On February 27, 2020, the Secretary of the U.S. Department of Health & Human Services (HHS) announced new leadership for the National Advisory Committee on Rural Health and Human Services.  Former Kansas Governor Jeff Colyer will be the fifth chair in the 32-year history of the Committee.

Also known as the NACRHHS, the Committee was formed in 1987 as an independent advisory group focused on provision of health care in rural areas.  Joining the chair for two meetings each year are 20 committee members who include hospital CEOs, educators, experts on aging, physicians, certified registered nurse anesthetists, physician assistants, researchers, community health center directors and state office of rural health directors.  For each meeting, two areas of focus are selected; committee members conduct site visits and follow up with a policy brief and recommendations for the HHS Secretary.

Colyer, a surgeon by training, will be the fifth chair in the 32-year history of the Committee and the second chair from Kansas after Nancy Kassebaum Baker, who served during the Bush Administration. Colyer’s appointment coincides with a series of actions the Secretary has taken to bring more attention to rural health.

In late 2018, Secretary Azar created the HHS Rural Task Force to streamline efforts across HHS to be more focused on developing policy and program changes needed to transform health care in rural America.

“Improving healthcare in rural America is one of President Trump’s most important healthcare priorities, and addressing our rural health crisis is one of the key impactable health challenges the President has identified,” said Secretary Alex Azar. “President Trump’s administration has already put more attention on this challenge than it has seen for years, and we are delighted to welcome someone of Governor Colyer’s stature and experience to chair this Committee. The Committee will play an integral role in our ambitious ongoing efforts at HHS to transform rural healthcare, and Governor Colyer will work closely with me, Deputy Secretary Hargan, and the HHS Rural Health Task Force.”

The Committee was established by statute in 1987 to advise the Secretary on access to, delivery of, and financing for health care and human services in rural areas. The Committee produces policy briefs and reports on key rural issues, along with recommendations to address the challenges. The Committee is comprised of 21 members, including the chair, who represent the diversity of health and human service issues in rural America. In addition, the members represent an appropriate geographic representative mix from across the country, including the chair, selected by the Secretary from authorities knowledgeable in the fields of delivery, financing, research, development and administration of health care and human services in rural areas.

Members provide an array of expertise, including the range of rural-focused health programs under the purview of the Secretary, and are knowledgeable in the fields of rural human and social services. Examples include issues related to transportation, children and family services, social work, services for the elderly and rural economic development.

“As a Kansas doctor and a former governor, I know how important good medical care is to our rural communities,” said Governor Colyer. “President Trump’s and Secretary Azar’s insistence on improving rural health is a major step forward, and I want to thank the President and Secretary Azar for their push to improve the lives of rural Americans.”

Governor Jeff Colyer M.D. of Overland Park, Kansas finished his gubernatorial term in 2019. He is a fifth generation Kansan from Hays who practices craniofacial and reconstructive surgery. In addition to his medical practice, he is known for volunteering with International Medical Corps in war and conflict zones around the world including the Rwandan, Afghanistan, Iraq, South Sudan, and Libya.

Before becoming Governor, Colyer served in the House and Senate and was the longest serving Lt. Governor in Kansas history. He led Kansas’s Medicaid transformation into the first fully integrated managed care program in the United States and was noted for improving health outcomes, cutting waiting lists and saving over $2 billion through better care. As Governor he funded schools, saw more Kansans working than ever before, and left a $750 million budget surplus. He oversaw the first credit outlook upgrade in Kansas in more than a decade. He also emphasized improving rural health programs.

In addition to his service to the National Advisory Committee on Rural Health and Human Services, Governor Colyer also works with businesses in artificial intelligence, technology and healthcare. He was a White House Fellow to Presidents Reagan and Bush. He has degrees from Georgetown University (economics/premed), Cambridge University (Master’s in international relations), and the Kansas University School of Medicine with residency training in surgery and trauma, plastic surgery, and pediatric/craniofacial surgery. With his wife Ruth, they have three daughters.

The most recent meeting, in September of 2019, provided an opportunity for the Committee to identify topics aligned with HHS priorities.  Past meetings have covered topics such as Adverse Childhood Experiences, the impact of suicide, improving oral health care services, and modernizing Rural Health Clinic provisions.  Visit the NACRHHS for more details, including the Committee’s recommendations on each of these topics.  The Committee will host its first meeting of 2020 beginning Monday, March 2 and running through March 4 in Atlanta, Georgia.

Improved access will benefit rural areas with limited treatment options

WASHINGTON – The Drug Enforcement Administration announced on February 26, 2020, an important step to improve access to medication assisted treatment, especially in rural areas where those suffering with opioid use disorder may have limited treatment options.

“Thankfully, prescription opioid overdose deaths have declined more than 13 percent, but thousands of Americans still suffer from addiction and opioid use disorder,” said DEA Acting Administrator Uttam Dhillon. “Today’s proposal is an important step to improve access to medication assisted therapy, a successful evidence-based practice to treat opioid dependence. DEA is committed to ensuring that these tools and resources are available to everyone, especially in rural areas where treatment options may be limited.”

Under the proposal published today, narcotic treatment program registrants authorized to dispense narcotic drugs approved to treat opioid dependence would be authorized to implement a “mobile component” to their registration, eliminating the need for a separate DEA registration. This streamlined registration process will make it easier for providers to offer needed services in remote or underserved areas.

In April 2000, DEA, in association with the American Methadone Treatment Association – now the American Association for the Treatment of Opioid Dependence – developed guidelines for NTPs to ensure more uniform standards throughout the United States. As the opioid crisis evolves, DEA and their partners seek to provide additional tools and resources to further increase accessibility for persons with opioid use disorder. Alternative methods, such as mobile components of NTPs, can be used to bring treatment to those in rural or other underserved areas where NTPs are not accessible, or to allow people who are unable to travel to an NTP to receive care.

According to the Centers for Disease Control and Prevention (CDC), more than 67,000 Americans lost their lives to drugs in 2018, and more than half of those deaths involved opioids. The demand for evidence-based medication-assisted treatment for substance use disorders, including opioid use disorder, has increased over the years, especially for services provided by NTPs. In some areas of the country, this has resulted in long waiting lists and high services fees, especially in rural communities.

The distance to the nearest NTP or the lack of consistent access to transportation in rural and underserved communities may prevent or substantially impede access to these critical services. There are more than 1,700 NTPs registered with DEA, including opioid treatment programs, detoxification treatment services that utilize methadone, and compounders. This proposed rule builds on existing experience and provides additional flexibility for NTPs in operating mobile components, subject to the regulatory restrictions put into place to prevent the diversion of controlled substances.

The proposed rule is available here

On February 25, 2020, HHS released the following statement on the coronavirus supplemental request.

“The Administration has been effectively utilizing all available resources to protect the American people from COVID-19. Today, the White House sent a supplemental request to Congress to make $2.5 billion available for COVID-19 response efforts, including an emergency supplemental appropriation of $1.25 billion. HHS will also use the Secretary’s transfer authority to provide needed resources to continue the Department’s robust and multi-layered public health preparedness and response efforts – including public health surveillance, epidemiology, laboratory testing, support for state and local governments and other key partners, advanced research and development of new vaccines, therapeutics and diagnostics, advanced manufacturing enhancements, and support for the Strategic National Stockpile.”

Read the letter here: https://www.whitehouse.gov/wp-content/uploads/2020/02/Coronavirus-Supplemental-Request-Letter-Final.pdf

Behavioral Health In Rural America: Challenges and Opportunities

Principal authors: John Gale, MS; Jaclyn Janis, BSN, RN, MPH; Andrew Coburn, PhD; Hannah Rochford, MPH

Prepared by the RUPRI Health Panel: Keith Mueller, PhD; Andrew Coburn, PhD; Alana Knudson, PhD; Jennifer Lundblad, PhD, MBA; Timothy McBride, PhD

The prevelence mental health and substance use diagnoses and unmet treatment needs are not equally distributed, with rural residence being one factor associated with these differences. Moreover, the rural context has proven challenging for ensuring the availability of and access to prevention, diagnosis, treatment, and recovery services in rural areas. This paper reviews the prevalence of behavioral health disorders in rural populations, rural access to behavioral health services, promising program and policy strategies targeted to improving rural BH systems, and opportunities for policy and system changes to improve rural BH systems and outcomes.

Click to download a copy: Behavioral Health In Rural America: Challenges and Opportunities – Full document

Provides an overview of the Government Accountability Office’s (GAO) review of 258 nongovernmental hospitals that participate in the 340B Drug Pricing Program and their contracts with state and local governments. Evaluates the contracts to determine if they meet the eligibility requirement to serve low-income individuals. Outlines weaknesses in the Health Resources and Services Administration’s review of the hospital contracts and offers six recommendations to improve the contract review process.

Jan 29, 2020 — The U.S. Department of Justice announced the White House task force on missing and murdered American Indians and Alaska Native held its first meeting. Describes how the task force will work with tribal governments, develop protocols, and increase awareness to address the high rates of violence towards Native community members.

Jan 30, 2020 — The Government Accountability Office is requesting nominations for the Physician-Focused Payment Model Technical Advisory Committee, which will provide feedback on physician payment models to the Department of Health and Human Services (HHS) Secretary. Nominations are due February 28, 2020.

During his remarks at the National Rural Health Policy Institute, U.S. Department of Health and Human Services (HHS) Deputy Secretary Eric Hargan announced President Trump’s new rural health plan’s four main areas of focus: preventing diseases, creating sustainable financing, using technology to improve access, and laying the groundwork for a stronger workforce. Also, the new program will attempt to tackle maternal health and opioid issues. Deputy Secretary Hargan has signaled more details to come explaining the intricacies of the plan.

During the week of February 10, 2020, the Office of the President released its federal budget proposal for the FY2021. The annual release of the President’s budget is a non-binding document that is not expected to be adopted. The President’s budget provides a roadmap of programs and initiatives being prioritized by the administration in office. Here is a breakdown of proposed Health and Human Services program spending.

During the week of February 10, 2020, Congressman Jodey Arrington (R-TX-19) announced the introduction of the Save Rural Communities Act (H.R. 5808). This legislation seeks to grant rural hospitals more flexibility in the services they provide. Specifically, it allows them to convert to an outpatient only, 24-hour emergency care center. The proposed change would allow hospitals to tailor their business model and balance their budgets, while also meeting the health care needs of their community.