March 2020

i Mar 17th No Comments by

Tasha Brown
SORH Coordinator
Mississippi State Office of Rural Health

Favorite thing about working at a SORH: The people

What led you to a career in rural health?: I started in the office as the administrative assistant and after 6 months I was offered a job as the SORH Coordinator. I developed a passion for rural over the years of meeting people that work in rural and seeing underserved rural areas.

The SORH work that I am most proud of: Our first Mississippi Rural Health Day in the SORH helped people know we are here and learn about our office resources.

If you could learn to do anything, what would it be? I would love to learn to ski (I hate the cold weather, but I love winter clothes!)

Favorite quote: “There is no force equal to a woman determined to rise.” W.E.B. Du Bois

Last place I traveled to: St. Thomas, U.S. Virgin Islands

People would be surprised if they knew: I have a seventeen-year-old son.

What advice do you have for new NOSORH members?: Take advantage of all available resources.

What I’m currently reading: The Most Powerful Woman in the Room is You – Lydia Fenet

Best advice I ever received: Trust your work.

COVID-19 Updates

i Mar 16th No Comments by

Additional updates, resources and information will be added to this page as they become available

With the growing COVID-19 concern brewing around us, here are some rural-relevant resources that might be helpful.

CMS has updated their Current Emergencies landing page to be a one-stop shop for Medicare and Medicaid related COVID-19 information. The number and frequency of testing for the virus will increase exponentially in coming days. With that, the inevitable spike in positive results may catch some providers unaware. That being said, a big question and major concern for providers is the process of payment for services rendered.

CMS has issued several guidance announcements and “special” announcements in the last few weeks dealing with this and many other potential challenges our providers may face. All of these documents are housed on the Current Emergencies web page.

Several additional resources – from assistance with supply chain to potential payroll tax reductions – are being introduced every day. Sometimes more than once a day. Keep an eye out to pertinent information that might be relevant to providers and stakeholders in your state.

On Friday, March 13, CMS issued this press release previewing guidance found in this COVID-19 Emergency Declaration Health Care Providers Fact Sheet. Regarding Critical Access Hospitals (CAHs) the Fact Sheet states: CMS is waiving the requirements that Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours.

In addition, a press release and a Memorandum were released regarding New Measures to Protect Nursing Home Residents. Find the press release here and Memorandum Ref: QSO-20-14-NH here.

Finally, if you are contacted by providers searching for COVID-19 resources, our friends at the University of Washington have developed and shared a public UW COVID-19 Public Resource Site containing screening and testing algorithms as well as policy templates. It also provides a few other links of interest at the bottom of the page. There is a note on the page that states all of the documents living on the site may be accessed by the public. Thanks so much to our UW friends for sharing! You’ll see more examples of state-specific resources in the tips below.

What’s going on in your state? How will your office keep up with the constant influx of information?

  • Commit time and talent to the cause – This tip is at the heart of developing strategy to increase any technical capacity – especially when the topic is fluid like COVID-19. Numbers and information change rapidly.
    • Find an office champion(s). Someone to lead the charge and keep everyone focused, informed and honest. This may be the point person for incoming information referenced above.
    • Dedicate time during team “gatherings” to continuously build knowledge and skills. These team gatherings may be virtual or in some other creative form.

How will your SORH disseminate pertinent information to the team, rural providers and/or stakeholders?

  • Integrate knowledge gained throughout SORH work – how can you build this information into the everyday workflow of the office? Having a “lunch and learn” or a short mini-education session during a team meeting might be a simple way to introduce available resources, update state-specific efforts or increase SORH overall knowledge. Keeping on top of information as it is made available is imperative but might seem daunting. Stick with a few, trusted sources of information such as the CDC, WHO, your state HHS officials, etc.

We recognize rural providers may be hit hard, if trends hold. It appears those most susceptible to the virus are older, those with compromised immune systems as well as those with respiratory vulnerability (COPD, Asthma, history of smoking, etc.). Sound familiar? I would venture to say this could be the patient profile for the majority of those our rural providers serve.

How might SORH work with sister-agencies to help facilitate potential bottlenecks and/or obstacles that may impede care in rural communities?

  • Share knowledge gained at every opportunity. As a SORH, this is a given. We naturally share what we know and what we have.Items for consideration using the Power of Rural tenets:
  • Educate – Yourself and others about current status updates, resources and programs available both in your state and nationally. Refer to the CDC website and the WHO website for the most up to date information. The HRSA website Health Center Program landing page also has relative information. Although most major health insurance payers have committed to provide COVID-19 testing at no charge to beneficiaries, there may still be other costs associated with identification, diagnosis and treatment of the virus (click here for additional information). Information on coverages should be forthcoming but SORH may consider facilitating that conversation, especially with Hospitals and major payers within the state. There is also word of special considerations with Medicare Advantage Plans. At the time of this writing, details are still in flux. Once there is clarity around coverages, that information should be shared with all provider types. For global statistics, check out this web site created by Avi Schiffmann, a 17-year-old from Mercer Island (which is outside Seattle), who started the site in late December, when coronavirus was undetected outside of China. For additional information, click here for Avi’s story.
  • Communicate/Collaborate – The more you know, the more you are able to share factual information that encourages preparation and assuages panic. At every opportunity share what you know to encourage partners and stakeholders to focus on preparation without panic. Be the calm in the chaos to establish your SORH as THE trusted advisory during uncertain events.
  • Innovate – The circumstances around COVID-19 are flush with innovative opportunities. This novel virus has already resulted in CMS adding a new ICD-10 code and interim coding guidance for coding and billing. New and revised processes may become more commonplace as the virus lifespan progresses.

At the end of the day, no one expects any one person to know it all; especially in highly fluid situations, however, we do have to know how to figure it out. We have the responsibility to spread knowledge gained and encourage team members and stakeholders alike to continue learning.

We are about preparation not panic. And don’t forget to wash your hands!

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The following are resources, guidance and information by category.  Items will be added to this page as they become available.

 

Centers for Medicare and Medicaid Services (CMS):

CMS – Requesting an 1135 Waiver (Updated 11.16.2016)

1135 Waiver- At A Glance Overview

CMS – Press Release APPROVED 1135 WAIVERS BY STATE 3-23-2020

CMS – MLN SPECIAL EDITION – se20011 – 3-16-2020

Coronavirus (COVID-19) Partner Toolkit _ CMS 3-17-2020

CMS – PACE Guidance Issued Press Release Email 3-17-2020

CMS – FAQs – COVID-19 Provider Enrollment (Medicare) 3-22-2020

CMS – POST ACUTE CARE QUALITY REPORTING Relief for Clinicians Providers Hospitals & Facilities 3-23-2020

CMS – Press Release – CHECKLISTS to Help Speed States’ Access to Emergency Flexibilities & Resources 3-23-2020

 

 

Telehealth:

MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET _ CMS 3-17-2020

CMS – MLN SPECIAL EDITION – EXPAND TELEHEALTH DURING COVID-19 3-17-2020

CMS – 3.17.20 COVID 19 Telehealth Waiver FAQ Final 3-17-2020

ASTHO – Telehealth-brief 3-20-2020

CMS – Email Telehealth Toolkit for Gen Pract & ESRD Providers 3-23-2020

CMS – TOOLKIT GENERAL PROVIDER Telemedicine 3-23-2020

CMS – TOOLKIT ESRD Providers TELEMEDICINE 3-23-2020

 

Partner Resources:

SHRT PROGRAM – Revenue Cycle Crisis Management_ Corona.. 3-18-2020

CDC – Coronavirus Website

NNOHA – COVID-19 Oral Health Listening Sessions, sign-up now! 3-18-2020

HRSA – OFAM FAQa for Grant Related COVID-19 Questions 3-24-2020

 

Education:

ASP COVID-19

 

SORH Resource Web Pages:

South Carolina Office of Rural Health: https://scorh.net/2020/03/06/coronavirus-resources-for-rural-providers/

 

NOSORH and State Offices of Rural Health at the NRHA Policy Institute

i Mar 2nd No Comments by

Last month, NOSORH and 22 State Offices of Rural Health attended the National Rural Health Association’s Policy Institute in Washington, D.C. “NRHA did a great job of bringing together policymakers and rural stakeholders in a jam-packed week focused on rural health,” said Teryl Eisinger, NOSORH CEO.

During the week, NOSORH spent multiple days meeting with members and staff on Capitol Hill. With the prospect of major rural health legislation being advanced by Congress this May, NOSORH used the visits to remind Congress on the importance of rural health and advocate for continued funding for the SORH and Flex programs. It is anticipated in rural health circles that Congress could advance rural health legislation as part of a larger health package, including surprise medical billing.

A highlight of the NOSORH effort during the Institute was presentation of the NOSORH Legislator of the Year Award to Representative Kurt Schrader (OR 5th District). This award recognizes an outstanding individual federal legislator for their work and support of rural health initiatives that address national rural healthcare needs. Congressman Schrader’s district runs from the Pacific Ocean to the Cascade Mountains with 22 certified Rural Health Clinics, 6 rural hospitals, 17 rural EMS agencies and 2 tribal clinics. He is a leading member of the House Energy and Commerce subcommittee on Health and in 2018 was the lead Democrat sponsor of the State Offices of Rural Health Reauthorization bill.

The award was presented by Bob Duehmig, Deputy Director of the Oregon Office of Rural Health, during a meeting of rural Oregon constituents and members of the Oregon Office of Rural Health. “It was great to see Bob and his state team getting right to the heart of what matters in rural Oregon with Representative Schrader. Bob facilitated the discussion with each member of that state team ready with simple, meaningful input for Mr. Schrader,” said Eisinger.

Duehmig was one of the 46 state coordinators NRHA taps to help organize Hill visits during the Institute. Ten other SORH also served in this role. Thanks to the NRHA for sharing data and their great work of making our voice louder and building the momentum!

Rural Health Policy Update

i Mar 2nd No Comments by

Fiscal Year 2021 Budget Request Sent to Congress
On February 10, the Trump Administration released their Fiscal Year 2021 budget request to Congress. Similar to previous years, HHS requested Congress make significant cuts to both discretionary and mandatory programs across the board. Within the HRSA budget, both the State Offices of Rural Health (SORH) and the Medicare Rural Hospital Flexibility (Flex) grant program lines were zeroed out for FY 2021. Also from the HRSA budget, the Administration asked for an increase for Rural Health Outreach Grants by $10M. Funding for the Rural Residency program was not provided.

While the annual budget proposal provides a peek into an Administration’s priorities, it is non-binding on Congress. The budget process for Congress begins in March with over 50 appropriations committee hearings scheduled throughout the month. Congress will also deal with supplemental funding for the Coronavirus. While HHS is expected to reprogram funding from HHS, HRSA funding is not believed to be impacted.

NOSORH will work to ensure Congress continues to fund the SORH program at its statutorily authorized level of $12,500,000 million.

Rural Health-Related Bills Introduced
Rep. David McKinley (R-WV) introduced H.R. 5924.  The bill seeks to amend the Public Health Service Act to authorize a loan repayment program to encourage specialty medicine physicians to serve in rural communities experiencing a shortage of specialty medicine physicians.

Rep. Jodey Arrington (R-TX) introduced H.R. 5808 to amend Title XVIII of the Social Security Act to provide coverage of rural emergency medical access services under the Medicare program.

Rep. Brendan Boyle (D-PA) introduced H.R. 5681, the Protecting Communities from Hospital Closures Act of 2020.

Data Analysis and Visualization

i Feb 10th No Comments by

Resources

 

NOSORH Manual: Using Data to Define Rural Populations

Understanding the data points that characterize rural communities ensures State Offices of Rural Health have a solid base for providing technical assistance and targeting resources to areas of highest need.

The Using Data to Define Rural Populations manual assists SORH and other rural health stakeholders in identifying the steps to developing an initial dataset for defining rural populations in their state.

The Manual outlines the following steps:

1. Defining rural for your state
2. Identifying your questions
3. Compiling your dataset
4. Answering your questions

Links to additional resources are included to further refine skills.

 


 

NOSORH Rural Health Data Institute

The Rural Health Data Institute (RHDI) is a set of eight 90-minute web-based sessions designed to establish a minimum data-use skill set for those working with rural health data. The sessions are designed for those with little or no knowledge of the data use process.

RHDI starts by throwing the term “research” out the window and defining terms in a way that everybody can understand. It moves through the process of collecting your data, cleaning it up, and analyzing it in a way that makes sense. Later sessions help participants work through the steps of crafting their messaging and displaying it in a visualized way so other people can understand it too. By doing very small “homework” assignments aligned to the data use process, participants will end the RHDI with a one-page infographic fact sheet to do whatever they want with it: hang on the fridge in the break room or, better yet, disseminate it to your partners!

For more information on the Rural Health Data Institute, please contact Chris Salyers.

U.S. Census 2020: Engagement Opportunities for Rural Health Stakeholders

i Feb 4th No Comments by

NEW Issue Brief

We know it’s important to get those rural counts, but what can you do?

Rural healthcare providers and stakeholders play an important role in assuring a complete count of the population in rural communities during the 2020 Census. The NOSORH Program Analysis & Response Committee (PARC) developed a new issue brief for State Offices of Rural Health, rural healthcare providers and other rural health stakeholders on how they can help support ‘hard-to-count’ populations. It provides an overview of the challenges to rural Census counts/enumerations and outlines engagement opportunities.

Rural Policy Update

i Jan 31st No Comments by

Rural Health Package Being Considered by Congress

With the Senators preoccupied with impeachment hearings during January, Congressional staff continue to work on advancing health care legislation in 2020. In May, Congress will need to reauthorize or extend a number of health care programs whose funding expires on May 22, 2020.

The May 22 deadline creates a potential vehicle for Congress to pass broader health care legislation, including surprise billing, drug pricing and rural health. While optimism abounds off the Hill for a broad rural health care package, look for a narrower, more targeted package being unveiled by the Senate Finance Committee. The cost of the legislative proposal will play a factor with the more expensive bills most likely not being included.

On the House side, it remains to be seen if the Ways and Means Committee will introduce a broad bipartisan rural health bill. Members of the House Rural Health Task Force have been working on various rural health proposals with a timetable still uncertain.

With 2020 being a presidential election year, it is also unclear if both sides will work together to advance a more comprehensive health care bill to the President’s desk. The inability of Congress to advance surprise billing at the end of 2019 suggests rough waters could await politically for health care legislation in 2020.

Rural Health Bills Introduced in the Senate

In December, a broad bipartisan and bicameral rural health bill was introduced in the House and Senate. The Rural Hospital Closure Relief Act (H.R. 5481/S. 3103) seeks to allow a limited number of rural PPS hospitals to convert to Critical Access Hospitals.

The Senate bill was introduced by Senators James Lankford (R-OK) and Dick Durbin (D-IL). The bill sponsors are hoping the bill will advance as part of a broader rural health package being put together by Senate Finance Chairman Grassley. NOSORH, along with the NRHA, has endorsed this bill.

Also recently introduced was the bipartisan Improving Access to Health Care in Rural and Underserved Act. The bill, S. 3194, was sponsored by Senators Lisa Murkowski (R-AK) and Jacky Rosen (D-NV).  The bill would create a five-year pilot program that provides funding for up to 100 FQHCs and RHCs to boost capacity in specific areas of medical need.

Webinar: The Rural Health Safety Net and the 2020 Top 100 Rural Providers (1/30/2020)

i Jan 30th No Comments by

Webinar Recording

Webinar Slides

Webinar: Preparing to Engage with Legislators and Policymakers 2020 (1/16/2020)

i Jan 16th No Comments by

Webinar Recording

Webinar Slides

Webinar: Overview of FY20 State Office of Rural Health (SORH) Application Instructions (1/15/2020)

i Jan 15th No Comments by

Webinar Recordings

Webinar Slides

Webinar Resources

GRANT BUDGET OPTIONS – 2019 FINAL 12-13-2019

FY17 MN SORH NCC Current Work Plan

FY17 MN SORH NCC Future Work Plan

FY17 MN SORH NCC Narrative