The Membership Organization of State Offices of Rural Health
In response to the novel coronavirus (COVID19) pandemic, NOSORH hosted a series of listening sessions with the 50 State Offices of Rural Health. Three calls were held during the week of March 16, 2020 to identify the challenges and opportunities that SORH are hearing from their constituents. This report documents the resulting identified rural challenges and concerns, innovative rural strategies, opportunities for collaboration, needed rural resources, and identified areas of concern or suggestions for SORH-managed federal programs.
Rural Health Concerns Opportunities and Strategies for COVID19
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?
How will your SORH disseminate pertinent information to the team, rural providers and/or stakeholders?
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?
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
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
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:
SORH Resource Web Pages:
South Carolina Office of Rural Health: https://scorh.net/2020/03/06/coronavirus-resources-for-rural-providers/
National Rural Health Day continues to be successful because of support from our members and partners. NOSORH is proud of the reach and impact this program has year after year as we work to bring new programs, ideas, events, and opportunities to celebrate the #PowerofRural – 2019 was no exception!
Below you’ll find a new fact sheet that highlights the impact of National Rural Health Day 2019 at the local, state and national level. Check it out!
National Rural Health Day Impact Fact Sheet
Mark your calendar for Thursday, November 20, and stay tuned for the roll out of resources for the 2020 National Rural Health Day and Power of Rural campaign!
Thank you for all you do to transform this moment into a movement!
NOSORH is excited to announce that registration is now open for the 2020 Rural Health Data Institute (RHDI)! Designed to establish a minimum data-use skill set for rural health stakeholders, RHDI is a weekly series of eight, 90-minute webinars held Tuesdays from May 12 -June 30.
Participation in the RHDI is available to all rural health stakeholders that could benefit from advancing their data-use skills. Former participants have included State Offices of Rural Health, state governmental agencies, academic institutions, community coalitions and more. The curriculum for RHDI is designed for those with limited, or no, knowledge of the data use process, and will not cover advanced topics (i.e., rural suppression strategies, etc.).
by Beth Blevins
“Come to supper!” is the invitation extended recently by the Virginia State Office of Rural Health (VA SORH). As a result, folks across rural Virginia have gathered to eat barbecue and discuss what is going on in their communities.
“We figure that people relax when they are eating, and that the conversation will flow a little freer than it would if someone is standing up in front of the room and asking questions,” said Heather Anderson, VA SORH Director.
The community suppers, based on the World Cafe method, sprang out of the SORH’s efforts to update the Virginia Rural Health Plan (VRHP), Anderson said. “We know what the data says, but we don’t know what is working in a community necessarily,” she said. “We wanted to hear from people we don’t always hear from—and who typically don’t get to hear from one another.”
“We already have access to people in the healthcare system since we work with hospitals and providers,” she continued. This time, she said, they wanted to hear from school district personnel, mental health professionals, business owners, and patients.
“We are trying to get beyond our typical healthcare sphere to make this a community-driven project,” she said. “We want to spark community involvement, collaborate where we are needed, and ultimately empower the communities to improve their health status.”
The suppers have been held “in places that reduce barriers,” Anderson said. “We don’t want it to be at the hospital necessarily but at the VFW or the library or a church, if that’s where the community gathers.”
They use local food, served by a community group, as a way of giving back to the community. “Since the first meetings have been held in Southwest Virginia, the local food has been barbecue,” she said. “Maybe by the time we get to Accomack (on the Eastern Shore) it will be seafood!”
Locations of Community Suppers throughout West Virginia.
The counties where the suppers are held (seen in purple on the state map, right) were chosen by using several data points, including Appalachian Regional Commission’s distressed county index, the Robert Wood Johnson Foundation’s County Health Rankings, and the Virginia Health Opportunity Index (HOI). “We felt like that gave us a state, national, and regional look at Virginia,” she explained.
Then they took the data, ranked the areas where they knew they wanted to go, and asked themselves, “where are we missing?” and “how can we engage the small business owner on Main Street and get their perspective?” Anderson said. “As the SORH, we want to learn what is working for the community, the hidden gems, not just what isn’t working, which is what the traditional data looks at. That’s how we could include a place like Amelia County, which is in the shadows of Richmond, but is still very rural. There are areas that get overlooked because they may not meet the federal definition of rural, but we consider them rural.”
As community members gather for supper, they are given the same three questions to discuss among themselves at each table: “Name one to two things that will improve the health of your community; what are the good things about your community; and what is wellness and what does it look like here,” Anderson said. “At the end we bring it all together with a local facilitator. The expectation is that we want to hear local things we might not have heard before.”
The community suppers so far have had an average of 30 people in the room, with a total of 120 participants. The conversations are being funded with Flex carry-forward funds, with SORH funds likely picking up some of the sustainability going forward, such as printing resource documents to distribute.
Anderson said that one thing they have learned already from the suppers is how faith communities are filling in service gaps in rural Virginia. “In Wythe County, we learned there’s a very strong food bank that’s been around for 20 some years that has blossomed into clothing and social services for people,” she said. “I don’t know that we would have found that out if we hadn’t had the opportunity to have these conversations.”
VA SORH is gathering so much information from the suppers that they will be using it beyond the creation of the VRHP, by sharing information about best practices and community champions in the areas they have visited, Anderson said. “Our SORH will take the qualitative information and promote a champion, either a person or an agency, on a monthly basis on our website,” she said.
“We’re hearing really wonderful things about the communities,” Anderson said. “We know they are lacking transportation, there’s an opioid epidemic, there aren’t enough providers. But we don’t always know what is working well—we are trying to get that out of these conversations. We’re trying to get people in the room that need to talk to each other. Sometimes we make things too complicated, and miss the boat by not talking to people.”
NEW Issue Brief
We know it’s important to get those rural counts, but what can you do?
While working with State Offices of Rural Health (SORH), NOSORH discovered an unmet need for more in-depth technical assistance (TA) to build SORH capacity as well as provide an extension of the SORH to rural providers. This led to the development of the Tiered Technical Assistance Program– a set of innovative services, TA strategies, and resources to help SORH engage rural primary care providers.
The fundamental focus of NOSORH’s work is to maximize the capacity of SORH. This new program is planned to bridge, supplement, strengthen and grow existing SORH efforts, partnerships and resources, at the request of the SORH. It is not meant to replace currently offered TA or compete with other TA providers or established relationships. This service set is designed to provide support services for unmet need(s) to SORH and the communities they serve while strengthening the SORH TA infrastructure. The program has been informed by the work of the leaders and partners of NOSORH’s Primary Care Committee (formerly known as the Rural Health Clinic Committee).
All TA services are provided and/or coordinated by Tammy Norville, NOSORH Technical Assistance Director. Tammy maintains Registered Medical Manager, Registered Medical Biller, Registered Medical Coder, Certified Professional Coder, and Certified Professional Coder – Instructor certifications. Tammy directly served rural communities during her almost 15-year tenure at the North Carolina SORH. The cornerstone of her experience is operational efficiency in various healthcare settings, allowing flexibility and innovative approaches to project management and challenge resolution.
For more information or to register for the program, please contact Tammy Norville (tammyn@nosorh.org).
by Beth Blevins
Funding from HRSA’s Rural Communities Opioid Response Program (RCORP) program has helped several State Offices of Rural Health (SORHs) recently start—or strengthen—their work related to substance use disorder and opioid use disorder (S/OUD). Those who receive the RCORP Planning grant have a year to create or strengthen a consortium focused on SUD/OUD. (HRSA currently offers an RCORP Implementation grant that some SORH have received as well.)
The new “SORH Response to the SUD Crisis” issue brief provides a scan of what SORH are doing to engage in the recent substance use disorder (SUD) and opioid use disorder (OUD) initiatives in their state.
For example, the South Carolina Office of Rural Health (SCORH) had never focused on S/OUD activities prior to receiving the RCORP Planning grant, according to Lindsey Kilgo, SCORH Director of Network Development. For them the grant was “about how we can understand what’s going on in the state,” Kilgo said. “There’s been a lot of information gathering, a lot of consortium and office conversations, a lot of convening and bringing folks together.”
Forging Stronger Partnerships
While creating their consortium, the Virginia SORH (VA SORH) discovered new partners. “There are additional people at the table who might not have been there because of the consortium,” said Heather Anderson, VA SORH Director. “We added to the conversation and got community health centers and other folks that maybe weren’t involved before. We have stronger partnerships in the region.”
Anderson continued, “Because of our experience with the planning grant, another agency was willing to run with the implementation grant. So we said, ‘Go for it. You’re local, you know all the people. We will support you any way we can, give you technical assistance, and help you convene people.’”
For the Michigan Center for Rural Health (MCRH), the planning grant “has allowed us to really bring everybody to the table and wrap our arms around the importance of the challenges in those counties we are working in,” said Crystal Barter, MCRH Director of Performance Improvement. “I think everyone has really bought into it, whereas before everyone was working in their own silo. And now we are working as a consortium and starting to leverage the resources each organization has.”
Hanneke Van Dyke, former SORH Coordinator at the Texas SORH, also talked about the importance of community outreach. “It was important to use relationships we already had and having an openness to expanding relationships to new project areas,” Van Dyke said. “In both of our (RCORP) project areas, community advisory councils—made up of community members and community leaders who are there for every step of the process—have been central. Making sure we built in a few back routes tied back to the community was very important for us.”
No Prior Expertise Needed
When asked what skills are needed for SORHs to engage with S/OUD work, Kilgo replied, “Having the determination to make things better and to make change—and then not being afraid to ask questions, in an effort to build knowledge, partnerships, and relationships.” Kilgo added, “For folks who work in this particular realm, it requires a level of passion and commitment. And when you have that shared passion and commitment, the relationship and trust come fairly easily. We all have a common vision and common theme. We’re moving forward together in a positive manner.”
The ability to seek out experts was also key for Van Dyke. “None of us on staff had worked on an S/OUD issues or had any particular training or experience with it,” she said. “As project coordinator, I’ve taken it on to educate myself through reading and talking with experts. I’m not an expert but I’m pretty comfortable now, knowing who to go to to get the right information.”
Although the North Dakota Center for Rural Health (NDCRH) has been involved with S/OUD activities for the state for a few years, they had no broad expertise in their office when they started their RCORP work, said Lynette Dickson, NDCRH Director. “Our knowledge has grown and continues to grow,” Dickson said.
“Even if you are not an expert in the field you can still have an impact in this arena,” Dickson explained. “Because what we (SORHs) do is convene people, and reach out and find the resources. You can have more confidence that you can have an active role in this—you can convene and connect like we do with anything else.”
For more information, see the new NOSORH Issue Brief, SORH Response to the National Substance Use Crisis. A full spectrum of NOSORH resources to address rural SUD/OUD are available in the Rural Opioids Educational Resources library on the NOSORH website.
In the past few years it has become evident how much Rural Health Clinics (RHCs) want advice on strategy, finance, operations and regulations. To address that need, Lilypad, one of NOSORH’s strategic partners and developer of the POND tool, has developed an approach to get that information out to the RHCs in a way that is simple, quick and focused.
These 30-minute, monthly webinars will be hosted by Lilypad and other subject matter experts in partnership with NOSORH — and they are available at no cost to the participating organization. The webinar series was developed specifically for RHC practice managers and providers with topics focusing on financial and operational improvement strategies.
Check out the POND Webinar flyer outlining FREE 30-minute webinars happening every month over the next year presented by rural-focused industry experts! Click on the link beside the topic you would like to attend to reach registration for each session.
NOSORH is excited to announce the relaunch of the NOSORH Mentoring Program and the newly designed Peer-Driven Resources webpage! The Mentoring Program builds upon the mentoring philosophy of Jim Bernstein, providing an opportunity for SORH Directors and equivalents to be paired with veteran SORH Directors or equivalents. The Mentoring Program requires that the Mentor and Mentee meet via phone at least two hours per month and is expected to last about 6 months. Mentees are also required to participate in a “NOSORH 101” webinar and attend the FORHP New SORH Orientation at FORHP offices. The Educational Exchange Scholarship may also be used in conjunction with the Mentoring Program to support a site visit between the Mentor and Mentee as pairs see fit.
With this launch, the NOSORH webpage for the Educational Exchange scholarships has been moved to a single Peer-Driven Resources page. This new comprehensive webpage features information on the Jim Bernstein mentoring philosophy, along with documents, applications and resources for the Mentoring and Educational Exchange scholarship programs. These guides and resources help ensure the mentoring experience is beneficial for all parties involved. If you’re looking for other opportunities for professional development, be sure to check out the Rural Health Leadership Institute and the SORH Proficiencies framework.
For more information or with questions, contact Chris Salyers, Education and Services Director, at chris.salyers@nosorh.org.