care Grants, created by President Biden’s historic legislative package, the American Rescue Plan Act.

In the past year, this program has helped rural health care organizations across the commonwealth purchase supplies, deliver food assistance, renovate health care facilities, and provide people with reliable medical testing and treatment.

These funds are helping save lives every day. For example, in April of this year, USDA awarded 18 Pennsylvania healthcare organizations a total of $10.5 million through our Emergency Rural Health Care Grant program. In Pittston, Pa., the ambulance service association received $226,000 of these funds for necessary lifesaving equipment such as heart monitors, automatic CPR machines, and loading devices for the ambulances.

On a larger scale, on Nov. 21, 2021, USDA partnered with St. Luke’s Health Network to open the first hospital in Carbon County in 65 years. The trauma-4 facility treated 17,324 emergency care patients thus far this year, thanks to a $98.5 million Community Facilities direct USDA loan investment for the project and a $16 million guaranteed loan.

Local healthcare officials said they are confident the three-story, 80-patient-room, 160,000-square-foot facility, has redefined health care access, convenience, and quality in northeastern Pennsylvania. Again, we are committed to saving lives and improving quality of life in our local rural communities.

We also know that increasing access to telemedicine and distance learning in rural Pennsylvania is critical to building healthier and more resilient communities.

People in remote parts of the state often need to travel greater distances to see a health care provider, are less likely to have access to high-speed internet to utilize telehealth services and are more likely to live in an area that has a shortage of doctors, dentists, and mental health providers.

Through programs like the Distance Learning and Telemedicine Grants Program, we are making it easier for people living in rural areas to access health care services remotely. In 2022, Rural Development funded three DLT projects in Pennsylvania that impacted more than 80,000 people in central and western Pennsylvania. Our funding share for the three projects totaled more than $1 million.

Health is about much more than medical care. Access to modern, reliable water and wastewater infrastructure is a critical necessity for the health and well-being of every American.

In Pennsylvania, we continue to work hand-in-hand with our partners and local community leaders to promote a healthy community and environment through our Water and Environmental Programs.

These programs help rural communities obtain the technical assistance and capital financing necessary to develop clean and reliable drinking water and waste disposal systems. Safe drinking water and sanitary waste disposal systems are vital not only to public health, but also to the economic vitality of rural America.

Through these programs, we make sure people, children and families across the state have clean water and safe sewer systems that prevent pollution and runoff.

For example, in March the South Wayne Water and Sewer Authority received a Water and Waste Disposal Loan and Grant of $14,879,000 to upgrade their wastewater treatment plant for their public sewer system. The plant currently serves residential communities located in Salem and Lake Townships, Pa. The plant is more than 40 years old, and the components have reached the end of their useful life.

USDA Rural Development is a partner who invests in keeping rural people healthy. Join us this National Rural Health Day, Thursday, Nov. 17 as we celebrate the power of rural.  You can learn more about our programs by visiting our website or by calling 717-237-2153.

Video, Telephone, and In-Person Buprenorphine Treatment for OUD During the Pandemic.

  A study of 17,182 patients from the Veterans Health Administration sought to determine if patient characteristics – age, race/ethnicity, comorbidities, housing status – made a difference in the effectiveness of telehealth-delivered buprenorphine for opioid use disorder (OUD).  Effectiveness was determined by 90-day retention; three different telehealth modalities were examined, with each patient receiving at least one video visit, at least one telephone visit but no video, or only in-person.  The study was conducted from March 23, 2020, to March 22, 2021, when policy shifted to allow greater use of telehealth to deliver a potentially lifesaving medication for OUD.  Results showed significantly higher retention for patients using telehealth versus in-person visits, with higher retention observed in those with video visits. But patient characteristics made a difference in the type of telehealth used, and subsequently their retention in treatment.  Among patients who received telehealth, those who were older, male, Black, non–service-connected, or experiencing homelessness and/or housing instability were less likely to have video visits.

COVID-19 Updated Booster Vaccines Covered Without Cost-Sharing for Eligible Children Ages 5 to 11

Following the actions of the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS) is announcing that Medicaid and Children’s Health Insurance Program (CHIP) coverage is available for eligible covered children for the updated COVID-19 vaccines. As a reminder, regardless of what coverage you have, or whether you have coverage at all, COVID-19 vaccines are free to anyone who wants one, for both children and adults. This coverage is part of the ongoing commitment to protect children against severe COVID-19 illness.

The CDC recently expanded the use of updated (bivalent) COVID-19 vaccines to children ages 5 through 11 years. This followed the FDA’s authorization of updated COVID-19 vaccines from Pfizer-BioNTech for children ages 5 through 11 years and from Moderna for children and adolescents ages 6 through 17 years.  People with Medicare, Medicaid, Children’s Health Insurance Program (CHIP) coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these COVID-19 vaccines.

Staying up to date with your COVID-19 vaccinations is the best defense against severe illness, hospitalization, and death from the virus. CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations.

Information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccines are provided through that program at no cost to recipients is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html and through the COVID-19 Vaccine Policies & Guidance page. For information on Medicare payment, billing and codes for the updated vaccine, visit the CMS COVID-19 Provider Toolkit.

Visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccine locations. For resources to promote COVID-19 vaccination, visit the We Can Do This campaign.

HHS Renews COVID-19 PHE for 11th Time — Here’s Why

From Beckers Healthcare

When President Joe Biden declared the COVID-19 pandemic “over” Sept. 18, his message divided the medical community and sent a clear message: the nation is moving on from COVID-19.

On Oct. 13, HHS extended the public health emergency once again and sent another clear message: the healthcare system is not ready to move on.

“It’s not that we necessarily want to continue the PHE for a long period of time,” Nancy Foster, AHA’s vice president of quality and patient safety, told Becker’s. “We want to make sure that all of the work that needs to get done, does get done, before it ends.”

“There’s 400 people dying every day, and most of those are in hospitals,” Chip Kahn, president and CEO at the Federation of American Hospitals, told Becker’s. “I don’t think we’re really into a new normal where we can say with confidence that this is still not an exceptional situation.”

HHS last renewed the PHE July 15 for an additional 90 days — it also told states it would provide a notice 60 days before if it did decide to end it. Aug. 14, the date in which states would have 60 days’ notice, came without a peep from the federal agency, all but confirming the declaration would be extended once more.

The 11th renewal of the PHE since its first declaration in January 2020 allows the country to continue operating under pandemic-era policies until at least the next deadline: Jan. 11, 2023.

But continuing to label the current situation as an emergency while also declaring that emergency over is increasingly being questioned.

Illinois Gov. JB Pritzker was asked in a political debate Oct. 6 why his state has now issued the same PHE 34 times since March 2020. Ten states still have their emergencies in effect.

“We’re following the federal disaster declaration,” Mr. Pritzker said. “It allows us to bring in Medicaid funds and support people who have COVID-19 and support our hospitals.”

Sen. Richard Burr of North Carolina, the top ranking Republican on the Senate health committee, asked in a Sept. 19 letter to the president when Medicaid redeterminations would begin again, or when federal employees and contractors would no longer need to get vaccinated.

“Without a clear plan to wind down pandemic-era policies, the deficit will continue to balloon and the effectiveness of public health measures will wane as the American people continue to be confused by mixed messages and distrust of federal officials,” he wrote.

The number of Americans who say they’re concerned about COVID-19 is 57 percent — among the lowest seen throughout the pandemic, according to a Sept. 14 Ipsos poll. In addition, 82 percent believe the country is in a better pandemic position now than it was one year ago.

“I think it’s the policymakers that are making the judgment because they’re not happy with the implications of the PHE in terms of spending,” Mr. Kahn said. “Also it’s symbolic. If the president said we moved on and there’s still a PHE, then that may put pressure symbolically on the White House to say by Nov. 15 that we’re going to have to move on.”

Moving on isn’t so simple. The pandemic-era policies led to a complete overhaul of telehealth and who can use it, they fast-tracked approvals of COVID-19 vaccines and treatments, and they preserved healthcare coverage for millions of Medicaid beneficiaries nationwide.

Preserving telehealth

“Despite staffing shortages and financial pressures and all the other things we could also talk about, what has not yet happened is fully thinking through how to unwind some of the flexibilities we currently have, and how to perhaps make permanent some of the others,” Ms. Foster said.

The AHA is in favor of cementing many of the PHE policies through legislation, including several around telehealth, rural care and hospital at home programs.

In April 2020, HHS relaxed telehealth restrictions and told providers it would not enforce HIPAA rules around audio-only telehealth services, meaning video calls could be used to treat patients.

In June, the agency released new guidance explaining how providers can maintain HIPAA compliance with telehealth post-PHE because the nonenforcement policy will only remain in effect while the PHE is in place.

Lawmakers are also looking to extend virtual opioid use disorder treatments for individuals with high-deductible health plans. The current rule allowing payers to offer virtual care to members before they meet their deductibles is set to expire at the end of this year.

In addition, waivers that allow patients to be virtually-prescribed buprenorphine for opioid use disorder will also expire when the PHE does.

For Medicare, preserving telehealth flexibilities is also still a work in progress. Medicare has covered the cost of telehealth visits and allowed all Medicare-enrolled providers to bill for telehealth services since early 2020.

As of now, the Medicare flexibilities will end 151 days after the PHE expires. In July, the House passed The Advancing Telehealth Beyond COVID-19 Act, but the legislation must still be approved by the Senate for Medicare patients to continue using telehealth through 2024.

“It’s a complex network of flexibilities that have been allowed,” Ms. Foster said. “It is hard to imagine continuing the robust delivery of telehealth and the way we want to do it and the way our patients seem to want if we don’t have all of the policies we’re identifying because they do build on each other.”

Medicaid redeterminations

Medicaid enrollment initially swelled as a result of early pandemic joblessness and a continuous coverage requirement of the Families First Coronavirus Response Act, meaning states had to keep people enrolled in Medicaid for as long as there was a pandemic. Since February 2020, total Medicaid/Children’s Health Insurance Program enrollment has increased by 17.7 million people, or nearly 25 percent.

If the public health emergency expires, a redetermination process will begin a major disenrollment of Medicaid beneficiaries. Once that occurs, HHS estimates up to 15 million people could lose Medicaid coverage, with about half of those being children.

“Comprehensive health insurance coverage is critical for access to care and it would be really disruptive for people and prevent them from seeking care,” Molly Smith, AHA’s group vice president of policy, told Becker’s. 

Ms. Smith says there will be major challenges if a Medicaid redetermination period is triggered – a process that is complicated in normal circumstances. States are suffering from workforce pressures too and it will be difficult for them to process millions of individuals concurrently, many of whom have moved in the last few years.

In addition, the AHA says the Biden administration and CMS have taken steps to support states with more time and information before the PHE eventually ends.

“There are policy things that can be done, and we think the administration has done many of them,” Ms. Smith said. “I know what they are trying to do is really make sure that all of the different stakeholders are aligned and speaking from the same talking points.”

All payers operating Medicaid plans will be affected, but those with higher enrollments are expected to be more impacted. The loss of beneficiaries will be mitigated through the Inflation Reduction Act’s extension of ACA premium tax credits through the end of 2025, which will allow some to regain coverage in the individual market.

Commercialization of COVID-19 vaccines and treatments

Until this fall, the federal government purchased and made available COVID-19 vaccines and treatments at no cost, but the process has begun to shift those costs to the commercial market.

“My hope is that in 2023, you’re going to see the commercialization of almost all of these products. Some of that is actually going to begin this fall, in the days and weeks ahead. You’re going to see commercialization of some of these things,” White House COVID-19 Response Coordinator Ashish Jha, MD, said Aug. 16.

The onus will fall on payers to become more involved in pricing negotiations, likely leading to higher premiums for members. Commercialization would also leave the over 26 million uninsured individuals in the U.S. with a major disadvantage in accessing free vaccines and treatments.

Some of these products only went to market after fast-track approval from the Food and Drug Administration’s emergency use authorizations, including vaccines. According to Bloomberg Law, that doesn’t mean the products disappear once the PHE does.

EUAs must be initially justified by a PHE, but the former is not reliant on the latter to exist. If HHS does terminate an EUA, it must provide an advanced public notice and begin a transition period “for proper dispositioning of the product.”

Physicians: This is still an emergency

It isn’t just the public and politicians looking to move on from COVID.

Starting Oct. 20, the CDC will no longer publish daily updates on total cases and deaths, instead opting to share the data every Wednesday. The agency has also dropped its quarantine protocols for everyone and masking requirements for healthcare facilities not located in a high-transmission community — much to the dismay of some physicians.

“That means that places with substantial transmission can unmask sick patients who haven’t been tested for COVID, right next to the elderly, chemo patients, people with pulmonary disorders, and pregnant women? My kid could identify the flaws with this plan,” said Megan Ranney, MD, emergency physician and academic dean of Brown University School of Public Health in Providence, R.I.

After the president declared the pandemic over, physicians across the country took to social media to express their disagreement.

“Heck no. With all due respect, [President Biden] — you’re wrong. Pandemic is not over. Almost 3,000 Americans are dying from #COVID19 every single week,” Eric Feigl-Ding, PhD, an epidemiologist and former faculty member at Boston-based Harvard Medical School, tweeted. “A weekly 9/11 is a very big deal. Don’t even get me started on #LongCOVID — wreaking havoc on millions more.”

Still, COVID-19 numbers have continued their downward trend. The nation’s seven-day case average was 40,631 as of Oct. 9, a 25 percent decrease in the last two weeks. The CDC forecasts new hospital admissions will remain stable or have an uncertain trend over the next month, and deaths are expected to fall.

“We don’t know what’s going to happen in the next few months,” Mr. Kahn said. “And if we look at Europe and the U.K., we see COVID on the rise. It is still a present issue.”

CDC Updates COVID-19 Infection Prevention Recommendations for Healthcare Personnel

On September 23 the Centers for Disease Control and Prevention (CDC) updated their COVID-19 infection prevention recommendations for healthcare personnel. Several updates were made that may be of special interest to health centers:

  • Vaccination status is no longer used to inform source control (masking), screening testing, or post-exposure recommendations.
  • When SARS-CoV-2 Community Transmission levels are high, source control is recommended for everyone in a healthcare setting when they are in areas of the healthcare facility where they could encounter patients.
  • When SARS-CoV-2 Community Transmission levels are not high, healthcare facilities could choose not to require universal source control. However, even though source control is not universally required, it remains recommended in some specific circumstances.
  • Updated circumstances when universal use of personal protective equipment should be considered.
  • Updated recommendations for testing frequency to detect the potential for variants with shorter incubation periods and to address the risk for false negative antigen tests in people without symptoms.
  • Clarified that screening testing of asymptomatic healthcare personnel, including those in nursing homes, is at the discretion of the healthcare facility

Health centers will need to follow the level of Community Transmission in their location to determine whether masking is required within their facility. Additionally, the Pennsylvania Department of Health (PA DOH) issued additional guidance and clarification in Health Alerts 661 and 662 issued this week.

Pennsylvania Health Department Recommendations Regarding the Bivalent COVID-19 Booster Vaccine

CDC Guidance released on September 1, 2022, recommends that patients 12 and older who received the primary series of any of the authorized COVID-19 vaccines should receive a booster dose of a mRNA bivalent COVID-19 vaccine. The mRNA bivalent booster dose should occur at least two months after the last dose of a COVID-19 vaccine. The bivalent Pfizer BioNTech booster is approved for patients aged 12 years and older and the bivalent Moderna booster is approved for patients aged 18 years and older. The mRNA bivalent vaccines are only available for booster vaccinations. The original monovalent COVID-19 vaccine must be used for the primary series. The original monovalent COVID-19 vaccine can no longer be used for booster doses except for children aged 5-11 who are not eligible for the booster dose of the bivalent COVID-19 vaccine. Since there are now multiple formulations of the mRNA COVID-19 vaccines it will be extremely important for vaccine providers to make sure that the correct vaccine is given to each patient. The CDC definition of up-to-date with COVID-19 vaccine is someone who has completed their primary vaccine series and received the most recent COVID-19 booster vaccine recommended for them by the CDC. It is highly recommended that patients also receive their Influenza vaccine this fall and can receive both the COVID-19 bivalent booster and the influenza vaccine during the same visit. For complete details, the full Health Advisory 659 will be available here when it is published.

Updated COVID-19 Vaccines Providing Protection Against Omicron Variant Available at No Cost

The Department of Health and Human Services (HHS), through CMS, announced that people with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these COVID-19 vaccines. CMS issued four new CPT codes effective Aug. 31, 2022: Code 91312 for Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product; Code 91313 for Moderna COVID-19 Vaccine, Bivalent Product; Code 0124A for Pfizer-BioNTech COVID-19 Vaccine, Bivalent – Administration – Booster Dose; and Code 0134A for Moderna COVID-19 Vaccine, Bivalent – Administration – Booster Dose. Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. See the full news alert.

Pennsylvania Health Department Says Providers Are Ready to Give Updated COVID-19 Booster Shots

The Pennsylvania Department of Health (DOH) announced that vaccine providers across the state are prepared to begin administering updated COVID-19 booster vaccines as soon as they receive them. The vaccines, which provide additional protection against the original coronavirus and Omicron variants BA.4 and BA.5, were recently approved by the Centers for Disease Control and Prevention (CDC) after receiving emergency use authorization from the Food and Drug Administration.