July 11, 2024 What's New Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2010-2022 In the United States, access to maternity care in rural counties continues to decline. This infographic from the FORHP-funded University of Minnesota Rural Health Research Center updates their 2017 analysis on hospital-based obstetric services in rural counties, showing that rural counties with no hospital-based obstetric services increased from 54% of rural counties in 2014 to almost 59% in 2022. This updated infographic also distinguishes micropolitan and non-core rural counties, finding that rural non-core counties continue to be much less likely to have – and more likely to lose – hospital-based obstetric services than rural micropolitan counties. The research center uses a two-stage method to identify hospital-based obstetric unit status and provide more accurate information by using multiple data sources and validation checks. NIH Request for Information: Helping to End Addiction Long-term (HEAL) Initiative – Comment by July 31. The National Institutes of Health (NIH) seeks public input on how scientific research can address opioid use disorder, overdose, and chronic pain. All interested parties – including members of the scientific community, the private sector, community-based organizations, health professionals, professional societies, advocacy groups, patient communities, people with living/lived experience, caregivers, funding agencies and other interested members of the public – should submit questions and responses to HEALquestion@od.nih.gov with "HEAL RFI" in the subject line. Analysis by FORHP's data team of CDC's WONDER data shows that the rural overdose rate is increasing faster than urban areas. FEMA and HHS Announce Resources for Extreme Heat. The Federal Emergency Management Agency (FEMA)joins the U.S. Department of Health and Human Services (HHS) with tips for staying safe, federal programs to assist with home energy bills, and a guide for clinicians to prepare for and respond to heat emergencies. ERS Updates Charts on Food Assistance and Nutrition Plans. The Economic Research Service (ERS) at the U.S. Department of Agriculture (USDA) provides information on food assistance, including the Supplemental Nutrition Program for Women, Infants, and Children (WIC), that account for roughly two-thirds of USDA's budget. This year, USDA announced a new program that provides money for groceries for school-aged kids during the summer. While the program is not available in some areas, USDA has a SUN Meals To-Go Site Finder specific to rural places in most states. CDC Update on Avian Flu – Tuesday, July 16 at 2:00 pm Eastern. Through its Clinician Outreach and Communication Activity Group, the Centers for Disease Control and Prevention (CDC) will give updates on highly pathogenic A (H5N1) virus, also known as avian flu. On the hour-long call, speakers will provide clinicians with information on testing, using antivirals, and infection prevention and control recommendations. Continuing Education credits are available. The CDC continues to provide written guidance and updates on their H5N1 Bird Flu website. Ongoing: 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, 2023, 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 $756,842 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 Learn About Long COVID & Fatiguing Illness – Thursday, July 11 at 3:00 pm Eastern. The Centers for Disease Control and Prevention funds this monthly webinar-style ECHO learning session to rapidly disseminate findings about Post-COVID Conditions (PCC) and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). The series offers presentations by subject matter experts, examples of emerging best practices and models of care, and a facilitated Q&A. This program is intended primarily for providers who care for patients with PCC and ME/CFS but is open to all healthcare professionals and all Long COVID and ME/CFS patient-lived experience experts interested in learning more about the treatment of Long COVID and ME/CFS. 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. Funding and Opportunities USDA Native Community Development Financial Institution Relending Demonstration Program – August 9. For this demonstration project, the U.S. Department of Agriculture (USDA) will provide funds to Native Community Development Financial Institutions, which are organizations certified by the U.S. Treasury to provide access to loans and other financial services in low-income communities. USDA Rural Business Cooperative Service – Delta Health Care Service Grants – August 12. The U.S. Department of Agriculture (USDA) provides financial assistance to address unmet health needs in the 252 counties and parishes served by the federal Delta Regional Authority. To apply, eligible organizations – including research/academic institutions of higher learning and economic development entities – must form a consortium and be located within the Delta region. USDA Rural Utilities Service Broadband Technical Assistance – August 20. The U.S. Department of Agriculture (USDA) provides financial assistance through cooperative agreements to eligible entities to receive or deliver broadband technical assistance and training. Eligible applicants include federally recognized Tribes and tribal entities, state and local governments, nonprofit organizations, and institutions of higher learning. Policy Updates Send questions to ruralpolicy@hrsa.gov. Proposed Updates to Medicare Outpatient Payments for Calendar Year 2025 – Comment by September 9. This proposed rule from the Centers for Medicare & Medicaid Services (CMS) seeks public comment on payment updates and policy changes to Medicare's hospital outpatient prospective payment system (OPPS), ambulatory surgical care center payment system, and other proposals affecting Medicare and Medicaid beneficiaries. For calendar year 2025, CMS proposes a 2.6 percent payment increase for outpatient services provided by hospitals that meet quality reporting requirements. There are also proposals to update payments for Intensive Outpatient Program services provided in outpatient departments and community mental health centers, to implement temporary additional payments for certain non-opioid treatments for pain relief, to make an additional payment to the all-inclusive rate for certain high-cost drugs for beneficiaries receiving care at Indian Health Service or tribal hospitals, and to update measures in the outpatient and rural emergency hospital (REH) quality reporting programs. This rule also includes proposals that go beyond outpatient services, including revisions to the Medicare special enrollment period for formerly incarcerated individuals, additions to Medicaid and Children's Health Insurance Program continuous eligibility requirements, and amendments to the Medicaid clinic services regulation that allows federal reimbursement for services furnished outside the "four walls" of a freestanding clinic by IHS/Tribal clinics as well as a request for comment on whether this policy should be extended to clinics in rural areas. Additional proposals and requests for information that rural stakeholders may want to provide feedback on include: - Conditions of Participation (CoPs) for Obstetric Services - CMS is proposing new baseline requirements for maternal health regarding organization, staffing, training, maternal health-focused quality assessment and performance improvement, and delivery of obstetrical services in hospitals and Critical Access Hospitals. The intent is to ensure that all Medicare and Medicaid participating hospitals and CAHs offering these services are held to a consistent standard of high-quality maternity care that protects the health and safety of patients. CMS is also proposing revisions to the emergency services CoP for hospitals and CAHs to improve facility readiness in caring for emergency services patients, including pregnant, birthing, and postpartum women. Lastly, CMS is proposing revisions to the Discharge Planning CoP for all hospitals and CAHs related to transfer protocols. Lastly, CMS requests public comments on whether these proposed requirements should also apply to REHs.
- Request for Information Regarding the Safety of Care Measures in the Overall Hospital Quality Star Ratings - The Overall Hospital Quality Star Rating provides a summary of hospital quality measure results reported through CMS' hospital quality measurement programs by assigning hospitals between one and five stars. CMS is considering modifying the methodology for determining the number of stars a hospital gets by putting more emphasis on the Safety of Care measures as part of the national commitment to improve patient safety. They present multiple options for the public to comment on.
CMS Announces a New Model for Dementia Care. On July 1, the Centers for Medicare & Medicaid Services (CMS) launched the Guiding and Improved Dementia Experience (GUIDE) Model, to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities. Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key support services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Under the model, people with dementia and their caregivers will have access to a care navigator who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations. FORHP-funded research has found that, compared to metropolitan counties, a higher percentage of nursing home residents in noncore counties had dementia or Alzheimer's disease (48.2 percent vs. 42.9 percent). CMS Announces Proposed Changes to Medicare Home Health Program – Comments due August 26. On June 26, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2025 Home Health Prospective Payment System (HH PPS) proposed rule, which proposes updates to the Medicare payment policies and rates for home health agencies (HHAs). This rule proposes changes to the Home Health Quality Reporting Program (HH QRP) requirements; provides an update on potential approaches for integrating health equity in the Expanded Home Health Value-Based Purchasing (HHVBP) Model; proposes a new standard for acceptance to service policy in the home health conditions of participation (CoPs) and proposes updates to provider and supplier enrollment requirements. The proposed rule also includes requests for information seeking input on permitting rehabilitative therapists to conduct the initial and comprehensive assessment and the factors that may influence the patient referral and intake processes. Payment Updates in CY 2025 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule. Comments Due August 26. On June 27, 2024, the Centers for Medicare & Medicaid Services (CMS) proposed changes in the latest rule making for the Calendar Year 202 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). Policies in this proposed rule may impact the estimated 24,000 rural Americans living with ESRD and the 22 percent of rural Americans who receive dialysis. This proposed rule updates the ESRD base payment with CMS estimated payment of $7.2 billion to approximately 7,700 ESRD facilities for furnishing renal dialysis services. CMS projects the updates would increase the total payments to all ESRD facilities by 2.2 percent compared with CY 2024. For hospital-based ESRD facilities, CMS projects an increase in total payments of 3.9 percent, and for freestanding facilities, CMS projects an increase in total payments of 2.1 percent. The rule also proposes an update to the wage index to reflect the latest core-based statistical area delineations, determined by the Office of Management and Budget. The rule expresses the change is to better account for differing wage levels in areas in which ESRD facilities are located. This rule also proposes updated requirements for the Conditions for Coverage for ESRD facilities, the ESRD Quality Incentive Program, and the ESRD Treatment Choices Model. The proposed policies presented in the rule, if finalized, will be effective January 1, 2025. HHS Finalizes Section 1557 Nondiscrimination Rule – Impacts for RHCs – Monday, July 15 at 2:00 pm Eastern. The National Association of Rural Health Clinics (NARHC) will host the free, FORHP-supported webinar, with information on the Department of Health and Human Services (HHS) Office of Civil Rights and the Centers for Medicare & Medicaid Services final rule under Section 1557 of the Affordable Care Act Nondiscrimination in Health Programs and Activities and the RHC impacts, including: - Requirement to post a notice of nondiscrimination.
- Requirements to post notice of availability of translation and auxiliary aid services in top 15 foreign languages.
- Requirement to establish and train employees on policies and procedures related to nondiscrimination.
Additional time for Q&A will be provided. Advanced registration is required. ACO PC Flex Model Office Hour – Tuesday, July 16 at 2:00 pm Eastern. In this hour-long session, the Centers for Medicare and Medicaid Innovation will provide an overview of the new ACO Primary Care Flex Model (ACO PC Flex Model), which will focus on primary care delivery in the Medicare Shared Savings Program (SSP). CMS has released a Request for Applications and the application portal is open until August 1 for new or renewing ACOs who submitted an application to SSP by June 17, 2024. CMS plans to announce applicants selected to participate in October 2024. This model seeks to increase accountable care relationships for people with Medicare, especially those in rural and underserved communities. Learning Events and Technical Assistance A Practical Guide to Landlord/Tenant Issues in Recovery Housing – Thursday, July 11 at 2:00 pm Eastern. The Fletcher Group is one of three FORHP-supported Rural Centers of Excellence on substance use disorder prevention, treatment and recovery. This open-access presentation will cover best practices for recovery home owners and operators. Register for the National Telehealth Conference – Tuesday, July 16 at 9:30 am Eastern. Join HRSA's Office for the Advancement of Telehealth for an online conference featuring health care professionals, policymakers, and industry stakeholders from around the country. Among topics for sessions during the all-day event: licensing across state lines for behavioral health professionals, and ensuring access to telehealth for low-income individuals. If you would like to receive announcements from the Office for the Advancement of Telehealth, you can sign up here. 3RNET's July Website Training for Employers – Wednesday, July 17 at 2:00 pm Eastern. Formerly known as the National Rural Recruitment & Retention Network, 3RNET is holding a live training session explaining how to post jobs and find job seekers on its site. Resources of the Week Rural Road Safety Awareness Week. This year, the National Center for Rural Road Safety calls attention to the issue July 15-19. Recently, the U.S. Department of Transportation released a guide for proven safety countermeasures in rural communities. Connecting Care: The Maine eConsult Pilot Program. This YouTube video describes the pilot, during which primary care providers were able to securely share patient information with specialists through Electronic Consultations (eConsults) extending care for rural patients through telehealth. The pilot was a direct result of a Rural Health Planning Grant through HRSA's Office for the Advancement of Telehealth. Approaching Deadlines CMS Seeks Feedback on Two Agency Information Collection Activities – Comment by July 11 First Nation's Development Institute – Native Agriculture and Food Systems College Scholarship Program – July 11 CMS Rural Hackathon Interest Survey – July 12 Call for nominations for a CMS Maternal Health Technical Expert Panel – Submit by July 12 CMS Increasing Organ Transplant Model – Comment by July 16 IHS Addressing Dementia in Indian Country: Enhancing Sustainable Models of Care – July 16 ACF Community Economic Development Project – July 17 HUD Supportive Housing for the Elderly Program – July 18 Telehealth Resource Centers: Telehealth Implementation Bootcamp – July 18 Call for Rural Health Papers - CDC's Preventing Chronic Disease Journal – July 19 DoD announces Removal of Certain Temporary Regulation Changes Made in Response to COVID-19 for TRICARE – Comment by July 23 DHS 2024 Regional Catastrophic Preparedness Grants – July 25 HRSA Nurse, Education, Practice, Quality and Retention – Workforce Expansion Program – July 26 HRSA Rural Hospital Stabilization Pilot Program – July 26 CMS Proposed Rule on Anomalous DME Spending and MSSP Financial Calculations – Comment by July 29 DOJ Meeting the Basic Needs of Underserved Crime Victims – July 29 DOJ National Sexual Assault Kit Initiative – July 29 Medicare ACO Primary Care Flex Model Request for Applications – August 1 HRSA Delta Region Maternal Care Coordination Program – August 2 HRSA Technology-Enabled Collaborative Learning Program – August 2 Foundation for Opioid Response Efforts (FORE) Opioid Crisis Innovation Challenge – August 8 DHS Funding One Entity for Rural Emergency Medical Communications Demonstration Project – August 9 USDA Native Community Development Financial Institution Relending Demonstration Program – August 9 National Medical Fellowships – Health Equity Leaders Program for Underrepresented Professionals – August 12 USDA Rural Business Cooperative Service – Delta Health Care Service Grants – August 12 NIH Advancing HIV Service Delivery Through Pharmacies and Pharmacists – August 13 HRSA New Access Points for Health Center Program – August 15 HRSA Rural Healthcare Provider Transition Project – August 15 DOL Mine Health and Safety Grants – August 20 USDA Broadband Technical Assistance Program – August 20 NIH Health Care Models for Persons with Multiple Chronic Conditions from Populations that Experience Health Disparities: Advancing Health Care towards Health Equity – September 7 NIH Notice of Special Interest: Telehealth Strategies for Individuals with HIV and Substance Use Disorders – September 7 CMS Innovation in Behavioral Health Model – September 9 Proposed Updates to Medicare Outpatient Payments for Calendar Year 2025 – Comment by September 9 CMS Transforming Maternal Health Model – September 20 AHRQ TeamSTEPPS®: No Cost Training for Patient Safety – Sessions through November 2024 EPA Environmental and Climate Justice Community Change Grants – November 21 Ongoing Opportunities HRSA Needs Rural Reviewers for Grant Applications Medicaid and CHIP Renewal and Transition Resources for Partners Extended Public Comment Period for FCC's COVID-19 Telehealth Program 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 Communities USDA Emergency Community Water Assistance Grants 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 Association of American Indian Physicians Tribal Grant Writing Training ASA Rural Access to Anesthesia Care Scholarship California Department of Health Care Access – Small and Rural Hospital Relief Program 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) Licensure Portability: the Multi-Discipline Licensure Resource Project NARHC Certified Rural Health Clinic Professional Course National Health Resource Center on Domestic Violence Technical Assistance National Indian Health Board Tribal Environmental Justice Technical Assistance Center National Indian Health Board Tribal Environmental Impact Network Call for Technical Assistance Providers 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 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 Researching Firearm Injury and Mortality Prevention – February 2026 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/UVA Seeking Rural Individuals to Participate in Weight Loss Study (iREACH) – until 2027 NIH Project Talk Initiative Host Site Applications NOSORH Rural Primary Care Institute Nominations for Federal Advisory Commission on HIV, Viral Hepatitis, and Sexually Transmitted Diseases NRHA Chief Nursing Officer Certification Program for Rural Hospitals Opportunity Finance Network/Partners for the Common Good – Economic Justice Partnership Fund 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 Treasury Department Opportunity Zone Economic Development Program United South and Eastern Tribes, Inc Tribal Health Program Support USDA Circuit Rider Program – Technical Assistance for Rural Water Systems 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/NRHA Rural Hospital Technical Assistance 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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