It may sound like a good problem to have – lots of extra money for rural healthcare facilities during a medical crisis. But state Offices of Rural Health found that hospitals needed extra assistance to use the pandemic-related funds effectively.

When billions of dollars in federal funding started flowing into rural healthcare agencies as part of the American Rescue Plan, facilities turned to State Offices of Rural Health for assistance in how to use it.

Shortly after the public health emergency declaration, nearly $400 million in funding went to 1,540 rural hospitals with fewer than 50 beds through the Small Rural Hospital Improvement Program (SHIP).

Those funds were to go toward operational improvements including hardware, software and training. Additionally, the Federal Office of Rural Health Policy developed a number of programs for Medicare-Certified Rural Health Clinics (RHCs) that provided each hospital with $49,000 (in May 2020) for Covid-19 testing, another $100,000 (in June 2021) for Covid testing and mitigation, and another $50,000 (in July 2021) for Covid vaccination confidence programs.

State Offices of Rural Health helped RHCs in their own states apply for funding and track how that funding was spent. But, since each state office is different, how the state offices responded to the crises varied.

In some states, Offices of Rural Health are a function of the state government. But many are not. Tammy Norville, CEO of the National Organization of State Offices of Rural Health (NOSORH), said in an interview with the Daily Yonder that each state is different. Three state Offices of Rural Health are non-profit organizations, while 13 are located in academic settings – either universities or community colleges. The rest, she said, are part of state government. Those located in state government, Norville said, are most often located in their state’s Department of Health and Human Services, except for one which is located in the state’s Department of Agriculture.

“We like to say, when you’ve seen one state Office of Rural Health, you’re really seen one state office of rural health,” Norville said. “They’re all set up differently. Even the ones in state government offices. They’re different in how they’re staffed, how the work is distributed. It’s all depends on the state they’re in.”

At NOSORH, the goal was to provide support to state offices of rural health as they, in turn, supported their RHCs.

In some cases, that meant taking the pulse of what was going on during the pandemic and highlighting some of the best practices that were going on among the offices.

For individual state Offices of Rural Health, the funding for Rural Health Clinics came at a critical time.

Robert Duehmig, interim director of the Oregon Office of Rural Health, said in an interview with the Daily Yonder that the money was needed, but almost overwhelming.

“The amount of money that flowed from the federal government and from the state government and different entities was huge,” he said. “And it was done at a time where even if we were fully staffed, we’re not huge offices, and neither are a lot of our clinics. We were starting to close down for a period of time. The expectations of some of those funds I think were often or somewhat unrealistic.”

The Oregon Office of Rural Health’s role in distributing that money was to make sure the hospitals were eligible and to help them identify how they were going to spend those funds. Once the hospitals had signed an agreement on how they would spend those funds, the state office would distribute them.

Some eligible hospitals chose not to take the federal funds though. Five rural hospitals in Oregon did not. Duehmig said it was not that they didn’t need it or that they weren’t eligible, but that in some cases they were having trouble finding expenses to apply those funds to. In other cases, there just wasn’t enough manpower in the hospital to monitor and record how the funds were used.

In Michigan, John Barnas, executive director of Michigan Center for Rural Health, said the relationship between the center and the state health organization was key in getting grant money to the right communities.

Working with the Michigan Department of Health and Human Services, the Michigan Center for Rural Health was able to cooperatively get funding to needy rural communities. And by looking at the data, the center was able to find populations that needed the funding the most.

“We utilized population-based data to look at age demographics, race, ethnicity demographics, poverty demographics,” Barnas said. “We also looked at data around immunization levels for flu and Covid-19.”

Norville said the money came as a blessing, but also as a curse. At a time when rural health clinics were at their busiest, she said, the federal government was throwing money at them, requiring them to spend it in certain ways, and asking them to track how they spent it. That meant more labor to monitor how the money was spent, she said.

“Just think about the effort that it took to do that in the middle of a public health emergency… but these guys did it, I mean, that’s the story, right? Regardless of what left hooks came at them, they rose to the challenge. And they did what they needed to do to take care of things.”

From Lancaster Farming

September was National Recovery Month, launched in 1989 to promote new evidence-based treatment, celebrate the vibrant recovery community and the service providers who furnish support, and to offer hope for those still struggling.

Three years ago in September, Pennsylvania joined Farm Town Strong, an effort spearheaded by the American Farm Bureau Federation and the National Farmers Union to bring attention to the opioid epidemic in farming communities and offer resources to those battling addiction.

The scope of the crisis in rural America was staggering, with 74% of farmers and farmworkers reporting they had been directly impacted by opioids, three in four farmers saying it was easy to access large amounts of opioids without a prescription, and one in three adults saying addiction treatment was readily available.

“Addiction is a is a complex disease that can’t be reduced down to simple neurobiology,” said Dr. Adam Scioli, medical director and head of psychiatry at Caron Treatment Center in Wernersville, Pennsylvania. The nonprofit rehab facility was founded as Chit-Chat Farms by recovering alcoholic Richard Caron and his wife, Catherine (Tildon) Caron, and opened the doors to its first patients in 1959.

Multiple factors play a role in both the development of a substance-use disorder and its progression, Scioli said, including co-occurring mental health conditions, such as depression or anxiety, that may also need addressing.

Sickness, Not Sin

“I had a mentor here many years ago who had a very, very simple way of summarizing it,” said Rev. Jack Abel, senior director of spiritual care at Caron. “He was a Catholic priest, but he used to say, ‘Jack, my understanding of this is that it’s sickness, not sin.’ And I think that can be helpful, sometimes, for people who have strong faith backgrounds.”

Faith communities especially may tend to view addiction as a moral failure, when it’s not, he said. Such a viewpoint can contribute to a reluctance to seek help, he said, and offer the false solution that a person in active addiction can simply make better choices, or simply repent

“One of the things that kind of defines addiction, in my experience, is that it’s frustratingly irrational,” Abel said, and so appealing to an addicted person’s power of reason can be useless. Thus, he said, it is difficult to intercept addictive behavior without intervention.

Faith communities excel at caring for the sick, he said, and so ministering to those afflicted boils down to changing that community’s mindset.

“It’s a different approach, where we encourage healing instead of repentance,” Abel said. “And that’s the direction that I’ve always tried to take with people, whether religious or not.”

Not Going Away

“Over the past, I’d say, 20 years, the increase in total number of deaths involving opioids, particularly fentanyl and other synthetic opioids, has increased dramatically,” Scioli said, adding that the opioid crisis was finally declared a nationwide public health emergency in the fall of 2017.

Fentanyl, which is about 100 times more potent than morphine and 50 times more potent than heroin, is sold by prescription, typically as a slow-release patch for severe pain treatment. It is also manufactured in illegal drug labs.

“We’re acutely aware here at Caron of the need to address substance use and, in particular, opioid use, because there’s a high likelihood of fatality,” Scioli said. “It certainly can happen very quickly. It certainly can happen on the very first use. And the unfortunate fact is that opioids that people are ingesting have gotten more dangerous because fentanyl has been either adulterating them, or people are actually seeking fentanyl.”

A large number of fentanyl overdoses occur in people who don’t even realize they are taking the drug, he said.

Opioids are in a class all by themselves when it comes to treating addiction, Scioli said.

“We at Caron actually have an opioid track where we focus on the disease opioid use disorder exclusively as a separate and distinct phenomenon, which requires a biopsychosocial spiritual approach,” he said.

That approach includes making sure the patient has a safe and comfortable withdrawal, helping them decide whether to use a medication — such as buprenorphine (Suboxone) — to assist recovery, and assuring they have the support network to sustain them once they leave the treatment facility.

“Addiction is certainly a family disease, and we have recognized that since our origins,” Scioli said. “There’s an expression here at Caron that resonates with me, that ‘the patient is the family and the family is the patient.’ We talked about the importance of a supportive environment, and that involves, when someone comes into treatment, making sure that their family members or loved ones understand that addiction is a disease and not a choice and that there are going to be certain supports that their loved one requires in order to succeed, not just changes at home, but attitudinal changes toward their loved one, who is now a patient.

Sadly, Scioli said, not everybody is able to overcome addiction.

“And when there’s a loss, the loss is felt by far more people than that person who was trapped in addiction probably ever realized. The disease of addiction does not discriminate based on socioeconomic status or gender or occupation—whether or not you have children or you are a child.”

​Submission period applies to PennDOT-owned projects and infrastructure

The Pennsylvania Department of Transportation (PennDOT) Office of Public-Private Partnerships (P3) announced today that it is accepting unsolicited proposals for transportation projects from the private sector through October 31.

The submission period applies to PennDOT-owned projects and infrastructure. During this period, the private sector can submit proposals offering innovative ways to deliver transportation projects across a variety of modes including roads, bridges, rail, aviation, and ports. Proposals can also include more efficient models to manage existing transportation-related services and programs.

The private sector may also submit applications for non-PennDOT-owned assets directly to the P3 board during this time. Transportation entities outside of the governor’s jurisdiction, such as transit authorities, may establish their own timelines or accept proposals year-round. Unsolicited proposals are being accepted through 11:59 p.m. on October 31. Instructions on how to submit a project and information on the unsolicited proposal review process can be found on the state’s P3 website, www.P3.pa.gov.

The state’s P3 law allows PennDOT and other transportation authorities and commissions to partner with private companies to participate in delivering, maintaining, and financing transportation-related projects.

As part of the P3 law, the seven-member Public Private Transportation Partnership Board was appointed to examine and approve potential public-private transportation projects. If the board determines a state operation would be more cost-effectively administered by a private company, the company will be authorized to submit a proposal and enter into a contract to either completely or partially take over that operation for a defined period of time.

The next unsolicited proposal acceptance period will occur in April 2023. To learn more about P3 in Pennsylvania, including active projects, visit www.P3.pa.gov.

Congratulations to the 40 fellows selected for the 2022-2023 Class of the Appalachian Leadership Institute!

This class of ARC’s leadership development program includes a diverse network of professionals representing all 13 Appalachian states and a wide spectrum of perspectives and sectors, including tourism, healthcare, education, civil service, and more.

“These leaders are already growing their Appalachian communities and will be even better equipped to drive positive change after their work with this program,” said ARC Federal Co-Chair Gayle Manchin. “I am eager to see this class of fellows collaborate across state lines to set big goals that will help the entire Appalachian region thrive.”

Over the next nine months, the fellows will participate in sessions focused on skill-building with regional experts, peer-to-peer learning, and case study analysis. They will then join a robust network of program alumni across the region.  Click here to read about the 2022-2023 Class!

See below for recently released information about the Inflation Reduction Act.  You can view a timeline showing when these changes happen in the Medicare, Medicaid and the Children’s Health Insurance Program, and Health Insurance Marketplace®.   Also the See Frequently Asked Questions has information about reduced drug prices and enhanced Medicare benefits under the Inflation Reduction Act.

It is FLU season and CMS has prepared Partner materials to be shared with the public!  These can be accessed on CMS.gov using the links below.

• 2022 Partner flu toolkit
• 2022 Partner flu toolkit (Spanish)
• Medicare flu shot images
• Medicare flu shot images (Spanish)

This CDC page of helpful FAQs is a great resource, too.  Remember that it’s safe to receive the updated COVID booster at the same time as the Medicare flu shot.

The White House will select its official 2022 Christmas tree to stand in the iconic Blue Room from Evergreen Acres Tree Farm.

On October 10, 2022 at 10:00am EST, Robert Downing, the White House Executive Usher, will lead a delegation to officially select the 2022 White House Christmas Tree.  The tree will be chosen from the many beautiful firs and pines growing on Paul and Sharon Shealer’s Christmas tree farm, Evergreen Acres.

The Shealers earned the honor of providing the official White House Christmas tree when their Douglas Fir entry was selected as Grand Champion at the National Christmas Tree Association’s National Tree and Wreath Contest. To qualify for the national contest, Shearles first had to win the 2021 Pennsylvania Farm Show’s competition earning the opportunity to represent Pennsylvania in the national contest.  Paul Shealer shared, “We were thrilled to win Grand Champion and are even more excited and privliged that our farm will provide the White House’s official Christmas tree. Evergreen Acres takes great pride in its trees every year, and it seems this year we can stand even taller!”

The tree selection event will include statements from Tim O’Connor, Executive Director of the National Christmas Tree Association, a representative from the Pennsylavania Department of Agriculture, and Randy Cypher, President of the Pennsylvania Christmas Tree Growers Association.

“Pennsylvania growers produce one million of the nation’s most impressive Christmas trees every year,” Pennsylvania Agriculture Secretary Russell Redding said. “We’re proud to showcase our finest growers at the PA Farm Show each January. We’re even prouder that the Shealer family qualified to win the National Christmas Tree competition by winning at Farm Show and will grace the White House, representing our commonwealth proudly and focusing the eyes of the nation on world-class PA-grown product.”

The event will take place at 10:00am at Evergreen Acres Tree Farm located at 135 Fort Lebanon Road, Auburn, PA 17922.

For more information about the official White House Christmas tree selection at the Shealer’s Evergreen Acres, please contact Aaron Grau at 717-229-9227 or aaron@christmastrees.org.

From the National Rural Health Association

Alongside the White House Conference on Hunger, Nutrition, and Health this past Wednesday, the Biden Administration released its National Strategy on Hunger, Nutrition, and Health. Please see below for a summary highlighting the most rural-relevant proposals.

The National Strategy is made up of five pillars, each with corresponding goals and action items to achieve the listed goals:

Pillar 1: Improve Food Access and Affordability

Help more individuals experiencing food insecurity benefit from federal assistance programs.

• The Administration will work with Congress increase funding for Older Americans Act nutrition programs. This will help address rural seniors’ unique health, social, and nutritional challenges associated with shopping and cooking.
• The Administration will make it easier for eligible individuals to access federal food and health services. The Department of Agriculture (USDA) will partner with other agencies to increase outreach and awareness for SNAP to older adults and other populations.
• USDA, through American Rescue Plan funds, will expand online shopping for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). NRHA is hopeful that this will expand access for rural residents that travel longer distances to grocery stores.
• The Administration will support Congress in removing unnecessary barriers for SNAP recipients, like the inability to purchase hot and prepared foods with SNAP dollars.

Invest in community and economic development to increase access to food. Almost 40 million Americans live in areas where no grocery stores are nearby, including rural areas.

• The Federal Trade Commission will publish a report summarizing how supply chain distributions have affected grocery stores, including independent grocery stores that often serve rural communities.
• The Federal Emergency Management Agency and USDA will partner to integrate food security as a priority area when conducting outreach with state, local, and Tribal leaders for disaster planning and messaging. This is especially important for rural areas when there are natural disasters and other emergencies.

Pillar 2: Integrate Nutrition and Health

Provide greater access to nutrition services to better prevent, manage, and treat diet-related diseases.

• Expand Medicare and Medicaid beneficiaries’ access to food as medicine by supporting legislation to create a pilot program for Medicare coverage of medically tailored meals for beneficiaries with diet-related health conditions.
• The Centers for Medicare and Medicaid Services (CMS) will use its 1115 demonstration authority to pilot innovative coverage options for diet-related interventions. For example, CMS just announced that it approved Oregon and Massachusetts’ Medicaid state plans for nutritional assistance and medically tailored meals.
• The Administration will support legislation to expand nutrition and obesity counseling to more Medicaid beneficiaries, specifically in states that have not expanded Medicaid and have large rural populations. The Administration also supports expanding nutrition and obesity counseling to Medicare beneficiaries who currently may only seek counseling in a primary care setting with a primary care practitioner. CMS will examine its authority to increase access to such counseling.
• Indian Health Services (IHS) will implement a National Produce Prescription Pilot Program. Produce prescriptions provide fresh fruits and vegetables as a medical treatment or preventative service for patients who are eligible due to diet-related health risk or condition or food insecurity.
• The Department of Veterans’ Affairs (VA) will implement produce prescription programs and mobile food pantries that will aid our rural veteran population.
• CMS will develop a strategy to increase access to diabetes prevention and treatment for Medicare and Medicaid beneficiaries. NRHA looks forward to this work as rural residents are at a greater risk for diabetes.
• CMS will support efforts to develop the data infrastructure needed for food insecurity and other social determinants of health (SDOH) elements to be captured in electronic health records. NRHA is hopeful that CMS will support rural providers in this endeavor.

Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices

Create healthier food environments and a healthier food supply.

• The Administration will work with Congress to expand incentives for purchasing fruits and vegetables with SNAP.
• USDA will make investments to support local and regional food and farm businesses.
• USDA will establish Regional Food Business Centers to support local food business growth, particularly in rural and underserved areas like Appalachia, Colonias, the Mississippi Delta, and in Tribal communities.

Pillar 4: Support Physical Activity for All

 Build environments that promote physical activity.

• Expand the Centers for Disease Control (CDC) State Physical Activity and Nutrition Programs to all states and territories. The Administration will work with Congress to expand the Program from 16 states to nationwide.

Pillar 5: Enhance Nutrition and Food Security Research

• HHS and USDA will create a 2025 Dietary Guidelines Advisory Committee with a diverse membership, including geographic diversity. The committee will review dietary guidelines with a health equity lens.
• USDA will conduct research to better understand nutritional needs of Native Americans and Native Alaskans.
• USDA will leverage its partnership with the University of North Dakota to better understand Native diets and Indigenous foods.
• CMS will measure SDOHs, including food insecurity, for at-risk Medicare Advantage beneficiaries.