The Health Resources and Services Administration (HRSA) will welcome Carole Johnson back in January as the agency’s new Administrator. Carole currently serves as the Testing Coordinator for the White House COVID-19 Response Team. Prior to joining the Biden-Harris Administration, she served as Commissioner of the New Jersey Department of Human Services. Carole served for more than five years as the White House Domestic Policy Council’s public health lead in the Obama Administration, which included overseeing HRSA issues, and has managed health workforce policy issues in HRSA’s Bureau of Health Professions. She has also worked on health care and public health policy on Capitol Hill, in academia, and in the non-profit and philanthropy sectors.
Pennsylvania House of Representatives Approves Bill Establishing COVID-19 At-Home Testing Distribution Program
The Pennsylvania House of Representatives unanimously approved a legislative amendment that would create a $10 million program to assist counties that want to distribute at-home COVID-19 tests. The amendment was added to HB 2033, that extends reporting requirements for state labs that conduct COVID-19 tests. The amended bill still must make its way through the Senate before it can reach the desk of Gov. Tom Wolf. According to the amendment, the Pennsylvania Department of Health would buy the test kits. Counties would then have 30 days to apply by stating how many tests they need and detailing how they plan to distribute them.
Pennsylvania Senate Sends Governor Bill to Create Broadband Authority
The Pennsylvania Senate voted unanimously in support of House Bill 2071, legislation that would create a statewide broadband authority to oversee the state’s strategy for spending federal dollars to close the digital divide. The bill creates the Pennsylvania Broadband Development Authority, which will be a one stop shop to oversee and support broadband deployment. The authority will manage at least $100 million in federal aid that Pennsylvania will receive to support a coordinated and strategic rollout of broadband to more areas with construction of new towers, lines and broadband equipment and other uses. Governor Wolf is expected to sign the bill into law.
USDA Rural Development: The Future Is Bright for Rural Pennsylvania
By Bob Morgan
USDA Rural Development State Director in Pennsylvania
If the past few weeks are any indication of things to come, Pennsylvania has found a partner that sees the value of investing in our rural communities. This partner may be from an agency that not many Americans might expect, the U.S. Department of Agriculture.
When Americans hear USDA, they usually think of food and farming. However, USDA is made up of 29 agencies with nearly 100,000 employees, who serve at more than 4,500 locations across the country and abroad. The Rural Development mission at USDA administers more than 50 economic development programs and investments in Pennsylvania have been steadily increasing in 2021 under the agency’s Build Back Better initiative.
Over the last four fiscal years USDA Rural Development has invested more than $3.5 billion in rural Pennsylvania through its loan and grant programs helping to expand economic opportunities and create jobs in rural areas by supporting: infrastructure improvements; business development; housing; community facilities such as schools, public safety, and health care; and high-speed internet access.
For example, on Dec. 16, Agriculture Secretary Tom Vilsack announced a $5.2 billion investment in rural America’s critical infrastructure. This good news included grants and loans for Pennsylvania, in the amount of $11.3 million for three water and waste disposal projects in Tioga, Westmoreland, and Venango Counties. These projects will improve communities by providing new pipes for water systems and necessary upgrades for waste water treatment. Since 2018, USDA has invested more than $211 million through these Rural Development programs.
The Biden-Harris administration has made infrastructure and critical agriculture supply chain investments a priority. Recently Secretary Vilsack announced the deployment of $100 million under a new Food Supply Chain Guaranteed Loan Program. This initiative funded through the American Rescue Plan Act, will provide loan guarantees to spur private investment in processing and food supply infrastructure that strengthens the food supply chain.
This is on top of a $500 million investment to expand meat and poultry processing capacity, which is vital to Pennsylvania producers. The Department will soon publish details on the new program and how to apply as part of USDA’s Build Back Better Initiative, a comprehensive plan to invest $4 billion to strengthen the resiliency of America’s food supply chain while promoting competition.
USDA also supports local efforts to adapt to our changing climate as evidenced this month during Secretary Vilsack’s visit to Saubel’s Market in York County. During his visit to the family-owned store in Shrewsbury, Pa., the Secretary announced $1 million to reduce the impacts of climate change on rural communities in Pennsylvania through the Rural Energy for America Program or REAP. Saubel’s Market received a $102,413 USDA REAP grant. With this funding, the small business installed solar panels on the roof of their family-owned grocery store a project which is expected to save enough energy to power 36 homes annually. Twenty-one other farms and businesses in Pennsylvania recently received REAP awards. Over the last four years Rural Development’s REAP and other energy efficiency progams distributed more than $9.7 million for 140 projects.
Moving from energy savings to saving lives, in healthcare, in 2018, there were 66 acute care hospitals with roughly 7,200 beds available in rural areas of the commonwealth, according to data compiled by the Center for Rural Pennsylvania. Seven counties did not have hospitals. On average, there were 2.14 hospital beds for every 1,000 rural residents. Rural Development has been determined to combat this problem.
St. Luke’s Carbon Campus Hospital opened its doors in November 2021. The 160,000-square-foot facility with 80 patient rooms is redefining health care access, convenience, and quality for the local community. This state of the art facility allows patients to experience their entire health care journey from primary to specialized care in a single location.
The trauma-4 rated hospital will also create new jobs and allow for recruitment of physicians from across the country. The project was funded in 2019 and consisted of a $98,500,000 Community Facilities Direct Loan which will be repaid by the borrower.
In 2020, Rural Development invested in the construction of a 240-bed three-story skilled nursing facility in Centre County (Centre Care, Incorporated) that serves a significant portion of the Medicaid population in the area. Also, Rural Development funded a new, 123-unit assisted living facility in Bucks County (LifeQuest). Since 2018, the Rural Development Community Facilities program has administered more than $293 million in health care loans within Pennsylvania.
USDA Rural Development is firmly committed to fulfilling the promise of improving opportunity for rural communities through the agency’s Build Back Better initiative, and we look forward to making further investments in Pennsylvania in 2022.
Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination
Today, the Centers for Medicare & Medicaid Services (CMS) released guidance on the Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule that was published on November 5, 2021. The emergency regulation helps safeguard health care workers and the people they serve from COVID-19 and its variants for all individuals seeking care by imposing requirements regarding vaccinations for eligible staff at health care facilities participating in the Medicare and Medicaid programs. This guidance provides important information on implementation, as well as guidelines to assess and maintain compliance with the COVID-19 vaccination requirements for health care workers at facilities participating in the Medicare and Medicaid programs.
A link to today’s guidance may be found here: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/guidance-interim-final-rule-medicare-and-medicaid-programs-omnibus-covid-19-health-care-staff-0
CMS also updated its Current Emergencies Page with corresponding FAQs and infographics. These items can be found under the “Clinical and Technical Guidance for All Health Care Providers” using the following link: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
Medicaid Expansion Alone Not Associated with Improved Finances, Staffing or Quality at Critical Access Hospitals
From Health Affairs
Critical access hospitals are important providers of care for rural and other underserved communities, but they face staffing and quality challenges while operating with low margins. Medicaid expansion has been found to improve hospital finances broadly and therefore may have permitted sustained investments in staffing and quality improvement at these vulnerable hospitals. In this difference-indifferences analysis, we found that critical access hospitals in Medicaid expansion states did not have statistically significant postexpansion increases in operating margins relative to hospitals in nonexpansion states. Nor did we see evidence of statistically significant differential improvement at critical access hospitals in expansion versus nonexpansion states on either staffing measures (physicians and registered nurses per 1,000 patient days) or quality measures (percentage point changes in readmissions and mortality within thirty days of admission for pneumonia or heart failure).
These findings suggest that critical access hospitals may need to take additional measures to bolster finances to provide continued support for the delivery of high-quality care to rural and other underserved communities.
Access the full article at CAH Medicaid Study – 2021
KFF COVID-19 Vaccine Monitor: Differences in Vaccine Attitudes Between Rural, Suburban, and Urban Areas
Throughout the past year, the Kaiser Family Foundation (KFF) COVID-19 Vaccine Monitor has provided a look into how the coronavirus pandemic has impacted people living in different areas of the U.S., including analyses of the vaccine intentions of rural residents. This latest report draws on two surveys conducted in November (before news of the omicron variant) – one of adults and one of parents – and shows that those living in different types of communities hold very different views of COVID-19 vaccines, particularly when it comes to children. In addition, parents living in different community types report getting different levels of information regarding COVID-19 vaccines from their children’s schools and pediatricians.
- Rural and suburban adults continue to lag somewhat behind those living in urban areas in terms of vaccine uptake. As of November, eight in ten urban residents (79%) say they have gotten at least one dose of a COVID-19 vaccine compared to seven in ten suburban adults and 67% of rural adults. One in five (21%) of those living in rural areas and one in six (16%) of those living in suburban areas say they will “definitely not” get a COVID-19 vaccine, at least twice the share of urban residents who say the same (8%).
- The rural-urban gap in vaccination intention is even larger when it comes to children. About half of rural parents say they will definitely not get their 12-17 year-old children or their 5-11 year-old children vaccinated for COVID-19. A quarter of rural parents (26%) say they have vaccinated their 12-17 year-old, compared to nearly two-thirds of parents in urban areas (64%) and about half of those living in suburban areas (47%) areas. One in ten rural parents and a similar share of suburban parents (14%) report that their 5-11 year-old child is vaccinated, compared to about a quarter (23%) of urban parents who say the same.
- Four in ten parents overall say they have spoken to their child’s pediatrician about the COVID-19 vaccine. Yet, those living in rural areas are more likely than those living in suburban or urban areas to report their child’s pediatrician did not recommend the vaccine for their child. More than one-third of rural parents say they had a conversation with their child’s health care provider and the provider did not recommended they get their child vaccinated (compared to around one in ten urban and one in seven suburban parents).
- Around half of all parents say their child’s school has provided them with information on how to get a COVID-19 vaccine for their child, but smaller shares of rural than urban parents say their child’s school has encouraged parents to get their child vaccinated (36%) compared to parents in suburban (44%) and urban (50%) areas.
- Views on COVID-19 vaccine mandates also differ across communities. A majority of urban residents support the federal government requiring large employers to either have their employees be vaccinated or get tested weekly, while rural and suburban residents are more divided on this Biden administration guideline. In addition, most workers living in urban areas say their employer already requires employees to be vaccinated for COVID-19 or that they support such a requirement, while six in ten rural workers and half of suburban workers do not want their employer to issue a vaccine mandate. Opposition to schools requiring eligible students to be vaccinated for COVID-19 is also higher among rural and suburban parents compared to urban parents.
- While differing partisanship and demographics may contribute to differences in vaccine attitudes between people living in urban, suburban, and rural communities, multivariate analysis suggests that there is a relationship between community type and COVID-19 vaccine uptake that exists even when controlling for party identification and demographics. Using a statistical technique called logistic regression, we find that rural and suburban adults are less likely than urban adults to report being vaccinated for COVID-19, even after controlling for age, race, ethnicity, education, income, party identification, and ideology.
To access the full set of findings and methodology, click here.
NIH Report Details 20 Years of Advances and Challenges of Americans’ Oral Health
Despite important advances in the understanding and treatment of oral diseases and conditions, many people in the U.S. still have chronic oral health problems and lack of access to care, according to a report by the National Institutes of Health. Oral Health in America: Advances and Challenges, is a follow-up to the seminal 2000 Oral Health in America: A Report of the Surgeon General. The new report, which is intended to provide a road map on how to improve the nation’s oral health, draws primarily on information from public research and evidence-based practices and was compiled and reviewed by NIH’s National Institute of Dental and Craniofacial Research (NIDCR) and a large, diverse, multi-disciplinary team of more than 400 experts.
The report updates the findings of the 2000 publication and highlights the national importance of oral health and its relationship to overall health. It also focuses on new scientific and technological knowledge – as well as innovations in health care delivery – that offer promising new directions for improving oral health care and creating greater equity in oral health across communities. Achieving that equity is an ongoing challenge for many who struggle to obtain dental insurance and access to affordable care.
“This is a very significant report,” said NIH Acting Director Lawrence A. Tabak, D.D.S., Ph.D. “It is the most comprehensive assessment of oral health currently available in the United States and it shows, unequivocally, that oral health plays a central role in overall health. Yet millions of Americans still do not have access to routine and preventative oral care.”
The newly issued report provides a comprehensive snapshot of oral health in America, including an examination of oral health across the lifespan and a look at the impact the issue has on communities and the economy. Major take-aways from the report include:
- Healthy behaviors can improve and maintain an individual’s oral health, but these behaviors are also shaped by social and economic conditions.
- Oral and medical conditions often share common risk factors, and just as medical conditions and their treatments can influence oral health, so can oral conditions and their treatments affect other health issues.
- Substance misuse and mental health conditions negatively affect the oral health of many.
- Group disparities around oral health, identified 20 years ago, have not been adequately addressed, and greater efforts are needed to tackle both the social and commercial determinants that create these inequities and the systemic biases that perpetuate them.
“This is an in-depth review of the scientific knowledge surrounding oral health that has accumulated over the last two decades,” said Rena D’Souza D.D.S., Ph.D., director of NIDCR, which oversaw and funded the project’s three-year research program. “It provides an important window into how many societal factors intersect to create advantages and disadvantages with respect to oral health, and, critically, overall health.”
The COVID-19 pandemic emerged while the report was being written. The science around SARS-CoV-2 continues to come into focus in real-time, and, although data were only starting to surface about the oral implications of the disease, the authors included a preliminary analysis of it to assess initial impacts.
The authors make several recommendations to improve oral health in America, which include the need for health care professionals to work together to provide integrated oral, medical, and behavioral health care in schools, community health centers, nursing homes, and medical care settings, as well as dental clinics. They also identify the need to improve access to care by developing a more diverse oral health care workforce, addressing the rising cost of dental education, expanding insurance coverage, and improving the overall affordability of care.
“Although there are challenges ahead, the report gives us a starting point and some clear goals that offer reasons to be hopeful, despite those challenges,” added D’Souza. “It imagines a future, as I do, in which systemic inequities that affect oral health and access to care are more fully addressed, and one in which dental and medical professionals work together to provide integrated care for all.”
Scientists and public health professionals will use the report to identify areas of scientific inquiry and research as well as develop and implement programs that ultimately will improve the oral health of individuals, communities, and the nation.
To view or download the report, please visit the NIDCR website at www.nidcr.nih.gov/oralhealthinamerica.
Questions about the report? Email OralHealthReport@nih.gov or call NIDCR at 1-866-232-4528.
COVID-19 Vaccine Access in Long-term Care Settings
The federal government is committed to ensuring that residents and staff in long-term care settings, such as nursing homes, assisted living, residential care communities, group homes and senior housing, have access to COVID-19 vaccines to receive primary series and booster shots.
Long-term care providers are encouraged to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, either in the local community or on-site. The CDC has additional details on these options. Find Medicare billing and payment information.
As a reminder, through enforcement discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare skilled nursing facility residents.
Introducing the Patient-Provider Dispute Resolution Process: Guidance Available
The patient-provider dispute resolution (PPDR) process is meant to protect uninsured (or self-pay) individuals from unexpectedly high medical bills. Effective January 1, 2022, providers, facilities, and providers of air ambulance services will need to give an uninsured (or self-pay) individual, or their authorized representative, a good faith estimate of expected charges after an item or service is scheduled, or upon request. The good faith estimate will include a list of items and services expected to be provided as part of the primary care, and items and services expected to be provided in conjunction with the primary care, for that period of care.
If an uninsured (or self-pay) individual receives a bill that is at least $400 more than the expected charges on the good faith estimate, they can choose to initiate the PPDR process, engaging a third-party entity certified by the Department of Health and Human Services (HHS) to arbitrate their dispute. This company will decide how much the uninsured (or self-pay) individual will pay to the provider or facility: the amount on the good faith estimate, the billed amount, or another amount in between the estimated amount and billed amount. To utilize this dispute process, there is a $25 administrative fee that the individual has to pay at the start of the process.
This PPDR process provides important consumer protections for the uninsured (or self-pay) individual from billed charges that are substantially in excess of the expected charges in the good faith estimate.
HHS has created PPDR guidance for different audiences. These guidance documents help providers and facilities and uninsured or self-pay individuals, and those who will help them, to better understand what information must be included in the good faith estimate, how to initiate the PPDR process, and address any questions you may have.
Guidance for Providers and Facilities: link available here
Guidance about Selected Dispute Resolution Entity: link available here
Guidance for Uninsured or (Self-Pay) Individuals: link available here
Guidance about the Administrative Fee: link available here
HHS intends to hold webinars in the future about the PPDR process. We’ll share webinar information in the coming weeks.