With the growing COVID-19 concern brewing around us, here are some rural-relevant resources that might be helpful.Additional updates, resources and information will be added to this page as they become available…
Visit the CMS Current Emergencies landing page for Medicare and Medicaid related COVID-19 information. 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.
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.
CMS – Lessons from the Front Lines: COVID-19 every Friday, 12:30 – 2:00 PM Eastern This call series is an opportunity for CMS officials to hear directly from physicians and other clinical leaders as they share their experiences, best practices, strategies, and insights related to COVID-19. These calls are held weekly on Fridays at 12:30 PM Eastern and specific topics vary. To join the calls: Participant Dial-In: (877) 251-0301 Access Code: 8672948 Webcast Streaming
We are about preparation not panic. Please reach out to Tammy Norville (firstname.lastname@example.org), NOSORH Technical Assistance Director, with questions, for discussion or for additional assistance.
In response to the novel coronavirus (COVID-19) pandemic, NOSORH is hosting weekly listening sessions with the 50 State Offices of Rural Health to identify the challenges and opportunities that SORH are hearing from their constituents. These reports document 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.
Communications and Stakeholder Outreach
Rural Community-based Responses
Rural Health Care Infrastructure
Looking to share your rural successes, challenges or concerns? Rural stakeholders can send an email directly to HRSA at RuralCOVIDemail@example.com
NOSORH and the fifty State Offices of Rural Health congratulate and appreciate the work of the National Rural Health Association team for their great work advocating for rural providers across the nation during this public health crisis. These are tough times for all. We value NRHA’s “rural voice louder” now more than ever. Thank you Alan Morgan, Maggie Elehwany, Mason Zeagler, Max Isaacoff, and the entire NRHA team for exemplary leadership and advocacy.
The Senate returns to Washington on May 4 for the first time since late March. The House will most likely return on May 11.
Putting together and passing a CARES 2.0 will be the main priority for Congress during the spring session. The legislation will likely include additional relief for hospitals, some form of liability protection, and funding for state and local governments to respond to COVID. Congress may consider a number of rural health-related provisions in the next recovery package including: increased flexibility for telehealth, supporting increased funding for broadband access, allowing CAHs to cost settle after the COVID pandemic, and updates to the Medicare Rural Hospital Flexibility Program.
Unlike the first three stimulus bills passed by Congress, members are considering including other non-COVID health priorities like surprise billing and drug pricing (H.R. 3/S. 2543) into CARES 2.0. The timeline for Congress moving a fourth stimulus is unclear, with Republican leadership indicating they would like to see how current virus funding impacts states and regions.
HHS Begins Distribution of Payments to Rural Hospitals, Providers with Elevated COVID Admissions: On May 1, HHS announced that $10 billion will be distributed to rural acute care general hospitals and Critical Access Hospitals, Rural Health Clinics, and Community Health Centers located in rural areas. Funds will be directly deposited, rural providers need not apply. Each RHC will receive a minimum of $100,000. CAHs will each receive a minimum of $1 million with the median receiving $3.6 million. HHS released a chart detailing the rural payment amount by State. Texas, Iowa, and Minnesota appear to receive the biggest share.
HHS also announced that $10 billion will be distributed to 395 hospitals who provided inpatient care for 100 or more COVID patients through April 10, 2020. $2 billion will be distributed to certain hospitals based on their Medicare and Medicaid disproportionate share and uncompensated care payments. HHS released a chart detailing the payment amounts by State.
Appropriations Update: With Congress returning in May, House and Senate appropriators will have limited time to pass their Fiscal Year (FY) 2021 funding bills. With Congress already approving trillions of dollars in stimulus funding this year, many programs are bracing to see how the committees write their FY 21 spending bills. Some of the house appropriations subcommittees are targeting late June as a date to move their bills.
COVID-19 has not only taught us more about social distancing, testing and the FDA approval process than we ever wanted to know, it has brought us hundreds of pages of new legislation leading to new funding, new service lines and new regulatory guidance. On April 30, yet another round of “sweeping changes” to support the healthcare community were announced. There are too many nuances to delve into all of them here, but the press release and other related guidance that has been released to date can be found on the NOSORH COVID-19 Resources web page. A couple of items of note:
When delving into these new guidelines, if using sources other than the agency providing oversight, ensure they are trusted and have established credibility. Rely on the official guidance from the oversight body when possible.
With guidance coming so quickly, there are more questions than answers in some topic areas. The NOSORH website houses two pages dedicated to COVID-19:
Looking to share your rural-specific questions, concerns, models, innovations, successes and challenges? The Federal Office of Rural Health Policy is now operating an email address for the general public. Send to firstname.lastname@example.org
As the COVID-19 pandemic swept across the country, NOSORH and the Association of State and Territorial Health Officials (ASTHO) were gearing up to host the 2020 Primary Care Office (PCO) Training Academy. The Academy includes a face-to-face meeting at the ASTHO offices in Arlington, VA, followed by site visits between each paired mentee and mentor.
Originally modeled upon NOSORH’s mentoring program, the Academy has been conducted for nearly 10 years and continues to grow in popularity with new PCO staff. When the health and safety of Americans became a concern, the decision was made to move the Academy to a virtual format.
Participants in the Academy overwhelming responded to the survey with positive reviews of their experience! Of the respondents to the survey, 100% indicated that the meeting was satisfactory or highly satisfactory. Though not quite the same experience as being face-to-face, the mentor and mentee pairs were able to break out into private chat rooms to have smaller conversations. Participants indicated that 100% found the virtual meeting useful in building working relationships and that the virtual meeting format was useful. In addition to specific mentor and mentee time, introductory presentations were delivered by the following partners: the Bureau of Health Workforce’s (BHW) Shortage Designation Branch, Loan Repayment Branch, Nurse Corps Loan Repayment Branch, Division of Participant Support and Compliance, and the Division of Regional Operations.
NOSORH would like to extend our thanks to all of the mentors that shared their expertise: Amber Myers (MI), Allison Mikuni (HI), Robert Martiniano (NY), Thomas Rauner (NE), Anna Riggan (VA), Cindy Ellis (TX), and Lynn Ann Bishop (KY).This year’s Academy included mentees representing PCO offices from Alaska, U.S. Virgin Islands, Iowa, Idaho, New Jersey, Tennessee, and the District of Columbia.
For more information on NOSORH’s collaborative efforts with the Primary Care Offices, please contact Beth Kolf, Project Coordinator, at email@example.com.
by Beth Blevins
The Oregon Office of Rural Health (OORH) has created a new repository that houses state and federal telehealth policy and payment resources in response to rapidly evolving changes during the COVID-19 pandemic.
COVID-19 Telehealth Policy and Payment for Oregon Clinics and Hospitals uses ArcGIS StoryMaps, an interactive platform with sections on the CARES Act, the Oregon Disaster Relief Waiver, state and federal payment resources, and pertinent webinars and events. It went live on April 3, 2020.
“When COVID-19 started, there was a rapid fire of policy changes coming out,” said Rose Locklear, OORH Field Services Program Manager. “I wanted to create a resource to organize all the information in a way that made sense to me. And I realized that just putting them up on our website as links wasn’t going to be useful—if I couldn’t quickly find what I was looking for others would probably experience the same thing.”
Locklear said she also realized that the situation was constantly evolving, meaning that something published at the beginning of March would no longer be relevant a couple of weeks later. “So I wanted to put these resources in something that was easy to navigate and update on my end without having to go through our IT, because by the time they might update it I would need to make another change,” she said.
Locklear chose the ArcGIS StoryMaps platform because it offered her “something to throw everything into,” she said. “The story map allows you to import text, images, hyperlink to sources, and embed multimedia content. On the left side you can import text and on the right side you can put in maps, web pages, or videos. It’s not perfect, but works well to organize and house quality information, and it’s free.” (The public account of the ArcGIS platform, which she used for the story map, is free for personal, noncommercial use.)
“I’m not a data person—my background is in public health,” Locklear said, “but I enjoy visualizing data and making it easy for people to understand. In public health, in general, that’s often a challenge. We’ve got so much information—how do we organize it and display it so people can easily find it?”
Another challenge was that the CARES Act has increased the number of healthcare facilities that can provide telehealth services during the pandemic. “You’ve now got folks who never did telehealth before, who need to understand the basics about payment rules and regulations because these differ by payer,” Locklear said. “So, I had to create something that incorporated all these pieces.”
The intended audience is anyone who wants a crash course in telehealth policy or any Oregon providers impacted by the state and federal policy changes. Other State Offices of Rural Health (SORHs) are welcome to use and adapt this story map.
“There are a lot of inventive things a state could do to make it their own,” Locklear said. “There’s definitely a learning curve if you’ve never worked with ArcGIS StoryMaps. However, replicating one like this without geographical data is much easier. There are tutorials online that offer help, and I would be more than happy to answer any questions from anyone who might be interested in the project.”
The telehealth policy and payment resource is a component of ORH COVID-19 Resources for Rural Health. Other sections on that site include information on EMS, Critical Access Hospitals, Grants, Policy, and Rural Health Clinics.
After the pandemic subsides, OORH will keep using the story map as a repository for telehealth policy and information.
The South Carolina Office of Rural Health (SCORH) created its Coronavirus Resources for Rural Communities and Providers website in the early days of the state’s pandemic response to provide a clearinghouse of critical information specific to rural healthcare providers, said Bridget Winston, SCORH Director of Communications.
“We wanted to cut through the overwhelming quantity of information being disseminated, and just share what our providers needed to be able to serve their rural patients—guidance on testing, PPE, billing, etc.,” Winston said. “Once we got past the first few weeks of the crisis response, we reorganized the page to share information by topic, rather than by source, and included information relevant to both rural healthcare providers and rural social service providers.”
Topics on the page now include behavioral health, food access, employment, financial assistance for small businesses and individuals, legal resources, resources for the elderly, and resources for veterans.
When asked how the site could evolve in the future, Winston said, “I imagine we will be in response mode for months (maybe years) to come, so we will likely keep the page, although we will continue to edit and tweak the information included so that we remain relevant and useful to our rural communities.”
The Arizona SORH (AZ SORH) at the Arizona Center for Rural Health is implementing multiple COVID-19 information gathering and dissemination activities.
“We are reviewing and sharing timely resources and information related to COVID-19 and secondary emerging issues, and are working to keep our website updated,” said Jennifer Peters, AZ SORH Program Manager.
An example of this is the resource spreadsheet AZ SORH created using Google Sheets, which is being updated with Arizona-relevant information, Peters said.
“We were receiving so much information and were looking for a way to organize it for our own office and for our partners,” she said. “We are also using synchronous technology such as webinars and Zoom conferencing, and have co-hosted one virtual town hall with tribal health leadership. We expect to be doing more events like this in the coming weeks and months.”
AZ SORH also is using its website (https://crh.arizona.edu/ppe) to provide information on PPE donations.
COVID-19 Spurs Passage of Landmark Spending Bills
With the spread of COVID-19 throughout the United States, Congress passed and the President signed into law three major funding bills addressing the COVID-19 crisis. Below is a look at the three bills and a preview of what’s next for Congress.
On March 6, President Trump signed into law H.R. 6074 – The Coronavirus Preparedness and Response Appropriations bill. This bill provides $950 million to the Centers for Disease Control and Prevention for grants to states. The bill also included $100 million to HRSA under the Health Centers Program as defined by section 330 of the Public Health Service Act.
On March 18, the President signed into law H.R. 6201 – the Families First Coronavirus Response Act. This multi-billion dollar spending bill largely addressed funding Unemployment Insurance and expanding the Emergency Family Medical Leave Act.
On March 27, the President signed into law H.R. 748 – the CARES Act. The Cares Act is the most significant of the three funding measures and includes billions of dollars in federal funding and many substantive rural provisions.
Fourth Stimulus Bill on the Horizon
A fourth stimulus bill is already being worked on by House Democrats. The bill is expected to address shoring up health systems, creating protective standards for frontline healthcare workers, and boost infrastructure along with some other priorities. With Congress working remotely until at least April 21, Senate Republicans have indicated they would prefer to wait and see how CARES funding impacts the virus before committing to a fourth funding bill.