Originating in Vermont, the Hub and Spoke model provides a point of care at each stage of recovery from opioid use disorder (OUD), from the intense beginning to long-term treatment.  This case study examines what happened in Montana, designated as a Frontier and Remote state by the federal government.  Earlier this year, the HRSA-supported Center on Rural Addiction at the University of Vermont conducted a baseline needs assessment (pdf) in that state of rural and non-rural practitioners during two separate one-month periods in 2020.  Both rural and non-rural practitioners named stigma and patient time/transportation as top barriers to treatment.  A majority of rural providers also named medication diversion as a top concern.

See Case Study: Barriers to Hub and Spoke Model for OUD Treatment for more information.

The Centers for Disease Control and Prevention (CDC) seeks information on best practices and promising practices for the positive mental health and well-being of health workers.  The feedback will be used to inform interventions under development by the CDC’s National Institute for Occupational Safety and Health.  The request includes feedback about first responders and emergency services personnel experiencing higher levels of stress during the pandemic.

See CDC Seeking Public Input on Work-Related Stress for Health Workers for more information.

Comments are due by November 26.

The U.S. Department of Health & Human Services (HHS) released a new strategy for expanding supply, ensuring equitable distribution, and improving the quality of the nation’s health workforce.  The plan is one of the requirements of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and will be implemented by the Health Resources and Services Administration and several other operating divisions of HHS (see Appendix D).

See HHS Announces New Plan for Health Workforce for more information.

The Centers for Medicare & Medicaid Services launched a new “one stop shop” for home and community-based services.  State-level stakeholders can learn about innovative models for care delivered to Medicaid beneficiaries outside of an institution, such as in their own home.  These services, which can be particularly challenging in rural areas, include personal hygiene, nutrition, home health, and transportation.  Funding from the American Rescue Plan provides qualifying states with a temporary 10 percentage point increase for certain expenditures for home and community-based services.

See New Funding and Resources for State Medicaid Agencies for more information.

The U.S. Department of Health & Human Services announced a new focus prioritizing four objectives: primary prevention, harm reduction, evidence-based treatment and recovery support.  Earlier this year, the Centers for Disease Control and Prevention determined that the rate of rural overdose deaths from 1999 to 2019 rose from 4.0 to 19.6 per 100,000 people.  In 2019, rates in rural counties were higher than in urban counties in California, Connecticut, North Carolina, Vermont, and Virginia.

See New Federal Strategy for Overdose Prevention for more information.

HRSA Payment Program for Buprenorphine-Trained Clinicians. In June 2021, the Health Resources and Services Administration (HRSA) launched an effort to improve access to substance use disorder treatment by paying for clinicians who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder.  Rural Health Clinics still have the opportunity to apply for a $3,000 payment for each clinician who trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019.  Approximately $1.5 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted.  Send questions to DATA2000WaiverPayments@hrsa.gov. There is ongoing availability of a free online course for waiver eligibility training from the American Osteopathic Academy of Addiction Medicine and the Providers Clinical Support System.

United States Department of Agriculture (USDA) Under Secretary for Rural Development Xochitl Torres Small announced that USDA is seeking applications to implement projects supported by regional economic and community development planning to help the people of rural America build back better.

The 2018 Farm Bill authorized USDA to make this funding available under the Strategic Economic and Community Development (SECD) initiative. It can be used to implement projects that are supported by multi-jurisdictional and multi-sectoral strategic community investment plans. In fiscal year 2022, this funding is available under the following USDA Rural Development programs:

• Community Facilities Direct Loan and Grant Program
• Community Facilities Loan Guarantee Program
• Water and Waste Disposal Direct Loan and Grant Program
• Water and Waste Disposal Loan Guarantees
• Rural Business Development Grants
• Community Connect Grants

To be eligible for SECD reserved funding, applicants must meet the requirements and deadlines under the covered programs. Applicants must also submit a Form 1980-88 to USDA. See additional requirements below.

• To apply for SECD reserved funding under the Water and Waste Disposal Direct Loan and Grant Program, applicants must submit forms electronically via RD Apply or submit paper forms at the USDA Rural Development office where the project is located.
• USDA will issue an announcement in the coming months when the application window opens for the Community Connect Grants program. To apply for SECD reserved funding under this program, applicants must submit forms electronically at https://www.rd.usda.gov/community-connect.
• To apply for SECD reserved funding under other grant programs or direct loan programs, applicants must submit forms to the USDA Rural Development office where the project is located.
• To apply for SECD reserved funding under loan guarantee programs, applicants must submit their Form 1980-88 concurrent with the 5001-1 and any documentation required under the OneRD Guarantee Loan Initiative application guidelines.

For more information on requirements and deadlines under the covered programs, visit www.rd.usda.gov. For additional information on SECD funding, see page 57409 of the Oct. 15, 2021, Federal Register.

USDA Rural Development encourages applicants to consider projects that will advance key priorities under the Biden-Harris Administration to help rural America build back better and stronger. Key priorities include combatting the COVID-19 pandemic, addressing the impacts of climate change and/or advancing equity in rural America. For more information, visit https://www.rd.usda.gov/priority-points.

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

Domestic violence and healthcare are closely linked. The month of October is National Domestic Violence Awareness Month and according to a survey of contacts with the National Domestic Violence Hotline (see 2021-10-04_Hotline-HRSA-focus-survey-report), 53% of respondents reported that an abusive partner has also controlled/and or restricted access to healthcare.

HRSA’s Office of Women’s Health and Bureau of Primary Healthcare are working with the Administration of Children and Families and the National Domestic Violence Hotline to address these intersections.  Learn more about other HRSA intimate partner violence work or view last year’s webinar, Sheltering in Place, Intimate Partner Violence, and the Healthcare Response.

Thank you for your efforts to bring awareness to this public health issue in your communities.