TruServe Roundtable Session (5/15/2019)

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Webinar Recording

RHIhub Spotlight

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RHIhub has published two new Rural Monitor stories highlighting the great things that are happening in rural communities across the nation:

  • Making Informed Decisions about Rural EMS – Discusses the EMS Informed Self-Determination Process developed by Kevin McGinnis and highlights the success of St. George, Maine, had in implementing the process. RHIhub learned about this process at a Joint Committee on Rural Emergency Care (JCREC) meeting.
  • Rising from the Ashes: How Trauma-Informed Care Nurtures Healing in Rural America – Features rural communities and healthcare organizations that are a using trauma-informed care approach to help people who have experienced adverse childhood experiences (ACES), sexual assault, and other traumatic experiences.

RHIhub has published several new Models & Innovations:

Three topic guides have been updated:

Save the date for an upcoming webinar on the soon to be released Rural Telehealth Toolkit! Wednesday June 5, 2019 at 12pm Central

Did you know? If you’re hosting a rural health event, you can request promotional materials from RHIhub!

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Committee Clips

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NOSORH committees are great focal points for engaging in many NOSORH initiatives.  Descriptions of all committees and contact information can be found on the NOSORH website.

Aging in Rural- The Aging in Rural Group would like to take this opportunity to thank Scott Ekblad for his vision, passion and facilitation of this Learning Community. His organic facilitation vision provided fertile ground for topics of group interest to grow and relationships to develop. As you may know, Scott retired from the Oregon State Office at the end of April with plans to move to Southern California! We wish Scott well in his next adventure! During the April meeting, the group learned about the Washington SORH Palliative Care work. Pat Justis shared history, details and resources related to this work. The group also briefly discussed the 2019 Prevention Week Planning Guide & Resource Calendar, the Get Connected Linking Older Adults with Resources on Medication, Alcohol, and Mental Health 2017 EDITION, Promoting Older Adult Health – Aging Network Partnerships to Address Medication, Alcohol and Mental Health Problems, and A Day In the Life of Older Adults – Substance Use Facts all from SAMHSA. The next Aging Group meeting is scheduled for July 16 at 3 PM ET.

Communications-The Communications Committee met to provide input on the new theme of the 2019 Partnership Invitation and the Power of Rural – “Plug into the Power of Rural”, the Community Stars book and possible presentation ideas for the NOSORH Annual Meeting. The May meeting has been moved to May 14 at 1:00 pm ET.

Executive Committee – The NOSORH officers met last month to discuss the policy for the Chief Executive Officer performance review, provide direction for future meetings of the Board, moving forward the efforts on the strategic plan and the Power of Rural campaign.

Educational ExchangeThe EE Committee met to review two documents, the SORH Proficiencies Benchmarking Report and the Mentoring program outline, and discuss how the work of the committee may shift to support the new NOSORH strategic plan. Members were asked to provide feedback to NOSORH staff which will be compiled into the final draft. The next meeting of the EE committee will be May 20th at 3:00 pm ET to further discuss future updates to the committee and review the first draft of the workforce proficiency and SORH impact rubrics.

PPMT- The PPMT committee met in April to begin discussing data points to add to the SORH Profiles. Updates were provided on Medicaid work requirements, Association health plans, AHA’s comments on the Hospital Star Rating system and ACA Insurer notice of benefits and payment final ruling. The next meeting will be May 22nd at 3:00 pm ET.

RHC Committee –The RHC Committee is reviewing questions for the RHC Technical Assistance Survey which will be distributed to all SORH mid-summer. The information gathered through this survey helps frame the work of the committee. Another resource that is coming soon is the revised RHC Education Module #1 – An Introduction to the Rural Health Clinic Program. All SORH will receive the revised module link via email, in Roots and another shout out in the Branch. The Committee heard from our NARHC Partner, Nathan Baugh, about the RHC Modernization Act legislation introduced a few weeks ago. Nathan is working toward having a strong advocate champion for this legislation in every state. If you have a contact (Hospital CEO, RHC individual, etc.) that might represent the work of RHCs in your state, please reach out to Nathan directly via email (

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Policy Update

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The following update was provided by Hall Render, NOSORH Policy Liaison:

FY 20 Spending Bills Introduced in Congress
On April 29, the House Labor-HHS Appropriations Subcommittee introduced their fiscal year (FY) 2020 spending bill. The bill provides $12,500,000 for the State Offices of Rural Health, a $2.5 million increase over FY 2019 funding. Also included in the spending bill is $59 million for Medicare Rural Hospital Flexibility Grants and $19,942,000 for the Small Rural Hospital Implementation Grant Program. The House subcommittee meets on April 30 to advance the spending bill to the full House Appropriations Committee.  The Senate Labor-HHS subcommittee is expected to introduce their spending bill in May. Funding for FY 2020 begins on October 1, 2019.

CMS Proposes Changes to How Rural Hospitals Are Paid
On April 23, CMS issued its proposed hospital inpatient payment update for fiscal year 2020. In particular, CMS proposed changing the formula to reimburse rural hospitals. The proposal changes how it calculates the Medicare wage index to limit the disparity between what high-and-low-wage index hospitals get paid. If implemented, the rule would increase the wage index for hospitals below the 25th percentile, and decrease the wage index for hospitals above the 75th percentile. The proposal would be in effect for at least four years starting this October. Decreases in a hospital’s wage index would be capped at five percent for FY 2020.  The Medicare wage index has long been a source of frustration for Congress. The deadline for submitting comments on the proposed rule is June 24, 2019.

House Committee Advances Legislation to Bolster ACA
During the first week of April, the House Energy and Commerce Committee advanced six measures intended to bolster the ACA. The measures include more funding for state-based ACA marketplaces, federal navigator programs and a reinsurance bill intending to lower ACA premiums (H.R. 1385, H.R. 1386, H.R. 1425).

The three other measures passed are focused on Trump administration policies aimed at changing the ACA: H.R. 1010 reverses the administration’s expansion of short-term health plans; H.R. 986 requires the administration to rescind guidance that made it easier for plans to soften protections for pre-existing conditions; and H.R. 987 that would restore ACA outreach and enrollment funding.

This legislation was advanced hours after the House passed a resolution condemning the Trump administration’s decision to support a federal court case in Texas that repeals the ACA. In a 240 to 186 vote, the House passed a resolution calling on the Justice Department to “halt its new advocacy for abolishing the Affordable Care Act,” which the measure calls ‘an unacceptable assault’ on Americans’ health care. The resolution is largely symbolic, as the Republican-led Senate will not advance the measure.

Rural Health Bills Introduced this Month
Sen. Shelley Moore Capito (R-WV) introduced S. 1190 to amend Title XVIII of the Social Security Act to provide for payments for certain rural health clinic and federally qualified health center services furnished to hospice patients under the Medicare program. The bill would remove a statutory barrier in current law that inhibits seniors’ access to hospice in rural communities, allowing them to receive hospice from their local primary care practitioner. The bill seeks to allow RHCs and FQHCs to receive payment for practitioners’ services while caring for their patients in hospice care.

Sen. Todd Young (R-IN) introduced S. 1045 to amend the Public Health Service Act to expand the authority of the HHS Secretary to permit nurses to practice in health care facilities with critical shortages of nurses through programs for loan repayment and scholarships for nurses.

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Regional Meeting Sessions to be Recorded

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The Regional Meeting season starts next month! The 2019 meetings will feature more diverse topics and structured one-on-one time with the SORHs, creating a great environment to share ideas, seek help, promote success, and most importantly, learn from each other. All five regions will hold either a pre or post meeting on various topics, and one session at each regional meeting will be recorded. The recordings will then be made available for listening as part of the meeting resources. Sharing these sessions is just one more way to provide value to SORH by communicating ideas and information across the regions. As final agendas are being prepared, please click here for up to date information about each meeting.

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2019 Primary Care Office Training Academy Kicks Off

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Last month, representatives from 12 primary care offices (PCOs) attended the PCO Training Academy and Mentoring Kickoff meeting. The meeting, planned by NOSORH and the Association of State and Territorial Health Officials (ASTHO), was held at the ASTHO offices in Crystal City, VA.

The training academy brings together six selected mentors and six mentees as they undertake a formal mentoring experience. The kickoff meeting is the initial step in the mentoring experience where mentees are provided an orientation to the role of a PCO from the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce. In addition, mentees learn about the PCO National Committee, traditional primary care access points, the evolution of primary care, and engage in a number of peer-led discussions leveraging the expertise of the mentors.

This year’s mentees come from the states of AR, DE, GA, ID, MS and VT. Experienced PCO staff from the states of CO, NE, NH, NY, TN and VA have been gracious with assisting their peers through mentoring. The PCO mentoring program is supported by NOSORH as a subcontract under ASTHO’s NOSLO Cooperative Agreement with HRSA. In addition to supporting the mentoring program, NOSORH also provides logistical support to the PCO National Committee and assists with the development of ASTHO resources for primary care and rural health issues.

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5th Annual National Rural EMS & Care Conference a Success

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The National Rural EMS & Care Conference, hosted by the South Carolina Office of Rural Health and the South Carolina Office of EMS, was a resounding success in Charleston! The conference brought together EMS providers, state EMS directors, State Offices of Rural Health and so many more. It is no small feat to pull off a successful national conference, and it wouldn’t have happened without a dedicated conference planning committee, a passion for the work, and the coordination of a small army of people. NOSORH, the JCREC, and the planning committee would like to thank all the volunteers, the host state, and all the people that made this year’s conference one of the best yet.

Kevin McGinnis, NASEMSO, reviews the draft Tactical Plan for Rural EMS with conference participants.

One of the attendees noted, “This meeting has benefited the state trauma program because it brings together not only EMS, trauma professionals, but also the rural health partners. The relationship between the partners is occasionally overlooked and this venue not only increases awareness, but helps to establish a foundation. This annual meeting may also help to educate and secure the relationships between ORH and EMS/Trauma/other time critical emergencies as the health department leadership can easily make the connection between the various rural health programs and their impacts on each other. Rural healthcare is often overlooked and this meeting increases awareness of the rural patient’s health disparities.”

Another said, “This was a great meeting for networking and discussion. The format and variety of sessions was great, and the speakers were all phenomenal – true leaders in rural EMS and excellent at providing quality education to attendees.”

For all the presentations from the conference, including information on a Tactical Plan for the Future of EMS, please click here. Also, be on the lookout for 2020 conference plans!

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CMS Moves Forward with New Arrangements for Medicare Providers

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Last week, CMS released information on a set of five new voluntary Accountable Care arrangements for Medicare PPS providers. Fact sheets and descriptions of each of the programs are provided on the CMS website. In a conference speech, CMS Administrator Seema Verma outlined the new program and noted thatLooking forward, you can expect that some of the models we have under development will be mandatory. One reason for mandatory models is that selection effects can be significant in voluntary models.  Selection effects happen when only the providers who would benefit financially from a model choose to participate, thereby reducing the amount of savings that the model can generate. Requiring participation also helps us understand the impact of our models on a variety of provider types, so the data resulting from the model will be more broadly representative.”

The arrangements are broken into two categories termed Primary Care First and Direct Contracting. The Primary Care First models can be implemented with as few as 125 Medicare patients. Note that the models may be limited to selected regions of the country. The Direct Contracting models are more varied, but may also have applicability in rural health systems. Both sets of arrangements are planned for the future, with many of the details still to come. Participants will be selected for a development year – 2020 – with implementation of the model in 2021.

Harvey Licht of Varela Consulting shared some insight with NOSORH leaders stating that “The primary care focus of this arrangement makes it particularly applicable to rural health systems. The two alternative Primary Care First arrangements may have wide applicability. Basically, the approach is to make a global primary care payment per patient and then to provide additional bonuses based upon specific cost and health quality outcomes. There is also a risk-bearing component, placing providers at some level of financial risk for failure to achieve outcomes. The financial risks appear to be more limited than the current risk-bearing ACO arrangements.”

The NOSORH staff, committees and partners are planning resources and education for State Offices of Rural Health and their stakeholders. The NOSORH Policy and Program Monitoring Team meeting on May 22nd at 3 PM eastern will provide a discussion forum for SORH.

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Register Soon for the SORH Leadership Institute!

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State Offices are invited to register for the brand-new Learning to Lead: The Jim Bernstein SORH Leadership Institute! This 12-part, online Institute provides rural-focused professional development for State Office of Rural Health (SORH) staff in current and future leadership positions. Registration is filling up quickly, so be sure to register by Friday, May 10, to reserve your spot!

Check out the Leadership Institute Flyer and Leadership Institute webpage for additional information, including session descriptions, registration information, and pricing.

Don’t miss this unique development opportunity to enhance your ability to provide influential leadership and management within your State Office (and earn a Rural Health Leadership certificate)! Please contact Tammy Norville for more information.

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RHIhub Spotlight

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The RHIhub recently published a new program model in our Models and Innovations. The School-based Drug Misuse Prevention Program was implemented in an Appalachian Ohio school system, grades K-12. Following implementation, the community experienced no new school-aged overdose deaths.

We’ve also recently updated several of our Topic Guides:

Speaking of grants, we’ve also updated the section of our website where we provide assistance in using our funding resources and services. This includes guidance on finding opportunities, determining a location’s rural eligibility, and finding data, research, and resources to support program development and grant applications.

We also have two new articles in the Rural Monitor:

In case you missed it, we have archived versions of recent webinars and a recent Twitter chat:

Did you know?

In addition to RHIhub Models and Innovations, we also feature a wide range of case studies from other organizations. Check them out!  

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