| Read this online. December 21, 2023 What's New New Information for Rural Emergency Hospitals. The Centers for Medicare & Medicaid Services (CMS) updated their fact sheet on the new provider-type designation that allows hospitals at risk of closure to remain in operation with Emergency Department services, observation care, and a limited number of outpatient services. CMS recently added details for: - Indian Health Service and other tribal-operated hospitals making the change to Rural Emergency Hospital (REH);
- Changes to monthly payment amounts to REHs and how they're reported;
- The HRSA-supported REH Technical Assistance Center that is helping hospitals meet the requirements for converting to this new provider type. See Resources of the Week below for Early Learnings from the Rural Emergency Hospital Technical Assistance Center.
A New Federal Effort for Improving Maternal Health to Begin in Spring 2024. A new model from the Centers for Medicare & Medicaid Services (CMS) will support State Medicaid Agencies through targeted funding and technical assistance. The Transforming Maternal Health (TMaH) Model was created by the CMS Innovation Center to bring a whole-person approach to pregnancy, childbirth, and postpartum care for people enrolled in Medicaid and the Children's Health Insurance Plan. Participating states will increase access to a range of maternal health providers – including midwives, doulas, and Birth Centers – and they will have their maternity care providers screen for and address pregnant women's health-related social needs including, but not limited to inadequate access to nutritious food, housing insecurity, and substance use disorder. CMS will begin accepting applications in spring 2024, from which they will select up to 15 states for cooperative agreements for a 10-year program. States are encouraged to collaborate with Rural Health Clinics, community-based organizations, and Managed Care Organizations, and there is an option to create regional partnerships in rural areas. Prepare for the application window by registering to receive email updates about the program and sending questions to TMAHModel@cms.hhs.gov. Interested rural health leaders may want to engage with their State Medicaid Agencies to encourage a focus on rural strategies as they develop TMaH plans and applications. CDC Details Downward Mortality Trend for Older Adults (Before COVID-19). The report from the Centers for Disease Control and Prevention (CDC) shows that, pre-pandemic, death rates were decreasing for both urban and rural U.S. adults aged 65 and older. Data from the CDC's National Center for Health Statistics show that, though death rates from 2009 to 2019 were higher in rural areas than urban areas for both men and women and for all race and Hispanic-origin groups, they declined 15 percent in rural areas over that time period. CDC research from 2019 showed rural Americans are more likely to die from five leading causes than people living in urban areas. The research showed that rural residents are also more likely to die of preventable deaths – with higher rates of cigarette smoking, high blood pressure and obesity, higher rates of poverty, and less access to health care and health insurance. Nationwide Health Data Exchange Now Operational. Last week, the U.S. Department of Health & Human Services announced a newly launched effort to give patients increased access to their health records and secure the exchange of electronic health information between health care providers and plans. Through its office that coordinates health information technology systems nationwide, HHS secured the services of five officially designated Qualified Health Information Networks™ (QHINs™) that can immediately begin supporting the exchange of data. This is only one phase of federal efforts toward interoperability that will be governed by the Trusted Exchange Framework and Common Agreement, known as TEFCA. While the use of various electronic exchange methods among hospitals and physicians has increased in recent years, the Government Accountability Office (GAO) recently found that use among small and rural hospitals is lower than that of other hospitals. Federal officials and other stakeholders told GAO that TEFCA could be helpful for small and rural providers because it could make the exchange of data less costly. Ongoing: Updates to Requirements for Buprenorphine Prescribing. As announced by the Substance Abuse and Mental Health Services Administration in January 2023, clinicians no longer need a federal waiver to prescribe buprenorphine for treatment of opioid use disorder. Clinicians are still required to register with the federal Drug Enforcement Agency (DEA) to prescribe controlled medications. On June 27, the DEA began to require that registration applicants – both new and renewing – affirm they have completed a new, one-time, eight-hour training. Exceptions for the new training requirement are practitioners who are board certified in addiction medicine or addiction psychiatry, and those who graduated from a medical, dental, physician assistant, or advanced practice nursing school in the U.S. within five years of June 27, 2023. Watch this 11-minute video that explains the changes. Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who trained between January 1, 2019 and December 29, 2022 (when Congress eliminated the waiver requirement). Approximately $889,000 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. COVID-19 Resources **New: COVID-19 Home Tests Available. Every home in the U.S. is again eligible to receive four (4) free at-home tests ordered at www.covid.gov. Delivery is free through the U.S. Postal Service. **New: Home Test to Treat is a new program funded by the National Institutes of Health focused on providing COVID-19 care and treatment for adults who are at greater risk of being affected by COVID-19. Adults who do not currently have COVID-19 or flu may enroll and receive free tests if they are uninsured or are enrolled in Medicare, Medicaid, the Veterans Affairs health care system, or the Indian Health Services. Individuals who are currently positive for COVID-19 can enroll to receive telehealth services for COVID-19 and treatment (if prescribed) at no cost. Enrollees may also be invited to participate in a completely optional research component of the program. Informational flyers are available in English and Spanish. HHS/DoD National Emergency Tele-Critical Care Network. A joint program of the U.S. Department of Health & Human Services (HHS) and the U.S. Department of Defense (DoD) is available at no cost to hospitals caring for COVID-19 patients. Teams of critical care clinicians - critical care physicians, nurses, respiratory therapists, and other specialized clinical experts – are available to deliver virtual care through telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians, and email to learn more and sign up. Mobilizing Health Care Workforce via Telehealth. ProviderBridge.org was created through the Coronavirus Aid, Relief, and Economic Security (CARES) Act by the Federation of State Medical Boards and HRSA's Office for the Advancement of Telehealth. The site provides up-to-date information on emergency regulation and licensing by state as well as a provider portal to connect volunteer health care professionals to state agencies and health care entities. Online Resource for Licensure of Occupational Therapists, Physical Therapists, Psychologists, and Social Workers. The site provides up-to-date information on emergency regulation and licensing in each state. Funding and Opportunities Indian Health Service Community Opioid Intervention Program – February 7. The IHS expects to make 27 awards, each up to $350,000 per year for a five-year project. The funding targets American Indian/Alaska Native communities to create a culturally appropriate response to the opioid use disorder. NOSORH Rural Health Grant Writing Institute – February 16. The National Organization of State Offices of Rural Health (NOSORH) provides a series of nine online learning sessions covering grant writing with a rural focus. The intended audience is beginners looking to gain the skills to research and draft winning proposals from various agencies. HRSA School-Administered Loans for Public Schools – February 21. HRSA's Bureau of Health Workforce provides funds for college-level public schools that offer degrees in health professions. Schools then offer loans to students who are going to school full- or part-time. There are four loan programs and schools may apply for more than one: 1) Loans for Disadvantaged Students; 2) Health Professions Student Loans, 3) Nursing Student Loans, 3) Primary Care Loans. SAMHSA FentAlert Challenge: Empowering Youth for Safe Choices – February 26. The Substance Abuse and Mental Health Services Administration (SAMHSA) created the challenge for teenagers, ages 14-18, to develop a community strategy to educate their peers about fake pills and fentanyl – an opioid drug that is up to 50 times stronger than heroin and 100 times stronger than morphine – and help prevent overdose deaths. SAMHSA will award a total of $80,000 to individuals and teams, with individual prizes up to $5000. Institute of Museum and Library Sciences Native American Library Services Basic Grants – March 1. The IMLS is an independent federal agency that libraries and museums through grants, policy development, and research. An expected 159 awards, each up to $10,000 will federally recognized Tribal governments to improve library services. According to IMLS, rural libraries provide access to reliable information for approximately 30 million people in the U.S. Other research has shown that public libraries are an essential component of health equity for rural communities, even promoting diverse representation in clinical trials that inform medical research and innovation. HRSA Primary Care Training: Physician Assistant Rural Training in Behavioral Health – March 15. Up to 12 awards will go to accredited physician assistant training programs. The goal of the program is to increase the number of physician assistants in rural areas trained to integrate behavioral health with primary care services. NIHB/CDC Strengthening Tribal Public Health Systems – March 21. The National Indian Health Board (NIHB) is supported by the Centers for Disease Control and Prevention (CDC) to provide funding and technical assistance for projects designed to build the health equity of tribes. Department of Treasury Community Development Financial Institutions – February 15. The federal government provides two types of awards to local banks and credit unions – known as Community Development Financial Institutions, or CDFIs – that provide affordable credit, capital, and financial services in low-income communities: 1) financial assistance awards may be used to provide loans, equity investments, grants, or other financial instruments; 2) technical assistance awards allow certified Community Development Financial Institutions, or entities wishing to become certified, to build their capacity. Policy Updates Send questions to ruralpolicy@hrsa.gov. New Price Transparency Tools for Hospitals. In an effort to empower decision-making for patients, the Centers for Medicare & Medicaid Services (CMS) made new requirements and provided tools for making standard charges for all items and services available to the public. Beginning January 1, 2024, institutions that are licensed as hospitals will be required to update their websites with a link labeled "Price Transparency" that goes directly to a machine-readable digital file. CMS provides resources and tools to support these new requirements and also provides details on enforcement measures for hospitals that do not comply. CMS Covering Mental Health Services for Dually-Eligible Medicare Beneficiaries. On January 1, 2024, Medicare will begin covering services provided by marriage and family therapists and mental health counselors as well as intensive outpatient program services furnished by hospital outpatient departments, community mental health centers, Rural Health Clinics, Federally Qualified Health Centers, or opioid treatment programs. In this letter to State Medicaid Agencies, the Centers for Medicare & Medicaid Services (CMS) explains that, for beneficiaries enrolled in both Medicare and Medicaid (also known as dual-eligibles), Medicare will become the primary payer when these services are delivered by Medicare-enrolled practitioners or providers. CMS anticipates that some of these providers will become Medicare-enrolled on or around January 1, 2024, but many others will not. States must pay claims from these providers if they are Medicaid-enrolled – whether or not they choose to become Medicare-enrolled providers – to the extent that the services are covered in the state plan. CMS Letter to Health Plans and Pharmacy Benefit Managers. The Centers for Medicare & Medicaid Services (CMS) details concerns about certain practices by some plans and pharmacy benefit managers (PBMs) that threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers, including those in rural areas. To address these concerns, CMS strongly encourages sponsors of Part D drug coverage and their PBMs to make necessary cash flow arrangements with network pharmacies in preparation for the new rules around prices charged at the point of sale, ensure adequate payment for and access to vaccines, and engage in sustainable and fair practices with all pharmacies, including those that are independently owned. Additionally, Medicaid Managed Care Plans and Private Insurance Plans should check their processes and systems to ensure they are providing full coverage, without cost sharing, of preventive services, as required by federal law, and they should ensure that utilization management tools, such as prior authorization, are not impeding access to needed care or delaying essential treatments. Resources for Planning Rural Training for Doctors – Wednesday, January 17 at 12:00 pm Eastern. In a one-hour session, experts will provide background information on Section 126 of the Consolidated Appropriations Act, 2021 – the federal legislation that creates positions (also known as slots) for physician residencies in underserved areas. The hospitals selected for these federally paid positions are being determined by the Centers for Medicare & Medicaid Services (CMS) in a five-year process that will distribute 200 new residency slots each year. This session hosted by the FORHP-supported program that helps hospitals plan and develop rural residencies will feature representatives from CMS to discuss the application process for Round Three, with a focus on considerations for rural hospitals interested in expanding rural residency training. Recently, researchers from FORHP's program released analysis of the 99 hospitals that were awarded slots in Round Two to determine rural location of new physician placements – whether sites were rural as defined by CMS or by FORHP – and the time they are planning to train in these locations. They found only three programs training their residents for 50 percent of the time or greater in a CMS or FORHP rurally located area. Learning Events and Technical Assistance AgriStress Response Network – Mental Health Innovations Exchange – Wednesday, January 3 at 11:00 am Eastern. The AgriSafe Network holds meetings on the first Wednesday of every month to hear from mental health and agriculture professionals. 3RNet January Training for Rural Health Care Recruiters – Tuesday, January 9 at 2:00 pm Eastern. Formerly known as the National Rural Recruitment & Retention Network, 3RNET is the national nonprofit with expertise in finding and placing clinicians in underserved areas. Each month, 3RNET holds a live training session explaining how to post jobs and find job seekers on its site. HRSA Virtual Job Fair for Health Professions – Wednesday, January 10 at 6:00 pm Eastern. HRSA's Bureau of Health Workforce holds regular online job fairs for clinicians and health care employers in underserved areas. Resources of the Week Early Learnings from Rural Emergency Hospital Technical Assistance. The FORHP-supported program that helps hospitals meet the requirements for this new CMS designation, provides new data on those that have already converted, including: operating income, net patient revenue, margins, and more. The report highlights common concerns raised by hospitals exploring REH conversion. Rural Health Care Coordination Program Directory, 2023-2027. Provides an overview of the 10 initiatives funded under the FORHP-supported Rural Health Care Coordination Program during the 2023-2027 project period. Each profile includes information on the focus areas to be addressed, project partners, and targeted populations. Learn more about what makes an effective program from the Rural Care Coordination toolkit at the Rural Health Information Hub. State Actions to Build the Behavioral Health Crisis Continuum. A toolkit from the National Academy for State Health Policy features strategies for program planning and development for state officials and agencies. Highlights models and resources for core components such as regional call centers, mobile crisis teams, and stabilization facilities, among others. It also includes crisis care principles, such as peer supports, law enforcement partnerships, and rural and frontier delivery challenges. Approaching Deadlines National Board for Certified Counselors Foundation Rural Scholarships – December 31 USDA Rural Economic Development Loan and Grant Program – December 31 Comments Requested: Disincentives for Health Care Providers that Commit Information Blocking – Comment by January 2 Comments Request: No Surprises Act Federal Independent Dispute Resolution Operations for FY 2024 – Comment by January 2 USDA Technical Assistance/Training for Rural Water and Waste Disposal Systems – January 2 AmeriCorps State and National Grants – January 4 Proposed Update: Medicare Advantage and Prescription Drug Plans – Comment by January 5 CDC Community Health Worker Services for HIV in Rural Communities – January 5 NARHC Bill Finerfrock Health Policy Fellowship – January 5 Proposed Updates: Health Insurance Marketplaces and Insurers for 2025 – Comment by January 8 NIDA Seeking Telemedicine/Remote-Based Platforms for SUD Treatment – January 8 Alzheimer's Association Supporting Research in Health Disparities, Policy, and Ethics – Letters of Intent January 9 Request for Information: Upcoming ICD-11 – Comment by January 12 Public Comments Requested: Interventions for High Body Mass Index in Children and Adolescents – Comment by January 16 NTIA Tribal Broadband Connectivity Program – January 23 Udall Foundation Native American Congressional Internship – January 24 Rural Health Network Development Planning Program – January 26 USDA Supporting Community Agriculture and Local Education Systems (Project SCALES) – January 26 HHS Environmental Justice Community Innovator Challenge, Phase 1 – January 30 EPA Small Communities, Big Challenges Competition – January 31 Frontline Indigenous Partnership Ohiyesa Premedical Program – January 31 Targeted Technical Assistance for Rural Hospitals Program – January 31 Department of Labor YouthBuild Grants – February 1 HHS Innovation Challenge: Preventing Human Trafficking/Women and Girls – February 1 CMS Enforcement of State Medicaid Renewal Requirements – Comment by February 2 EPA Training/Technical Assistance for Safe Drinking Water in Small Public Water Systems – February 2 HRSA Nurse Faculty Loan Program – February 5 HRSA Regional AIDS Education and Training Centers – February 5 RWJF Summer Health Professions Education Program – February 5 USDA Hispanic-Serving Institutions Education Grants Program – February 6 Indian Health Service Community Opioid Intervention Prevention Program – February 7 HRSA Rural Residency Planning and Development Program – February 12 Department of Treasury Community Development Financial Institutions – February 15 USDA Sustainable Community Projects for Children, Youth, and Families At-Risk – February 15 NOSORH Rural Health Grant Writing Institute – February 16 Treasury Department Native American Community Development Financial Institution Assistance Program – January 16 HHS Assistance for Tribal Self-Governance Negotiation – February 19 HRSA School-Administered Loans for Public Schools – February 21 SAMHSA Strategic Prevention Partnerships for Communities – February 21 SAMHSA Strategic Prevention Framework/Partnerships for States – February 21 HRSA Geriatric Workforce Enhancement Program – February 26 SAMHSA FentAlert Challenge: Empowering Youth for Safe Choices – February 26 USDA Produce Prescription Program – February 28 USDA Rural Business Development Grants – February 28 Institute of Museum and Library Sciences Native American Library Services Basic Grants – March 1 HRSA Primary Care Training: Physician Assistant Rural Training in Behavioral Health – March 15 CMS Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model – March 18 SAMHSA Rural Emergency Medical Services Training – March 20 NIHB/CDC Strengthening Tribal Public Health Systems – March 21 Ongoing Opportunities HRSA Needs Rural Reviewers for Grant Applications Economic Development Administration Public Works/Economic Assistance Program (CARES Act Funding) Extended Public Comment Period for FCC's COVID-19 Telehealth Program FCC Affordable Connectivity Program for Broadband Service National Indian Health Board Vaccination Event Funding – Ongoing while funds last SAMHSA 988 Suicide and Crisis Lifeline Volunteer and Job Opportunities USDA Disaster Repair Grants for Rural Community Facilities – Ongoing while funds last USDA Water Infrastructure Grants for 2022 Disaster Areas – Ongoing while funds last ACF Low Income Home Energy Assistance Program ACF Rural Community Development Program for Rural Water Systems Addiction Policy Forum: Sites for Anti-Stigma Pilot AgriSafe Mental Health Training for Agricultural Producers & Families American Association of Birth Centers (AABC) Foundation - Accreditation Grants American Heart Association Rural Health Care Outcomes Accelerator American Indian Public Health Resource Center Technical Assistance AmeriCorps American Connection Corps for Broadband in Rural Areas Appalachian Community Fund Technical Assistance Grants Appalachian Regional Commission J-1 Visa Waivers for Doctors ASA Rural Access to Anesthesia Care Scholarship CDC Direct Assistance to State, Tribal, Local, and Territorial Health Agencies CDC Training Pediatric Medical Providers to Recognize ACEs CORH Targeted Technical Assistance for Rural Hospitals Program Delta Region Community Health Systems Development Program Delta Regional Authority Community Infrastructure Fund Delta Doctors J-1 Visa Waiver Program Department of Commerce: Economic Development Assistance Programs DRA Technical Assistance for Delta Region Community Health Systems Development EPA Drinking Water State Revolving Fund EPA Water Infrastructure and Innovation Act Program FEMA/SAMHSA Post-Disaster Crisis Counseling Assistance and Training Program GSA Federal Surplus Property Available for Public Use GPHC & RWJF: Rapid Cycle Research and Evaluation Grants for Cross-Sector Alignment HRSA/SAMHSA Medications for Opioid Use Disorder Training and Mentoring HRSA Seeking Nominations for Migrant Health Advisory HRSA Technical Assistance for Look-Alike Initial Designation for the Health Center Program Housing Assistance Council: Housing Loans for Low-Income Rural Communities HUD Distressed Cities and Persistent Poverty Technical Assistance Program HUD Hospital Mortgage Insurance Program IHS Tribal Forensic Healthcare Training IHS/DOD Medical Supplies and Equipment for Tribes (Project TRANSAM) NARHC Certified Rural Health Clinic Professional Course National Health Resource Center on Domestic Violence Technical Assistance National Indian Health Board Vaccination Event Funding National Indigenous Women's Resource Center Technical Assistance for Domestic Violence Programs Native Americans into Medicine Host Sites for National Environmental Public Health Internship NIH Special Interest Research – Pandemic Impact on Vulnerable Children and Youth – May 2024 NIH Research to Improve Native American Health – October 2024 NIH Researching Mental Health Practices in Low-Resource Settings – September 2024 NIH Researching Social, Behavioral, and Economic Impact of COVID-19 in Underserved/Vulnerable Populations – September 2024 NIH Researching the Role of Work in Health Disparities – Various dates until September 2024 NIH Addressing the Impact of Structural Racism and Discrimination – Various dates until October 2025 NIH Research to Address Vaccine Hesitancy in Health Disparity Populations – June 2026 NIH Planning Grants for Native American Research Centers for Health (NARCH) – various dates until July 2026 NIH Research to Understand Disparities in Maternal Morbidity and Mortality – Various dates until October 2026 NIH Data Informed, Place-Based Community-Engaged Research to Advance Health Equity – January 2027 NIH Project Talk Initiative Host Site Applications Nominations for Federal Advisory Commission on HIV, Viral Hepatitis, and Sexually Transmitted Diseases NRHA Chief Nursing Officer Certification Program for Rural Hospitals Oweesta Native CDFI Loan Funds and Technical Assistance Primary Care Development Corporation Community Investment Loans Rural Community Assistance Corporation Community Facility Loans for Western States and Pacific Islands Rural Community Assistance Corporation Environmental Infrastructure Loans for Western States Rural Graduate Medical Education Planning and Development Rural Grocery Transition Specialist Program RTT Collaborative: Rural Training Track Directors University RWJF Investigator-Initiated Research to Build a Culture of Health RWJF Pioneering Ideas Brief Proposals SAMHSA Crisis Counseling Assistance and Training Program for Communities Post-Disaster SAMHSA Training to Provide Medication Assisted Treatment SBA Guaranteed Loans for Small Business Southeast Rural Community Assistance Loans Tribal Grant Writing Training Treasury Department Opportunity Zone Economic Development Program United South and Eastern Tribes, Inc Tribal Health Program Support USDA Community Facilities Program USDA Community Food Projects Technical Assistance USDA Drinking Water and Waste Disposal for Rural and Native Alaskan Villages USDA Economic Impact Initiative Grants USDA Emergency Community Water Assistance Grants USDA Healthy Food Financing Initiative Technical Assistance USDA Intermediary Relending Program USDA Multifamily Housing Loan Guarantees USDA National School Lunch Afterschool Snack Program USDA Rural Business Development Grants USDA Rural Business Investment Program USDA Rural Energy Savings Program USDA SEARCH – Special Evaluation Assistance for Rural Communities and Households (for Water/Waste Projects) USDA Summer Food Program USDA Technical Assistance for Healthy Food Financing Initiative USDA Telecommunications Infrastructure Loans and Loan Guarantees USDA Funding for Rural Water and Waste Disposal Projects USDA Water and Waste Disposal Grants to Alleviate Health Risks on Tribal Lands and Colonias USDOT Rural Opportunities to Use Transportation for Economic Success (R.O.U.T.E.S) Veterans Affairs Health Professional Scholarship Program Veterans Affairs Virtual Living Room - Using Technology to Address the Critical Healthcare Needs of Veterans in Rural Areas Western Region Public Health Training Center – Future Leaders Program WWAMI Area Health Education Center Scholars Program 3RNET Recruitment and Retention Assistance | 
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