The Membership Organization of State Offices of Rural Health
RHIhub is excited to be co-hosting a Twitter chat with NOSORH for National Rural Health Day on Access to Healthcare in Rural Communities on November 15, 2018 at 12 pm Eastern. Please join us on Twitter for this important discussion. Also, watch RHIhub’s social media feeds for our countdown to National Rural Health Day, featuring successful rural programs around the country.
What’s New on RHIhub?
The RHIhub updated its topic guide on Rural Health Clinics (RHCs), which provides an overview of RHCs and includes information on certification, considerations for becoming an RHC, staffing requirements, reimbursement, resources related to maintaining the primary care workforce, and more.
Two new articles have been published in the Rural Monitor:
RHIhub recently held two webinars. If you missed them, check out the recordings online:
New in Models and Innovations:
RHIhub is hiring!
Please help spread the word that the RHIhub is looking for a dedicated and passionate person who wants to help rural communities across the country. Interested candidates can apply online by November 9, 2018 to join a team of Web Writers contributing to the Rural Monitor and Models and Innovations.
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 Group – The Aging in Rural Group held its October meeting at the NOSORH Annual Meeting in Cheyenne, Wyoming. The group was fortunate to have two experts on hand to provide perspective and introduce the group to innovative programs. Dr. Kathy Black, Principal Investigator, Age-Friendly Sarasota, and faculty at University of South Florida Sarasota-Manatee, presented a plenary session on Rural Health Alignment with Age – Friendly Communities before joining the group discussion. She shared a vast array of resources and tools available for use in aging work. Shelly Jackson, OVC Visiting Fellow, Elder Justice Initiative, US Department of Justice, spoke to the group at length regarding the Rural and Tribal Elder Justice Initiative and associated resources. The group will continue to follow the work of these two highly regarded experts and will provide any relevant information and/or resources in coming months. If you have interest in joining the Aging in Rural group, please email Tammy Norville at tammyn@nosorh.org.
Development Committee – The Development Committee’s discussion centered around sponsorship status and potential growth of sponsorship opportunities moving forward. If you have interest in joining the Development Committee, please forward contact information to Tammy Norville (tammyn@nosorh.org).
Flex Committee –Harvey Licht, Varela Consulting joined the Flex Committee to share information regarding the CMS Star Rating Program for Hospitals proposed rules. Harvey is working with the PPMT Committee to formulate NOSORH comments on these proposed rules and having him join the Flex call provided members an opportunity to ask questions and provide “boots on the ground” input for consideration. There was also continued discussion around the desire for access to quality, affordable, easily accessible education for Board Members as well as potential topics for the coming year. Generally, the Flex Committee does not meet in November nor December. However, the Flex Guidance is scheduled for release in December, so there will be a call on Thursday, December 27 at 3 PM ET to discuss the Guidance. If you have interest in joining the Flex Committee, please forward contact information to Tammy Norville (tammyn@nosorh.org).
Executive Committee– Last month, the Executive Committee reviewed recommendations from the Governance and Structure task force, prepared for the NOSORH membership meeting and planned the appointment and election of Regional Reps to the 2019 Board of Directors.
Communications- The Communications Committee continued making plans for National Rural Health Day, including webinar topics and presenters. The group discussed the option of printing hardcover copies of the Community Stars e-book for the first time.
Policy Program Monitoring Team- Last month, the PPMT worked to finalize comments on rural ACO. At the Annual Meeting, Harvey Licht shared information on tracking state coverage initiatives and led a discussion on the increasingly important role of states on ensuring access. Analysis of these initiatives and several links for tracking these initiatives were included in the presentation. The work of the PPMT in November will include reviewing appropriate measures and recommends for hospital star ratings, and tracking efforts on global payment systems.
The Policy Committee invites all State Rural Health Associations to join the monthly meeting of the NOSORH Policy Committee. Updates will be provided on federal regulatory issues, efforts to reauthorize the SORH program and other policy issues.
SORH Reauthorization Bill Update
While the House and Senate were out of session for most of October, the House version of the State Office of Rural Health Reauthorization bill (H.R. 5641) continued to gain momentum picking up three new cosponsors. In addition to gaining House Energy and Commerce member Morgan Griffith (VA), Reps. Steve Russell (OK) and Elise Stefanik (NY) also signed on a cosponsor. NOSORH met with the Energy and Commerce Committee this fall and believes it is likely the SORH reauthorization bill advances next time the committee addresses public health legislation. The Senate has already passed the reauthorization bill. If there is a House member of the Energy and Commerce Committee in your state, please contact their staff and urge them to cosponsor H.R. 5641.
President Signs Opioid Reform into Law
On October 3, 2018, the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” or short hand—the SUPPORT for Patients and Communities Act (the “SUPPORT Act”)—was approved by the Senate and sent to the President. The President has now signed the SUPPORT Act into law. The SUPPORT Act is the compromise version of the opioid response bills approved by the House and Senate earlier this year.
The bill package includes a broad array of new programs and reforms specific to the opioid crisis and substance use disorders (SUDs) generally advocated by the healthcare industry. The final compromise opioid package contains over 70 opioid-related bills. For a comprehensive summary of the package’s provisions, see the section-by-section summary at: https://tinyurl.com/y9vlrsmy. Some of the key issues addressed in the SUPPORT Act are:
by Beth Blevins
People in Arizona communities are becoming more aware of their health insurance options through Project SHARE (Students Helping Arizona Register Everyone).
Project SHARE, run by the Arizona Center for Rural Health (AzCRH), trains University of Arizona health sciences students as Certified Application Counselors (CACs) that provide information on enrollment through the Affordable Care Act (ACA) marketplace. Alyssa Padilla, who supervises the SHARE program for the Arizona State Office of Rural Health (AzSORH) under the AzCRH, said that the program helps not just the patients but also the students, who become more rural and health insurance literate.
Second-year UA College of Medicine – Phoenix student and SHARE leader, Jaymus Ryan Lee
“SHARE gives the students a better understanding of social support services and how to connect individuals with those services,” Padilla said. Through SHARE, the students earn volunteer credits that allow them to graduate with distinction. But, more importantly, Padilla said, graduates of the program “are better equipped to answer patients’ questions about coverage on the spot.” To become a SHARE participant, students take five to 10 hours of online federal training in addition to in-person session training, Padilla said.
When surveyed afterwards, participants have said the program has given them a better understanding of the ACA, health insurance premiums and deductibles, and the value of expanding Medicaid in Arizona, Padilla said.
Lauren Dominick said she has already benefited from the program. Dominick, an MD candidate and Project SHARE leader for the UA-College of Medicine–Phoenix, joined last year hoping to develop the skills that will help her better serve current and future patients. “I have gained so much knowledge of how the marketplace works and how to navigate it,” Dominick said. “I’ve helped patients complete their ACA applications and seen the empowerment they experience as they take better control of their health care. The program opens up their opportunities to seek preventative health care rather than just when they have an acute, major issue.”
Unfortunately, Dominick said, as a medical student she has seen many patients with very advanced diseases who were unable to access care earlier. “This is heartbreaking, especially when their condition could have been prevented or effectively managed if they had had access to health care.” Dominick added, “Helping sign people up for insurance makes me feel like I am making a difference and hopefully having a positive impact on their health even before I see them in the clinic or the hospital.”
Kendra Marr, SHARE leader, presents on the SHARE project
Kendra Marr, an MD/PhD student at the UA College of Medicine-Tucson and Tucson SHARE leader, said that another benefit she has found with SHARE is the “wealth of opportunities for collaboration with other clubs and services within the College of Medicine,” including the Commitment to Underserved People (CUP) health clinics. Marr has been working with the free, student-run CUP clinics to form a partnership so that SHARE can refer patients to them and vice versa, and has been holding her SHARE enrollment office hours at the clinics.
Project SHARE has benefited the university as well. “The University of Arizona is a White House Healthy Campus because of Project SHARE and UA Campus Health’s efforts to improve access to health insurance coverage,” Padilla said.
Right now, Project SHARE offers in-person, outreach, education, and one-on-one enrollment services in Pima County and in-person outreach services in Maricopa County, Padilla said. The CACs also can volunteer to staff the Cover Arizona phone number, where they answer insurance questions and schedule appointments for patients across the state.
Typically, 15 to 25 students work for SHARE each year, Padilla said. So far, 90 students from the UA Colleges of Medicine, Nursing, Public Health, and Pharmacy have gone through the SHARE program since its inception in 2015.
In her role with the AzSORH, Padilla oversees the licensing, recruitment, training, and mentoring of the SHARE participants. Most of the funding for the program comes from SORH grants, Padilla said, with small additional amounts of funding from UA College of Medicine CUP, which pays for things like food for the students during their trainings.
Padilla said she hopes other SORHs will consider replicating Project SHARE. The AzSORH has created templates on the processes involved and how-to directions, which Padilla will provide to any interested SORHs. Meanwhile, Padilla said that AzCRH is planning to extend the reach of SHARE to remote areas of her state through partnerships with Critical Access Hospitals and rural faith-based communities.
Since the ACA has been in effect, Padilla said, the uninsured rate in Arizona has been cut in half (to 10 to 11 percent), similar to the national average. “It’s important to note that we have a conservative Republican governor, and we have expanded Medicaid,” she said. “Our hospitals are no longer in the red because we have patients that are now insured due to Medicaid expansion and the ACA.”
“Medicaid expansion has really helped our bottom line,” Padilla concluded. “State Offices of Rural Health support that effort and that message ‑ it can do wonders for our rural and underserved communities.”
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Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Ashley Muninger to set up a short email or phone interview in which you can tell your story.
Congratulations to the 2018 NOSORH Award recipients! Awardees were honored at a ceremony during the NOSORH Annual Meeting in Cheyenne, Wyoming. A special thank you to the NOSORH Awards Committee, co-chaired by Margaret Brockman (NE) and Cathleen McElligott (MA)! We appreciate all who took the time to nominate a deserving colleague!
Emerging Leader Award:
Kirby Lecy, Massachusetts Office of Rural Health
“Kirby has become an emerging leader in NOSORH in the few short years that she has been with the Massachusetts Office of Rural Health. Facilitating partnerships, creating opportunities for collaboration, and dynamic problem-solving and planning are a few of the strengths that she has successfully brought to her role in the SORH. She is an active member of NOSORH’s Communications and Educational Exchange Committees. Her ideas are strategic and innovative, while always incorporating the big picture. She also has provided assistance to other states in her region and is always eager to share thoughts and opinions.”
The James D. Bernstein Mentoring Award:
Ernie Scott, Kentucky Office of Rural Health
“Ernie’s office door is always open. (And, he’s very often standing at our doorways as well!) He’s always willing to answer questions and provide guidance. If he’s been there, he’ll tell you about his experiences. If he knows someone who can help, he’ll share a contact. If he’s got questions for you, he’ll ask as well. On top of all of that, he is one of the few bosses – if not the only boss –who, at the end of the workday, thanks us, individually, for the work that we do. That is unheard of in the typical workplace. But, its effect is nothing short of magical: It provides ownership and investment to each of us – we feel that we are part of a solid team that is doing good work for the rural communities of Kentucky.”
Values Recognition Award
Michelle Rathman, Impact! Communications, Inc.
“Michelle’s boundless energy, creativity, and innovation has led her team to deliver beautiful, professional images and messages that have made National Rural Health Day a national campaign. This work helped National Rural Health Day earn NRHA’s Outstanding Rural Health Program award as well as national respect and visibility. She has a great understanding and appreciation of the work of State Offices of Rural Health and NOSORH and is a true rural health advocate.”
The Distinguished Andrew W. Nichols Rural Health Advocate Award and the Legislator of the Year Award will be announced later this year.
NOSORH and its members would like to thank the Wyoming State Office of Rural Health for hosting the 2018 Annual Meeting this past month in Cheyenne. To the volunteers, planning committee members, facilitators and scribes for the roundtable sessions, and to the NOSORH members who presented in the breakout sessions, thank you! Teryl Eisinger, NOSORH executive director, opened the meeting by demonstrating the importance of volunteerism and how it is key to the work of NOSORH, a message that resonated throughout the meeting.
Member feedback is always of great value to evaluate the success of the Annual Meeting. It guides the planning committee in the future as well as helps the NOSORH staff ensure they deliver a high quality and meaningful conference each year. The evaluations show that 91% of respondents rated the meeting as excellent. One member stated, “I really gained some great information from the main sessions and breakouts. There were excellent opportunities for networking and making friends, too!” Another said, “I needed the session on making the most of National Rural Health Day because I really needed to know what our office should be doing and how to get things done. This helped me tremendously.”
The lineup of sessions and networking opportunities was excellent, with more sessions offered than ever. “We appreciate the extra effort everyone made to get to Cheyenne,” said Eisinger. “I learn so much from listening to all of our partners and members at this meeting. The planning committee and Matt Strycker did a great job.”
As always, a big thank you to the sponsors and exhibitors for your support of the work of NOSORH and State Offices of Rural Health across the country. Special thanks to NOSORH Platinum Sponsor, Stroudwater and Associates, and Gold Sponsors, Hall Render and The Compliance Team!
Stroudwater provides outstanding operational consulting services to our rural health partners and stakeholders.
Hall Render advocates tirelessly on the behalf of NOSORH, SORH and the rural work we do every day
The Compliance Team provides outstanding services to rural health providers on regulatory compliance and have recently been awarded recognition as PCMH surveyors with a focus on rural providers!
The 2019 Annual Meeting will be held in Albuquerque, New Mexico! All of the presentations have been uploaded to the NOSORH website here.
NOSORH, all 50 State Offices of Rural Health, their partners, sponsors, and community stakeholders are gearing up to celebrate the Power of Rural on November 15, 2018! It’s not too late to get involved with National Rural Health Day (NRHD) activities! Visit the PowerofRural.org website for the latest news and events happening throughout the country.
Here are some fun, easy ways to be part of the Power of Rural movement this month:
Join an Event
More events are being scheduled daily! Check the PowerofRural.org website for the latest updates.
Download Free NRHD Toolkits
The 2018 NRHD Engagement Toolkit is an easy-to-use online toolkit with resources designed for community stakeholders, including hospitals, clinics, first responders, and others who serve the health needs of rural communities. It includes logos, display advertising, social media, public service announcement and media release templates, and much more!
Are you a State Office of Rural Health? The NRHD Starter Toolkit for SORH contains comprehensive toolkits as well as promotional items, such as posters, social media posts, and postcards that support this year’s NRHD efforts.
Showcase the #PowerofRural on Social Media
Follow NOSORH on Facebook and Twitter and help make the #PowerofRural trend by liking, sharing, and retweeting posts! Be sure to use the #PowerofRural in every post and encourage others to do the same.
Click here for free NRHD social media graphics.
Click here to put a National Rural Health Day frame on your Facebook Profile Pic!
“Walk with a Doc” on 11.15.18
Invite rural hospitals, health clinics, etc. in your state to host a free Walk with a Doc community walk on NRHD. Walk with a Doc is a fun and easy way to engage communities in better health and celebrate the Power of Rural. Click here to learn how to host a walk.
Take the Pledge to Partner
Take the Pledge at PowerofRural.org and commit to four specific calls to action: Innovate, Educate, Collaborate & Communicate!
Visit www.powerofrural.org for more ideas! Contact Ashley Muninger, NOSORH Communications & Development Coordinator, for more information.
SORH Reauthorization Bill Update
The House and Senate returned to Washington in September for their final legislative work period before the 2018 mid-term elections. With the Senate having already passed the State Office of Rural Health (SORH) Reauthorization bill, the focus shifted to the House. The House bill, H.R. 5641, picked up a critical cosponsor with Rep. Morgan Griffith (R-VA) agreeing to sign-on. Griffith is a member of the House Energy and Commerce Health Subcommittee which has primary jurisdiction over SORH legislation.
NOSORH met with the Energy and Commerce Committee during September and believes there is a good chance the Committee advances the SORH reauthorization bill the next time the committee addresses public health legislation.
SORH Funding Remains Unchanged
On September 13, the House and Senate conferees approved the conference report for the FY 2019 DoD and Labor-HHS spending bill (H.R. 6157). Five days later, the Senate passed the conference report by a 93-7 vote . On September 26, the House easily passed the conference report thus sending the FY 19 spending bill to the President which he is expected to sign.
The SORH number for FY 19 came in at $10,000,000 which is the same number as FY 18. When the House originally passed the FY 19 Labor-HHS bill, the funding was $11,000,000 for SORH. The Senate passed version was at $10,000,000. Conferees went with the Senate number.
Other rural health related items included in the conference report were Medicare Rural Hospital Flexibility grants which were funded at $53,609,000. This is a four million dollar increase over FY 18. Small Rural Hospital Improvement Grant Program was funded at $19,942,000 for FY 19. This is also a four million dollar increase over FY 18.
Lisa Davis (far right) speaks on a panel at a Rural Summit held by Senate Democrats.
NOSORH Speaks Before U.S. Senate
On September 27, Lisa Davis, Director of the Pennsylvania Office of Rural Health, spoke before the U.S. Senate Democratic Steering and Outreach Committee at their annual Rural Summit. The Summit was kicked off by Senate Democratic Leader Chuck Schumer (D-NY) and featured Senators and participants from across the county addressing issues facing rural America.
Lisa Davis spoke on a panel addressing health care issues in rural America. The panel was led by Senators Bob Casey (D-PA) and Tina Smith (D-MN) and moderated by Sen. Jeanne Shaheen (D-NH) and Heidi Heitkamp (D-ND). Senators Smith and Heitkamp were original cosponsors on the SORH Reauthorization bill. Davis thanked the Senate for passing the State Offices of Rural Health Reauthorization Act of 2018 and spoke passionately about the challenges facing rural health.
The RHIhub is hosting a webinar with the National Center for Health Statistics (NCHS) on October 11 at 1:00 pm Central. Rural Insights on Adult and Youth Obesity, a National and Community-based Perspective is the second in this series of webinars exploring rural/urban differences in health issues. Featured speakers include:
A webinar was recently hosted with the Centers for Disease Control and Prevention (CDC) on Closing the Gap between Urban and Rural HPV Vaccination Rates. The recording and transcript are available online.
Two new stories are available in the Rural Monitor:
There are also several new Models and Innovations:
Finally, two Topic Guides have been updated:
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.
Board – During the September meeting, the Board heard plans of the Committee/Governance task force to assess Board expertise and to consider the Board Source recommended practices for non-profit Boards. These assessments will support the efforts to consider Board structure of the future. The Flex Committee Co-Chairs asked the Board to approve recommendations to update the Flex program for the future. The Board approved a budget for 2018-19 fiscal year and new policies on procurement, human trafficking and limited English proficiency.
Educational Exchange- The EE Committee met in September to discuss topics for future educational resources, review the results of the annual member survey, and receive an update on the SORH Proficiencies. On September 18th, co-chairs Natalie Claiborne (MT) and Alisa Druzba (NH) presented a webinar on completing the SORH Proficiencies self-assessment. The committee would like to thank Natalie and Alisa for their great work and encourage all SORH to complete the self-assessment. The Committee will host the next NOSORH 101 on Tuesday, October 2nd. Due to the NOSORH annual meeting, the committee will not meet in October. The next regular meeting of the committee will be Monday, November 19th at 3:00pm ET.
Executive Committee – The September meeting of the Committee included preparation for the NOSORH annual membership meeting, discussion of moving forward the strategic planning for 2018-19, and a brief on possible changes to personnel policies.
Flex Committee– The Flex Committee discussed what each program is doing with their new awards. Projects range from billing and coding workshops, to charge master reviews, to leadership education to revenue cycle management. The committee had a lengthy discussion about the need for board education and how Flex Programs are currently addressing the needs. The Flex Committee is scheduled to meet again on October 25 at 3 PM ET. Please contact Tammy (tammyn@nosorh.org) if you would like to join the Flex Committee and/or if you have potential agenda items.
Finance Committee – Policies for the investment of NOSORH reserve funds were considered by the Finance Committee during its September meeting. The committee will work with Edward Jones to identify NOSORH priorities for investment. The committee reviewed a proposed annual budget in preparation for recommendation to the Board. Thanks to Shannon Chambers (SC) who joined the Finance Committee this month after reading the request in the Branch newsletter in September.
JCREC- Considering some new input, the JCREC is postponing the release of the Stroke Center Designation position letter. The JCREC is also looking closely at pending legislation, especially with the upcoming elections. The committee is also in the process of reviewing an EMS Tactical Plan for the future. Plans are to release the report later this year.
Communications- The Communications Committee continued preparing for National Rural Health Day 2018. Committee members provided input on the NRHD breakout sessions at the NOSORH Annual Meeting and are currently creating video clips to promote NRHD Toolkit resources.
Policy Program Monitoring Team- The PPMT committee met in September to discuss the first draft of NOSORH comments on the proposed ACO regulations. Comments were filed with CMS on the physician fee schedule last month. The committee also explored issues related to the CMS Hospital Star system, the final NQF report, and were provided an update on state Medicaid litigation. The PPMT committee will meet again on Wednesday, October 24th at 3:00pm ET.