Effective January 1, 2019, CMS announced new strategies to further help Medicare Part D sponsors prevent and combat opioid overuse including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention.  The new policies include (1) improved safety edits when opioid prescriptions are dispensed at the pharmacy and (2) drug management programs for patients determined to be at-risk for misuse or abuse of opioids or other frequently abused drugs.

CMS has posted tip sheets and other resources to help increase awareness of the new policies among stakeholders. Three sets of outreach materials designed for physician, pharmacist, and beneficiary audiences are available on the CMS website for download. Materials can be found at: https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html

Please click here to read Rural Horizons Winter 2019.

In any community, developing a coordinated strategy to address unsheltered homelessness is challenging. Community Supportive Housing (CSH) now offers guidance that can help ensure better outcomes. Learn about their new Community Response Resources: Tools, Policies & Templates for Addressing Unsheltered Homelessness. These tools will assist you in identifying and leveraging local champions and strategies to tackle issues that may arise during the development and implementation of an outreach and engagement system.

In October 2018, the Office of the National Coordinator for Health Information Technology (ONC), in collaboration with the HHS Office for Civil Rights (OCR), released an updated, downloadable Security Risk Assessment (SRA) tool. This updated SRA tool is easier to use and applies more broadly to the risks of confidentiality, integrity, and availability of health information. The tool is designed to help healthcare providers conduct an SRA as required by the HIPAA Security Rule and the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program. The tool diagrams HIPAA Security Rule safeguards and provides enhanced functionality to document how your organization implements safeguards to mitigate, or plans to mitigate, identified risks. The new SRA tool is available for Windows computers and laptops. However, the previous iPad version of the SRA tool is still available from the Apple App Store (search under “HHS SRA Tool”). Go to the HealthIT.gov website to download the updated SRA tool.

Pennsylvania residents now have access to the Drug and Alcohol Referral Tool (DART), an online resource to help individuals seeking substance use disorder (SUD) treatment find appropriate, local care. This tool is fully anonymous, user friendly and can be translated into over 100 languages. DART is a centralized hub that will ask a series of questions based on a person’s age, county of residence and veteran status to assess appropriate needs and locate care. The tool will also provide potential resources that consider issues of homelessness, transportation and legal concerns. “Substance use disorders often occur when a person experiences other medical and behavioral health concerns, and they may need additional resources to live a stable, healthy life in recovery,” said Human Services Secretary Teresa Miller. “Connecting people seeking treatment to comprehensive services that can help meet all of their needs from the start is critical as they work towards recovery.”

Surgeon General releases advisory on E-cigarette epidemic among youth

Urges parents, teachers and health professionals to protect children from nicotine addiction

U.S. Surgeon General Vice Adm. Jerome M. Adams issued an advisory today stressing the importance of protecting children from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use.

E-cigarette use among youth has skyrocketed in the past year at a rate of epidemic proportions. According to data from the Centers for Disease Control and Prevention and the Food and Drug Administration’s National Youth Tobacco Survey, the percentage of high school-age children reporting past 30-day use of e-cigarettes rose by more than 75 percent between 2017 and 2018. Use among middle school-age children also increased nearly 50 percent.

Data from National Institutes of Health’s Monitoring the Future survey also shows that America’s teens reported a dramatic increase in their use of e-cigarettes in just a single year, with 37.3 percent of 12th graders reporting use in the past 12 months, compared to 27.8 percent in 2017.

“We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes,” said Adams. “Everyone can play an important role in protecting our nation’s young people from the risks of e-cigarettes.”

The surge in e-cigarette use among our nation’s youth has been fueled by newer cartridge-based devices that have become increasingly popular. Many of these e-cigarettes look like a USB flash drive, making them easy to conceal. One of the most commonly sold versions is JUUL, which now has more than a 70 percent share of the cartridge-based e-cigarette market in the United States. A typical JUUL cartridge, or “pod,” contains about as much nicotine as a pack of 20 regular cigarettes.

“In the data sets we use, we have never seen use of any substance by America’s young people rise as rapidly as e-cigarette use is rising,” said HHS Secretary Alex Azar. “Combustible cigarettes remain the leading cause of preventable death in the United States, and providing an effective off-ramp for adults who want to quit using them is a public health priority. But we cannot allow e-cigarettes to become an on-ramp to nicotine addiction for younger Americans. HHS has been and will continue developing a comprehensive, balanced policy approach to this challenge.”

As noted in the 2016 Surgeon General’s report on E-cigarette Use Among Youth and Young Adults, e-cigarette use poses a significant – and avoidable – health risk to young people. Besides increasing the possibility of addiction and long-term harm to brain development and respiratory health, e-cigarette use may also lead to the use of regular cigarettes that can do even more damage to the body.

“We have evidence-based strategies to prevent tobacco use that can be applied to e-cigarettes.” said Adams. “We must take action now to protect the health of our nation’s young people.”

For facts about the risk of e-cigarettes, and how to protect our youth, visit:

e-cigarettes.surgeongeneral.gov.

New Projections for the Behavioral Health Workforce.  HRSA’s National Center for Health Workforce Analysis recently released its updates and projections for the nation’s behavioral health workforce from the year 2016 through 2030.   The report includes updated fact sheets and state-level projections on the supply and demand for eight occupations: addiction counselors, marriage and family therapists, mental health and school counselors, psychiatric technicians and psychiatric aides, psychiatric nurse practitioners and psychiatric physician assistants, psychiatrists, psychologists, and social workers.  There is a significant need for mental health services in rural America. According to the Results from the 2017 National Survey on Drug Use and Health, 19 percent of residents aged 18 or older in nonmetropolitan counties had Any Mental Illness (AMI) in 2017, approximately 6.8 million people. In addition, 4.9 percent, or nearly 1.7 million, of residents of nonmetropolitan counties experienced serious thoughts of suicide during the year. Visit the Rural Health Information Hub for programs, toolkits,  and other resources for behavioral health workforce in rural areas.

Hawaii is the healthiest U.S. state and Louisiana is the unhealthiest state, according to the United Health Foundation’s 2018 America’s Health Rankings report. The report also noted some concerning health trends, such as a “record-breaking prevalence of obesity and rising mortality rates,” and an increase in the United States’ premature death rate. (Source: Politico‘s “Pulse,” 12/12)

New Federal Report: Reforming America’s Healthcare System through Choice and Competition.  The Department of Health and Human Services (HHS) in collaboration with the Departments of the Treasury and Labor and the Federal Trade Commission collaborated to develop this report, which identifies challenges to and recommendations for improving the health care system.  It describes the influence of state and federal laws, regulations, guidance, and polices on choice and competition in health care markets and identifies actions that states or the Federal Government could take to develop a better functioning health care market.  Rural relevant issues addressed include scope of practice, workforce mobility, and telehealth.