June 20, 2019 What's New Scorecard on State Health System Performance. Last week, The Commonwealth Fund issued its annual report on state-by-state performance on health care quality, access, cost of care, and income-based disparities. The scorecard highlights the rise in deaths from suicide, alcohol and drug overdose, and particularly the factors that make a difference in each state. See the Rural Health Research Section below for recent work on these topics. Binge Drinking and Prescription Opioid Misuse. Research published in the American Journal of Prescription Medicine examined the relationship between alcohol and drug use and found that prevalence of prescription opioid misuse was similar among nondrinkers, but was 3.5 times higher among binge drinkers (Binge drinking refers to consuming four or more drinks within a couple of hours). The research measured differences by race, gender, income and rural-urban location. Among the findings: binge drinkers in rural areas have a higher prevalence of prescription opioid misuse than binge drinkers in urban areas (Table 2). SAMHSA Behavioral Health Barometer. In this newly-released report, the Substance Abuse and Mental Health Services Administration (SAMSHA) provides a broad overview of behavioral health in metropolitan and nonmetropolitan areas of the U.S. with an emphasis on illicit drug, alcohol, and tobacco use, as well as the estimated percentage of people living with serious mental illness. The report includes a special focus on the misuse of prescription pain relievers, heroin use, and medication-assisted therapy (MAT) for opioid addiction. Significant rural-metropolitan differences found include past-month cigarette use among teenagers (2.8 percent urban vs. 5.1 percent rural) and past-year serious mental illness among adults aged 18 or older (4.4 percent urban vs. 5.2 percent rural). Trends in Meeting Physical Activity Guidelines Among Urban and Rural Dwelling Adults. In its latest Morbidity and Mortality and Weekly Report, the Centers for Disease Control and Prevention finds that the prevalence for physical activity remains low, especially for some rural subgroups with high incidences of chronic diseases. The report recommends incorporating culturally appropriate strategies into local, evidence-based programs might help communities build on recent progress. Funding Opportunities Assessing Public Transportation in Appalachia – July 12. The Appalachian Regional Commission (ARC) invites proposals to conduct research and provide guidance regarding public transportation in the Appalachian Region, with a particular focus on rural public transportation issues. The project will help ARC better understand the extent to which existing public transportation services provide adequate access for disadvantaged populations and help to better connect transportation, economic development, education, and health practitioners throughout the region. DOJ Telehealth to Improve Sexual Assault Forensics – July 17. The U.S. Department of Justice (DOJ) will invest $4 million to enhance care for sexual assault victims and improve the quality of forensic examinations through telehealth. The funding is intended for rural, tribal and remote communities where access to expertise is particularly challenged. Eligible applicants are state and local agencies, federally recognized tribal governments, nonprofit and for-profit organizations (including tribal nonprofit and for-profit organizations), and institutions of higher education with demonstrated experience and understanding of telehealth technology, sexual assault victimization, and the many needs of sexual assault victims DOJ Services to Support Victims of Sex and Labor Trafficking – July 19. The Department of Justice (DOJ) will invest $46.5 million for 70 grants funding direct services to victims of sex trafficking and labor trafficking. Eligible organizations are states, territories, units of local government, federally recognized Indian tribal governments (as determined by the Secretary of the Interior), and nonprofit, nongovernmental organizations. In addition to providing direct services to victims, program grantees will increase the capacity of their communities to respond to human trafficking through interagency partnerships, professional training, and public awareness activities. According to the National Human Trafficking Resource Center, rural areas have several economic risk factors for human trafficking, including persistent rates of poverty, decreasing workforce participation rates and high demand for low-skilled manual labor. Bureau of Justice Assistance – Rural Responses to the Opioid Epidemic – July 26. Within the U.S. Department of Justice, the Bureau of Justice Assistance (BJA) has created an online resource site for its Comprehensive Opioid Abuse Program. As part of that program, the BJA will grant eight awards of up to $750,000 each for a two-year effort to reduce morbidity and mortality from opioid overdose in high-risk rural communities. Priority consideration will be given to rural regions previously selected for the Health Resources & Services Administration's (HRSA's) Rural Communities Opioid Response Program—Planning initiative (RCORP-Planning), although new applicants are welcome. DOL YouthBuild Grants – August 6. The U.S. Department of Labor (DOL) will make awards up to $1.5 million each to 70 organizations offering pre-apprenticeship services that support education, occupational skills training, and employment services for at-risk youth, ages 16 to 24, while performing meaningful work and service to their communities. Training includes affordable housing construction skills and other in-demand industries, such as healthcare, information technology, hospitality, retail services, and logistics. Eligible applicants for these grants are private non-profit or public agencies. These organizations include rural, urban, or Native American agencies that have previously served disadvantaged youth in a YouthBuild or other similar program. Research has shown that nearly 1 in 5 rural youth are disconnected from work or school. ACL Alzheimer's Disease Program Initiative – August 13. The Administration for Community Living (ACL) will invest $10.7 million for the development and expansion of dementia-capable home and community-based service (HCBS) systems in states and communities. A 2017 study from the Alzheimer's Association calculated that 6 million people in the U.S. are currently living with Alzheimer's, a number that's predicted to double by 2060. Primary care providers do not routinely test for Alzheimer's disease or related dementias, and people with the disorder are more often undiagnosed in rural and minority populations. HRSA Teaching Health Center Graduate Medical Education Program – August 30. The Health Resources and Services Administration (HRSA) will invest $48 million for 61 awards to community-based patient care centers that operate an accredited primary care residency program. These include, but are not limited to, Federally Qualified Health Centers, community mental health centers, Rural Health Clinics, health centers operated by the Indian Health Service, and Indian tribes and tribal organizations. The program supports the training of residents in new or expanded primary care residency training programs. Research has shown that medical students completing rural rotations were three times more likely to practice in a rural community compared with the national average. Rural Health Research Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence. Using 2010-2016 data from the National Survey on Drug Use and Health, researchers from the Rural and Underserved Health Research Center found that the overall mean prevalence of suicidal thoughts among adults was significantly higher for non-metropolitan and small metropolitan counties. This page on the Rural Health Research Gateway contains links to additional research on illicit drug and opioid use disorders in rural areas. Measuring Access to Care in National Surveys: Implications for Rural Health. In order to assess the efficacy of healthcare in meeting the needs of the population and to ensure access to timely, appropriate care, it is important to have nationally representative measures of access and barriers to healthcare. Given the unique healthcare context in rural settings, it is also important to understand whether, and how, access is measured in ways that are salient for rural populations. This brief from the University of Minnesota Rural Health Research Center reviews access measures included in major national surveys and presents implications for rural research on access to care. Cost-Sharing as a Barrier to Accessing Care at FQHCs and RHCs for Rural Medicare Beneficiaries. Cost is often a significant barrier to accessing care for the rural Medicare population, so having a better understanding of the variations in cost-sharing per claim (deductibles and coinsurance amounts) at various types of safety-net facilities is important. The purpose of this study from the North Carolina Rural Health Research and Policy Analysis Center is to investigate cost as a barrier to accessing care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for the rural Medicare population. Policy Updates Visit the FORHP Policy page to see all recent updates and send questions to ruralpolicy@hrsa.gov. Comments Requested: CMS Issues Draft Guidance on Hospital Co-location – July 2. The Centers for Medicare & Medicaid Services (CMS) seeks public input on draft guidance regarding how CMS and State Agency surveyors will evaluate a hospital's co-location of space and staff when assessing the hospital's compliance with the Medicare Conditions of Participation (CoPs). It clarifies that sharing of staff may be done through a contractual arrangement where there are clear lines of authority and accountability and that sharing public areas, such as entrances and waiting rooms, would be permissible. RHIhub highlights several programs in rural communities that have used co-location of services and staff to improve efficiencies, including lessons learned about this approach. See Events section below for an upcoming session on this topic. Learning Events and Technical Assistance Standards for Minimizing Pesticide Exposure – Thursday, June 20 at 1:00 pm ET. The U.S. Environmental Protection Agency's (EPA) Worker Protection Standard (WPS) is the primary federal regulation that provides workplace protections for farmworkers who are exposed to pesticides. This session, featuring experts from Farmworker Justice and Migrant Clinicians Network, will provide an update on the status of the WPS, review major provisions that aim to prevent exposure to farmworkers and their families, and the roles and responsibilities of clinicians and other stakeholders regarding worker protection. Additionally, this session will provide participants with resources to help educate farmworkers and their families about the WPS and pesticide exposure, to facilitate reporting of pesticide exposure, and to assist clinicians in the recognition and management of pesticide exposures. Models of Hepatitis C Care for People with SUD – Thursday, June 20 at 2:00 pm ET. This hour-long webinar will present models of care for hepatitis C virus (HCV) care for people with substance use disorders (SUD). The overall goal of the webinar is to encourage more providers to integrate hepatitis C care into their practices both for people living with hepatitis C and those that are co-infected with HIV and HCV. Incidence of HCV infection has been noticeably higher in rural areas over the last ten years. National Rural Institute on Alcohol and Drug Abuse – June 23-27 in Menomie, WI. Registration is still open for this unique annual conference for rural alcohol and drug abuse professionals, federal agency representatives and nationally-known experts. Key resource professionals from throughout the U.S. will present intensive study tracks and special topics on current innovative and emerging topics. National Opioid Leadership Summit – Tuesday, June 25 in Sacramento, CA. Join the Public Health Institute, U.S. Surgeon General Jerome Adams and colleagues from across the country on June 25, 2019 in Sacramento to learn about, share and collaborate on real solutions to the opioid crisis that bridge the criminal justice, health care, and public health sectors. Promising Practices on Integrating HIV Testing and Care – Wednesday, June 26 at 3:00 pm ET. The Health Resources and Services Administration will host this hour-long webinar focused on the integration of routine HIV services in primary care settings. Presenters from Southcentral Foundation in Anchorage, AK, and Family Health Center in Louisville, KY, will highlight promising practices that enhance routine HIV testing, Pre-Exposure Prophylaxis (PrEP), and linkage to care. Recent research has shown the dynamics of new and established HIV infections have shifted from a predominantly urban-centered challenge to become a nonurban-centered problem. Call-in: 888-790-3088; Passcode: 3209784. Hospital Co-location Listening Session — Thursday, June 27 at 2:00 pm ET. The Centers for Medicare & Medicaid Services (CMS) is holding a listening session on June 27 to hear your feedback on new draft guidance for Appendix A of the State Operations Manual. Under the Medicare Conditions of Participation, hospitals may co-locate with other hospitals or health care entities, meaning they share certain common areas on the same campus or building. CMS is seeking your input on staffing, contracted services, emergency services, and distinct and shared spaces. You may email comments/questions in advance of the listening session to HospitalSCG@cms.hhs.gov with June 27 in the subject line. These may be addressed during the listening session or used for other materials following the session. After the call, CMS will continue to seek comment on these draft revised policies until July 2. Auto-HPSA Portal Training for Rural Health Clinics – Thursday, June 27 at 2:00 pm ET. Rural Health Clinics (RHCs) are among facilities automatically designated as Health Professions Shortage Areas (auto-HPSAs). This two-hour online session will provide training for the updated process for HPSA scoring. Using Telehealth to Treat Substance Use Disorder – June 28, 2019 at 3:00pm ET. Anyone may attend this online session for community health centers (CHC) and Federally Qualified Health Centers (FQHC), hosted by the HRSA/FORHP-supported Telehealth Resource Centers. Experts will discuss the types of substance use disorder (SUD) services that can be provided via telehealth, how they can be integrated into primary care, and the potential issues that may be encountered. Though recent reports have found that telehealth adoption is slower in rural areas, more federal programs and funding have been implementing telehealth to bring SUD treatment to remote areas. Save the Date: 3RNet 2019 Annual Conference – September 24-26 in Wichita, KS. The National Rural Recruitment and Retention Network (3RNet) is a nonprofit that matches health care professionals to employers in rural and underserved areas. Attendees at their annual two-day conference will network with other 3RNet members, learn strategies for rural recruitment and retention, and get insight from experienced leaders in health professions staffing. Last year, 3RNet made more than 2,500 clinician placements in rural, frontier, and underserved urban communities. Resource of the Week Online Training and Resources for Rural First Responders. The Rural Domestic Preparedness Consortium provides free online training and resources to help rural communities plan for and respond to mass injuries and fatalities. Supported by The Center for Rural Development, the site provides self-paced online training and scheduled, in-person training that has been certified by the U.S. Department of Homeland Security. Approaching Deadlines Comments Requested: Proposed Updates for FY2020 Medicare Inpatient and Long-term Care Hospital Payments – June 24 USDA Telehealth Innovations for Women, Infants, Children – Letters of Intent June 25 New Opportunity to Apply to be a Medicare Shared Savings Program ACO—Notice of Intent June 28 Proposals Requested: Medicare Measures for Promoting Interoperability – June 28 Hardship Exclusion for Medicare Interoperability – July 1 HUD Comprehensive Housing Counseling Grant Program – July 1 IHS Tribal Management Grant Program – July 1 Comments Requested: CMS Issues Draft Guidance on Hospital Co-location – July 2 Request for Information: State Waivers for Health Insurance – July 2 Contractor Sought for RWJF Rural Leadership Pathways Learning Initiative – July 8 HRSA Requests Public Feedback on Health Center Service Areas – July 8 Indian Health Service Requests Feedback on Community Health Aide Program – July 8 USDA Rural Housing Preservation Grant – July 8 DOT Public Transportation on Indian Reservations – July 9 Assessing Public Transportation in Appalachia – July 12 Federal Investment in Rural Transportation – July 15 DOL Workforce Opportunity for Appalachian and Delta Regions – July 15 Supporting HRSA's Maternal Health Innovation Program – July 15 DOJ Telehealth to Improve Sexual Assault Forensics – July 17 NHSC Rural Community Loan Repayment Program – July 18 DOJ Services to Support Victims of Sex and Labor Trafficking – July 19 Seeking Host Applicants for Citizens' Institute on Rural Design – July 22 Bureau of Justice Assistance – Rural Responses to the Opioid Epidemic – July 26 CDC National Harm Reduction Syringe Services Program Monitoring and Evaluation – July 26 DOJ Tribal Victim Services Set-Aside Program – July 29 USDA Telehealth Innovations for Women, Infants, Children – July 29 DOL YouthBuild Grants – August 6 USDA Tribal Colleges Research Grants – August 9 CMS Requests Feedback Reducing Regulatory Burden – August 12 ACL Alzheimer's Disease Program Initiative – August 13 AHA Rural Hospital Leadership Team Award – August 30 HRSA Teaching Health Center Graduate Medical Education Program – August 30 Indian Health Service Loan Repayment Program – Ongoing through August 2019 NIH: Research for Disparities Among Minority/Underserved Children – Cycles thru May 2020 Guaranteed Loans for Rural Rental Housing – Ongoing through 2021 HUD Hospital Mortgage Insurance Program – Ongoing RWJF Investigator-Initiated Research to Build a Culture of Health – Ongoing Telecommunications Infrastructure Loans – Ongoing Funding for Rural Water and Waste Disposal Projects – Ongoing Drinking Water and Waste Disposal for Rural and Native Alaskan Villages – Ongoing HIT Strategies for Patient-Reported Outcome Measures – Ongoing HIT to Improve Health Care Quality and Outcomes – Ongoing Community Facilities Program – Ongoing Summer Food Service Program – Ongoing | 
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