November 21, 2019 NATIONAL RURAL HEALTH DAY What's New CDC Reports on Rural Health. The Centers for Disease Control and Prevention (CDC) recently released two reports that compare health issues between metropolitan and nonmetropolitan areas of the U.S. In Potentially Excess Deaths from the Five Leading Causes of Death, researchers found that the gap in the percentages of preventable deaths between rural and urban counties widened over the eight-year study period for cancer, heart disease, and chronic lower respiratory disease, remained relatively stable for stroke, and decreased for unintentional injuries. A study on Lung Cancer Incidence found that rates decreased in both urban and rural areas during the ten year period from 2007-2016, but the smallest decrease occurred among females living in nonmetropolitan counties. Hospitals Selected for Small Rural Hospital Transition Project. In an effort to better prepare and assist small rural hospitals in moving from a fee-for-service and volume-based payment system to one that is drive by value and quality, the Federal Office of Rural Health Policy (FORHP) administers the Small Rural Hospital Transition Project (SHRT). The program provides technical assistance through onsite consultations to eligible hospitals that have 49 beds or less and are located in a federally-designated persistent poverty county. Core areas of technical assistance include: 1) financial operational assessment, and 2) quality improvement projects. Last month, nine hospitals were identified through the objective review process to receive this assistance in the 2019-2020 cohort of the project. Now in its fifth year, the SHRT program shares what's learned on issues relevant to rural health stakeholders through the National Rural Health Resource Center. Funding and Opportunities AcademyHealth/NCHS Health Policy Fellowship – January 1. The National Center for Health Statistics (NCHS) and AcademyHealth seek senior researchers with at least five years of post-doctorate research experience to conduct research on-site at NCHS for up to twelve months. The program is designed to encourage the use of NCHS data systems and programs by the health services research community in response to current policy questions, and to provide a basis for future health policy. Applicants must have a demonstrated record of research independence and accomplishments in health services research in disciplines such as public health, public administration, health care administration, sociology, health economics, health statistics, anthropology, and behavioral sciences; or in clinical care, including medicine, nursing, dentistry, and pharmacology. DOJ Grants for Domestic Violence/Sexual Assault – January 8. The U.S. Department of Justice (DOJ) will make 20 awards of up to $650,000 each for community-level efforts to respond to domestic violence, dating violence, sexual assault, stalking, and child sexual abuse. Eligible applicants include state and local governments, federally-recognized tribal governments, and nonprofit organizations. Priority areas for the funding include challenges specific to rural communities, where violence often goes unreported. EPA Environmental Justice Collaborative – February 7. The U.S. Environmental Protection Agency (EPA) will provide direct financial and technical assistance to address local environmental and/or public health issues in underserved communities with low income, rural, tribal, indigenous, and homeless populations. The EPA's Office of Environmental Justice (OEJ) brings together community-based organizations, tribal and local governments, as well as industry, and non-governmental organizations in an ongoing effort to discover what works to reduce and eliminate environmental harm. Applicants can find ideas in the case studies listed in the OEJ's Environmental Justice Collaborative Problem-Solving Program. HRSA/FORHP Rural Health Research Center Program – February 21. The Health Resources and Services Administration (HRSA) will make seven awards of up to $700,000 each to fund high-quality research that informs policy for rural health. Eligible applicants include domestic public or private, non-profit entities, including faith-based and community-based organizations, tribes, and tribal organizations. Successful applicants will become part of the Rural Health Research Gateway, producing timely and relevant information for HRSA's Federal Office of Rural Health Policy (FORHP). See Rural Health Research and the Learning Events sections below for opportunities to learn about current work under this program. Rural Health Research Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway. Sign up for alerts when new publications become available. Severe Maternal Morbidity and Hospital Transfer Among Rural Residents. Rural residents often travel farther to access medical care, especially obstetric care, and are more likely to be uninsured or underinsured than urban residents, contributing to higher rates of maternal morbidity. To raise awareness and increase understanding of the relationship between transfer, delivery hospital location, and severe maternal morbidity and mortality (SMMM) for rural residents, researchers at the University of Minnesota Rural Health Research Center compared data for rural and urban residents who gave birth between 2008 and 2014, to describe the relationship between a need to transfer patients for specialized care and increased risk for maternal morbidity and mortality. Differences in Preventive Care Among Rural Residents by Race and Ethnicity. Rural areas have long been racially and ethnically diverse. Yet most research on rural health focuses on rural-urban disparities without an explicit focus on within-rural differences in health by race and ethnicity. In that research on rural-urban disparities in health, rural residents tend to fare worse on most measures, including mortality, health status, access to care, and use of preventive services. Less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. In this from the University of Minnesota Rural Health Research center, researchers examine differences in preventive care among rural residents by race and ethnicity. Policy Updates Visit the FORHP Policy page to see all recent updates and send questions to ruralpolicy@hrsa.gov. Comments Requested: Transparency in Coverage Proposed Rule – January 14. On November 15, the U.S. Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury proposed requirements for group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request, to a participant, beneficiary, or enrollee (or his or her authorized representative), including an estimate of such individual's cost-sharing liability for covered items or services furnished by a particular provider. If you are looking for information on health insurance in rural areas, you can find resources on RHIhub. Comments Requested: Medicaid Fiscal Accountability Proposed Rule – January 17. Last week, the Centers for Medicare & Medicaid Services (CMS) proposed changes to state Medicaid reporting and clarifications of key definitions in order to improve payment transparency and program integrity. Proposals in this rule focus on four payment areas: fee-for-service (FFS) supplemental provider payments; disproportionate share hospital (DSH) payments; financing for the non-Federal share of payments; and health care-related taxes and provider-related donations. CMS seeks comment on all elements of this proposal, including whether supplemental provider payments should be capped, if there should be a separate cap for rural areas and/or HRSA-designated geographic health professional shortage areas, and whether there should be other special considerations for providers in underserved areas. CMS Issues Hospital Price Transparency Final Rule. On November 15, the Centers for Medicare & Medicaid Services (CMS) finalized policy changes to the CY 2020 Hospital Outpatient Prospective Payment System (OPPS) on price transparency requirements for hospitals. This final rule establishes requirements for hospitals, including Critical Access Hospitals (CAHs) and other rural hospitals, to make public a machine-readable file online that includes all standard charges along with discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges for a set of "shoppable services." CMS is finalizing that the effective date of the final rule will be January 1, 2021, to ensure that hospitals have the time to be compliant with these policies. FCC Publishes Final Rule on Rural Health Care Program - Recently, the Federal Communications Commission (FCC) finalized regulations to promote transparency and predictability, and further the efficient allocation of limited Rural Health Care Program resources while guarding against waste, fraud and abuse. The FCC promotes telehealth in rural areas through the Rural Health Care Program (RHC Program), which provides financial support to help rural health care providers obtain broadband and other communications services at discounted rates. The regulations went into effect on November 12, unless noted otherwise for some specific provisions in the final rule. Learning Events and Technical Assistance Intro to Farm Stress: Mental Health Needs Among Diverse Farm Populations – Monday, November 25 at 1:00 pm ET. Thomasine Heitkamp, Director of the Mountain Plains Mental Health Technology Transfer Center, and Dr. Shawnda Schroeder with the Center for Rural Health will present the first topic in a series of webinars addressing farm stress. In this first session, you will learn about the definition of farm stress, contributing factors, the impact of farm stress on the family, and how farming demographics and associated stress may vary by U.S. region. Finally, this session will introduce resources that currently exist for farmers to address stress and suicide risk, as well as present ongoing gaps and barriers to utilizing mental health services among agricultural communities. Rural Health Research Forum – Wednesday, December 4 at 9:00 am ET. The December 2019 issue of Health Affairs explores various dimensions of health and health care in rural America. Authors examine the health care needs of people living in rural areas, investigate inequities in the availability, accessibility, and financing of care, and identify policies, financing mechanisms, and practices that can improve the health and well-being of rural Americans. At this four-hour event held in Washington, DC, several research centers forming the Rural Health Research Gateway will present on their new research funded by the Federal Office of Rural Health Policy. Registration is available for viewing the event online. HIV/AIDS Prevention in Rural Communities – Thursday, December 5 at 10:00 am ET. In recognition of World AIDS Day on December 1, the Health Resources and Services Administration will hold a 90-minute webinar on the ways rural primary care providers are increasing access to Pre-Exposure Prophylaxis, also known as PrEP. When taken daily, PrEP reduces the risk of contracting the virus that causes AIDS. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99%, and by at least 74% among people who inject drugs. Resource of the Week Creating a Consortium to Combat the Opioid Epidemic. Two organizations in southern Ohio created a unique collaboration to maximize federal dollars in their efforts to combat the opioid epidemic across five counties. Ohio University (OU) had already been working with the Pacific Institute for Research and Evaluation (PIRE) for about ten years, providing training, technical assistance, and leadership development to local communities. Each organization applied separately to receive funds from the Rural Communities Opioid Response Program (RCORP), an initiative launched in 2018 by the Health Resources and Services Administration's Federal Office of Rural Health Policy to address the opioid crisis. While RCORP is designed for rural areas of the country, it allows urban organizations to be the lead applicants as long as funded services directly benefit rural communities. This case study in the publication Rural Monitor explains how and why OU and PIRE chose to apply for the funding separately to maximize their reach across five primarily rural counties. Approaching Deadlines Comments Requested: Rural Eligibility for FORHP Funding – EXTENDED to November 23 Rural Health Network Development Program – November 25 Instructor Training Grants for Physical Activity Programs in Local Parks – November 26 Comments Requested: Development and Reevaluation of Outpatient Outcome Measures for the Merit-based Incentive Payment System – November 27 HRSA Rural Health Network Development Planning Program – November 29 Bloomberg Public Health Fellows – December 1 Deadline for Critical Access Hospitals to Submit Hardship Exception – December 2 Delta States Rural Development Grant Program - December 6 SAMHSA Tribal Behavioral Health Grant Program – December 10 NIH Strategies to Reduce Disparities in Rural – December 13 HHS Request for Information: PreventionX – December 13 Partnership to Promote Local Efforts To Reduce Environmental Exposure – December 15 SAMHSA Expanding Practitioner Education for SUD – December 16 SAMHSA Grants for the Benefit of Homeless Individuals with SUD – December 16 AcademyHealth/NCHS Health Policy Fellowship – January 1 Comments Requested: Medicaid Fiscal Accountability Proposed Rule – January 17 SAMSHA Recovery Community Services Program – December 23 DOT Access and Mobility for All Pilot Program – January 6 DOJ Grants for Domestic Violence/Sexual Assault – January 8 DOJ Sexual Assault Services for Tribes – January 10 Comments Requested: Transparency in Coverage Proposed Rule – January 14 AJPH Call for Papers on Rural Public Health – January 15 Participate in Kidney Care Choices Model – January 22 Participate in Primary Care First Model Options – January 22 HRSA Primary Care Residency Training Program – January 24 EPA Environmental Justice Collaborative – February 7 HRSA/FORHP Rural Health Research Program – February 21 NIH: Research for Disparities Among Minority/Underserved Children – Cycles thru May 2020 Guaranteed Loans for Rural Rental Housing – Ongoing through 2021 USDA Emergency Community Water Assistance Grants – Ongoing Community Food Projects Technical Assistance – Ongoing SBA Guaranteed Loans for Small Business – Ongoing Drinking Water State Revolving Fund – Ongoing Seeking Nominations: National Advisory Committee on Migrant Health – Ongoing 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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