Establishing a Recovery Ecosystem to include multiple sectors and services. Addressing recovery needs and developing recovery communities. Coordinating services to help individuals in recovery navigate needed services. Expanding education skills training opportunities and recovery-friendly workplaces. Sharing effective practices to help communities assess, plan, and develop strategies that promote the recovery ecosystem. These are some of the key themes outlined in a recently released synopsis report from the six that the Appalachian Regional Commission (ARC) hosted Recovery-to-Work Listening Sessions. At each of the six sessions — held between December, 2018 – April, 2019 in Big Stone Gap, Virginia; Wilkesboro, North Carolina; Muscle Shoals, Alabama; Pineville, Kentucky; Portsmouth, Ohio; and Beckley, West Virginia — ARC leadership discussed substance abuse related workforce issues with representatives from local and state government, treatment and recovery service providers, workforce development entities, employers, law enforcement, and individuals currently in recovery.

Drawing on the Listening Session themes,  ARC’s Substance Abuse Advisory Council (SAAC) — a 24-member volunteer advisory group of leaders from law enforcement, recovery services, health, economic development, private industry, education, state government, and other sectors representing each of the Region’s 13 states — met in Washington, DC this week to continue developing recommendations to anchor ARC’s strategy to help address the workforce impacts of Appalachia’s substance abuse epidemic. The Council’s final recommendations will be formally presented to the Commission in early September. “ARC’s continued efforts to study and address the substance abuse crisis in our region are well-reflected by this report and by the continued efforts of the SAAC, which can positively impact Appalachian communities,” said ARC Federal Co-Chair Tim Thomas.  “I am very pleased with the progress of the Advisory Council, and look forward to reviewing their work alongside the rest of the Commission.”

July 17, 2019 – The Washington Post

Death rates from opioids soared in the towns, cities and counties that were saturated with billions of prescription pain pills from 2006 through 2012, according to government death data and a previously undisclosed database of opioid shipments made public this week.

The highest per capita death rates nationwide from opioids during those years were in rural communities in West Virginia, Kentucky and Virginia. In those seven years, those communities also were flooded with a disproportionate share of the 76 billion oxycodone and hydrocodone pain pills from some of the country’s largest drug companies, an analysis by The Washington Post reveals.

The national death rate from opioids was 4.6 deaths per 100,000 residents. But the counties that had the most pills distributed per person experienced more than three times that rate on average. Thirteen of those counties had an opioid death rate more than eight times the national rate, according to the government data. Seven of them were in West Virginia.

Access the entire article, including graphs and maps, here.

Licensed alcohol and drug counselors, nurses, psychologists, psychiatrists, and social workers can get continuing education credit for this five-hour e-learning course on cultural competency.  The course covers all aspects of cultural identity – including ethnicity, ability, gender identity, and socioeconomic status among others – that have an influence on the therapeutic process. The course can be accessed here.

This interactive online training is sponsored by the American Public Health Association and the U.S. Department of Health and Human services to help clinicians and public health officials understand safe and effective use of opioids to manage chronic pain.  Continuing education credits are available for the one-hour course.  The training can be accessed here.

Section 1332 of the Patient Protection and Affordable Care Act permits states to apply for State Innovation Waivers (aka Section 1332 Waivers or State Relief and Empowerment Waivers) to pursue innovative strategies for providing high value and affordable individual health insurance regardless of income, geography, age, gender, or health status.  As a follow-up to the guidance released last year, CMS has created concept papers and templates for four waiver concepts to help states develop new approaches to providing health coverage: State Specific Premium Assistance, Adjusted Plan Options, Account-Based Subsidies, and Risk Stabilization Strategies.  In 2018, rural areas had fewer insurers offering individual health insurance and higher average adjusted premiums compared to urban areas.

On July 10, 2019, CMS put on public display a proposed rule that would implement two new mandatory Medicare payment models under section 1115A of the Social Security Act—the Radiation Oncology Model (RO Model) and the End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model). The proposed RO Model is an innovative payment model designed to improve the quality of care for cancer patients receiving radiotherapy treatment and reduce provider burden by moving toward a simplified and predictable payment system. The ETC Model is one of five new payment models CMS announced last week aimed at transforming kidney care to improve access to high quality care and reducing Medicare expenditures. The rule details the proposed geographic units of section for model participation, Core Based Statistical Areas (CBSAs) for the RO Model and Hospital Referral Regions (HRRs) for the ETC Model, with implications for rural participation. The proposed rule is scheduled to be published in the Federal Register on July 18, and public comments are due 60 days after publication.  Click here for more information.

On July 11, 2019, CMS released a proposed rule that would remove the regulatory text that sets forth the current required process for states to document whether Medicaid payments in fee-for-service systems are sufficient to enlist enough providers to assure beneficiary access to covered care and services consistent with the Medicaid statute. In the proposed rule, CMS noted that states have raised concerns over the administrative burden associated with the current regulatory requirements. CMS also issued on July 11 an informational bulletin announcing the agency’s strategy to measure and monitor beneficiary access to care across Medicaid. For more information on rural Medicaid issues in general, the Rural Health Research Gateway provides a selection of policy briefs on the topic. Click here for more information.

On July 11, 2019, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Home Health Prospective Payment System (Home Health PPS). This includes routine updates to the home health payment rates for calendar year (CY) 2020 and a proposal to implement a new home infusion benefit for beneficiaries in CY 2021. The proposed rule would also increase Medicare payments to home health agencies (HHAs) by 1.3 percent ($250 million) overall, which reflects a 0.2 percent decrease in CY 2020 payments due to the rural add-on percentages mandated through CY 2022 by the Bipartisan Budget Act of 2018. Unlike previous rural add-ons, which were applied to all rural areas uniformly, the extension provided varying add-on amounts depending on the rural county (or equivalent area) classification. The average increase in payments to rural providers overall is 4.7 percent. RHIhub provides additional information on Rural Home Health Services as well as helpful FAQs. Click here for more information.

The Federal Communications Commission (FCC), under its existing Rural Health Care Program authority, is proposing a three-year, $100 million Connected Care Pilot program that would support bringing telehealth services directly to low-income patients and veterans.  It would provide an 85 percent discount on connectivity for broadband-enabled telehealth services that connect patients directly to their doctors and are used to treat a wide range of health conditions.  The Notice of Proposed Rulemaking (NPRM) adopted by the Commission seeks comment on testing the new program. In particular, the NPRM seeks comment on the appropriate budget, duration, and structure of the Pilot, along with other issues. Comments are due 30 days after publication in the Federal Register, and reply comments are due 60 days after publication in the Federal Register. For more information, visit the Center for Connected Health Policy, part of the HRSA/FORHP-supported National Telehealth Policy Research Center.  Click here to access additional information.

On July 18, 2019, the Health Resources and Services Administration (HRSA) awarded approximately $20 million for Rural Residency Planning and Development Program (RRPD) grants. Recipients across 21 states will receive up to $750,000 over a three-year period to develop new rural residency programs while achieving accreditation through the Accreditation Council for Graduate Medical Education.

“Health care in America is under increasing strain due to many factors, including workforce gaps. This is a particular problem, because heart disease, cancer, and chronic lower respiratory disease are found at higher rates among rural Americans than urban Americans, and this is contributing to an ever-growing health disparity gap that must be slowed and eventually stopped.  Rural residency grants are an effective tool that will help rural communities recruit and retain high quality healthcare providers who can improve access to healthcare and health outcomes for patients,” said U.S. Department of Health and Human Services, Deputy Secretary Eric D. Hargan.

Read the news release.