USDA Seeks Applications to Improve Water and Waste Treatment for Rural People Living in Manufactured Homes

U.S. Department of Agriculture (USDA) Rural Development Under Secretary Xochitl Torres Small today announced that the department is accepting applications for grants to help improve water treatment and waste disposal systems for rural people living in manufactured homes by providing technical assistance and training.

The applications are being accepted under the Water and Waste Disposal Technical Assistance and Training Grants program. This program is one of the many ways USDA promotes a healthy community and environment with funding that makes sure people, children and families have clean water and safe sewer systems that prevent runoff and pollution.

This program is designed to help qualified, private nonprofit organizations provide technical assistance and training to benefit people living in manufactured homes. It will help identify and evaluate solutions to water and waste problems, while helping communities prepare applications for water and waste disposal loans and grants. It also aims to improve the management, operation, maintenance and sustainability of water and waste facilities serving manufactured homes in rural areas and address contamination of drinking and surface water supplies.

The funding being announced today sets aside $1 million for applications that support improved sustainability of water and waste services related to manufactured homes.

All information on applying is available in the application guide on the program webpage. Applications must be submitted through Grants.gov by 11:59 p.m. ET on Nov. 13, 2022.

USDA is offering priority points to projects that advance key priorities under the Biden-Harris Administration to help communities create more and better market opportunities, advance equity and combat climate change. These extra points will increase the likelihood of funding. For more information, visit https://www.rd.usda.gov/priority-points.

Additional information is available on Grants.gov.

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

Everyone Deserves Safe, Healthy Relationships Free From Abuse—Confidential Help Available in Pennsylvania

Domestic violence is a pattern of coercive behavior used by one person to gain power and control over another in an intimate or familial relationship. 

Domestic violence can happen to anyone regardless of gender, race, sexual orientation, age, education level, socio-economic status, ethnicity, religion, or ability. There is no typical case of domestic violence. Domestic violence survivors are our neighbors, our co-workers, or our family members. Most people who experience domestic violence are women — 1 in 4 women will experience domestic violence — although men experience domestic violence, too.

In Pennsylvania alone, 112 people died in domestic violence incidents last year.

October is Domestic Violence Awareness Month. This month provides an opportunity to remember victims of domestic violence, raise awareness of what domestic violence ishow to recognize it, and what we can all do to collectively prevent it.

Where to Get Help

National Domestic Violence Hotline
    • Call: 1-800-799-SAFE (7233) or TTY: 1-800-787-3224
    • Text: “START” to 88788
    • A live online chat is also available

Pennsylvania Coalition Against Domestic Violence (PCADV)
    • Call: 1-800-932-4632 (PA); 1-800-537-2238 (National)
    • Find your local domestic violence center
Among the services provided to domestic violence survivors are: crisis intervention; counseling; accompaniment to police, medical, and court facilities; and temporary emergency shelter for survivors and their dependent children. Prevention and educational programs are provided to lessen the risk of domestic violence in the community at large.

Pennsylvania Coalition Against Rape (PCAR)
    • Call: (888) 772-PCAR
• Find your local Sexual Assault Center

PCAR is a nonprofit organization working at the state and national levels to prevent sexual violence. Founded in 1975, PCAR continues to use its voice to challenge public attitudes, raise public awareness, and effect critical changes in public policy, protocols, and responses to sexual violence. To provide quality services to victims/survivors of sexual violence and their significant others, PCAR works in concert with its statewide network of 48 sexual violence centers serving all 67 counties. The centers also work to create public awareness and prevention education within their communities.

National Sexual Violence Resource Center (NSVRC)
    • Call: 877-739-3895
The National Sexual Violence Resource Center (NSVRC) is the leading nonprofit in providing information and tools to prevent and respond to sexual violence. NSVRC translates research and trends into best practices that help individuals, communities and service providers achieve real and lasting change.

Pennsylvania Office of Victim Services
    • Find Victim Service Programs near you

Pennsylvania Department of Human Services Resources

Adult Protective Services (APS)
    • Call: 1-800-490-8505
APS was enacted to protect adults between the ages of 18 and 59 with a physical or mental disability that limits one or more major life activities. The program is meant to detect, prevent, reduce and eliminate abuse, neglect, exploitation, and abandonment. A report can be made 24/7 on behalf of the adult whether they live in their home or in a care facility such as a nursing facility, group home, hospital, etc.

ChildLine
    • Call: 1-800-932-0313
Available 24/7 to receive referrals of suspected child abuse and general child well-being concerns. Each report is handled by a trained specialist who determines the most appropriate course of action.

A Guide To Victim’s Assistance
Learn about the resources available to victims and survivors after abuse, neglect, financial exploitation, or other crimes such as domestic violence, sexual assault, simple and aggravated assault, harassment, theft, and homicide.

Additional Domestic Violence Resources

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.”

National Plan for Health Workforce Well-Being Launched

In the United States, 54% of nurses and physicians, 60% of medical students and residents, and 61% of pharmacists have symptoms of burnout. Burnout is a long-standing issue and a fundamental barrier to professional well-being. It was further exacerbated by the COVID-19 pandemic. Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of health care. Thus, a thriving workforce is essential for delivering safe, high-quality, patient-centered care.

The National Plan for Health Workforce Well-Being is intended to inspire collective action that focuses on changes needed across the health system and at the organizational level to improve the well-being of the health workforce. As a nation, we must redesign how health is delivered so that human connection is strengthened, health equity is achieved, and trust is restored. The National Plan’s vision is that patients are cared for by a health workforce that is thriving in an environment that fosters their well-being as they improve population health, enhance the care experience, reduce costs, and advance health equity; therefore, achieving the “quintuple aim.”  Access the Plan here:  National Plan for Health Workforce Well-Being

Together, we can create a health system in which care is delivered joyfully and with meaning, by a committed team of all who work to advance health, in partnership with engaged patients and communities.

CMS Kicks Off Medicare Open Enrollment with Lower Premiums, Improved Benefits for 2023

Thanks to the Inflation Reduction Act, enrollees will have lower costs for insulin and free ACIP-recommended vaccines starting in 2023People with Medicare should review their coverage and drug and health plan options through December 7, 2022 on Medicare.gov

Medicare Open Enrollment begins tomorrow — Saturday, October 15 — and will remain open through December 7, 2022. Medicare’s Open Enrollment period gives people with Medicare the opportunity to make changes to their health plan or prescription drug plan, pick a Medicare Advantage plan, or return to Original Medicare (also referred to as Medicare Part A and Part B). Medicare plans can change their offerings and costs every year, and individuals’ health needs can change from year-to-year, too. Now is the time for people with Medicare to review their coverage options and make a choice that best meets their health care needs.

The Biden-Harris Administration has made expanding access to health insurance and lowering health care costs for America’s families a top priority. Just last month the Biden-Harris Administration announced that people with Medicare will see lower average premiums for Medicare Part B, Medicare Advantage, and Medicare Part D prescription drug plans in 2023.

This year, thanks to the Inflation Reduction Act that President Biden signed into law in August, Medicare enrollees will also see lower costs for insulin and vaccines beginning in 2023. Starting in 2023, all people with Medicare who take insulin covered by their prescription drug plan or through a traditional pump covered under Original Medicare will pay no more than $35 in cost-sharing for a month’s supply of each covered insulin product. People with Medicare also will not pay a deductible with respect to each covered insulin product. Additionally, people with Medicare drug coverage will pay nothing out-of-pocket for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) — including the shingles vaccine and Tetanus-Diphtheria-Whooping Cough vaccine. More information on the Inflation Reduction Act and these changes is available at https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-lowers-health-care-costs-millions-americans.

“This year, more than ever, it is vital that people with Medicare review and compare their options to find the coverage that best meets their needs,” said HHS Secretary Xavier Becerra. “Thanks to the Inflation Reduction Act, we are lowering the cost of insulin and vaccines for the more than 64 million people with Medicare. The Biden-Harris Administration is unwavering in our commitment to strengthening Medicare, and we will keep doing all we can to lower costs and improve benefits.”

“We are committed to providing comprehensive and easily accessible information to support people with Medicare in their decision making,” said CMS Administrator Chiquita Brooks-LaSure. “Medicare.gov makes it easier than ever to compare coverage options and shop for plans. People can do a side-by-side comparison of plan coverage, costs, and quality ratings to help them more easily see the differences between plans.”

Since 2021, CMS has introduced a number of enhancements to Medicare.gov to optimize customer experience and create a more welcoming and user-friendly experience. Improvements include a redesigned Medicare.gov home page, the addition of pricing details to the Medigap policy comparison, streamlined landing and summary on the Medicare Plan Finder, and a redesigned “Talk to Someone” section to find additional help and contacts. All of these enhancements improve the overall experience, making it easier to navigate and access information to compare and select health and drug coverage and find providers.

The Medicare Open Enrollment period occurs every year from October 15 through December 7, with coverage changes taking effect January 1.

Things to Consider When Shopping for Medicare Coverage       

  • There are two main ways to get your Medicare coverage — Original Medicare and Medicare Advantage (Medicare-approved plans from private companies). There are differences between the two that are important to understand when choosing your coverage.
  • If you are selecting a Medicare Advantage plan, check with your health care providers to confirm they are in a plan’s network.
  • If you are selecting a Medicare prescription drug plan, check if your prescriptions are included on a plan’s formulary.
  • Remember that a low monthly premium may not always be the best overall value to meet your specific needs.
  • Review a plan’s estimated total costs to you, including deductible and other out-of-pocket costs.
  • If you take insulin, there is a new out-of-pocket cap on a month’s supply of each insulin product when covered by a prescription drug plan or under Original Medicare. Talk to someone for help comparing plans by calling 1-800-MEDICARE

Medicare is Here to Help

Here are four ways you can compare plans and look at savings options:

  1. Go to Medicare.gov to learn the difference between Original Medicare and Medicare Advantage, and do side-by-side comparisons of costs and coverage for Medicare Advantage and prescription drug plans.
  2. Call 1-800-MEDICARE. Help is available 24 hours a day, including weekends.
  3. Access personalized health insurance counseling at no cost, available from State Health Insurance Assistance Program (SHIP). Visit shiphelp.org or call 1-800-MEDICARE for each SHIP’s phone number. Many SHIPs also offer virtual counseling.
  4. Check eligibility for Medicare Savings Programs. If you have limited income and resources, you could qualify for Medicare Saving Programs run by your state Medicaid program. These programs could help save you money on health and prescription drug costs and/or could reduce your Part B premium from $165 to $0. For more information, contact your state Medicaid program or call 1-800-MEDICARE and ask about Medicare Savings Programs.

For more information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Help is available 24 hours a day, including weekends.

Brief Explores Barriers to Oral Health Equity

The Center for Health Care Strategies, with support from the CareQuest Institute for Oral Health, published a brief, “Advancing Oral Health Equity for Medicaid Populations.” The brief describes common barriers for addressing oral health equity for Medicaid populations and outlines recommendations to improve oral health access and quality within four key areas: coverage and access, workforce capacity building, partnerships, and payment.

Click here to view the brief.

Affordability of Employer Coverage for Family Members of Employees

On October 11, 2022, the Internal Revenue Service released a final rule that changes the way health insurance affordability is determined for members of an employee’s family, beginning with plan year (PY) 2023 coverage. Beginning in 2023, if a consumer has an offer of employer-sponsored coverage that extends to the employee’s family members, the affordability of that offer of coverage for the family members (of the employee) will be based on the family premium amount, not the amount the employee must pay for self-only coverage.

The final rule is effective for PY2023. The change will be reflected in the online application through the HealthCare.gov enrollment platform and enhanced direct enrollment certified partner applications during the PY2023 Open Enrollment period beginning November 1, 2022. State-based Marketplaces not using the HealthCare.gov enrollment platform are also working to implement this change, but may have different implementation timelines.

To view the final rule, visit: https://www.federalregister.gov/public-inspection/2022-22184/affordability-of-employer-coverage-for-family-members-of-employees.

USDA Invests $1.8 Million to Improve Health Care in Rural Pennsylvania

U.S. Department of Agriculture (USDA) Rural Development State Director Bob Morgan today announced that USDA is awarding $1.8 million in grants to improve health care facilities in rural towns in Pennsylvania. These grants will help two health care organizations and one food bank.

“Emergency Rural Health Care Grants support rural communities in providing health care to the people and places that often lack access,” Morgan said.

The projects awarded in this round of funding are:

  • The Elk Haven Nursing Home Association received a grant of $767,200 to reimburse lost healthcare revenue.
  • The City of Braford in McKean County received a grant of $105,100 to purchase an ambulance.
  • The Chester County Food Bank received a grant of $1 million to reimburse costs of food purchases because of the COVID-19 pandemic.

You can read the complete news release here.

New Rural Innovation Profiles Released!

The Rural Health Value team recently released two new Rural Innovation Profiles:

Experience in the Pennsylvania Rural Health Model: Barnes-Kasson County Hospital
A critical access hospital in Susquehanna, PA provides insight into their experience participating in the Pennsylvania Rural Health Model, which includes a global budget and transforming care to address community health needs.

MaineHealth ACO – Integrating and Using Data to Support Care Delivery
A predominantly rural network of hospitals and clinics in Maine integrates clinical and claims data to support improvements in care delivery and target patient needs as part of their Accountable Care Organization.

Related resources on the Rural Health Value website:

  • Catalog of Value Based Initiatives for Rural Providers – One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).
  • Guide to Selecting Population Health Management Technologies for Rural Care Delivery – Better manage the health of existing patient populations by implementing technology with this guide from Rural Health Value that walks you through the process to plan for and implement the technology.
  • Value-Based Care Assessment – This tool helps a rural organization assess readiness for the shift of healthcare payments from volume to value. The resulting report may be used to guide the development of action plans.

 Contact information:

Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu

Rural Health Value helps create high performance rural health systems by building and offering an actionable knowledge base through research, practice, and collaboration. Visit www.ruralhealthvalue.org.