- Celebrating National Rural Health Day
- DEA, HHS: Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications
- Talking Rural Health Care with U of M
- Public Inspection: DEA, HHS: Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications
- CDC Presents a Five-Year Plan for Rural Healthcare
- Kansas Faith Leaders 'Well Positioned' To Help Fill Mental Health Care Gaps in Rural Areas
- The CDC Wants More Kansas Farm Workers to Get Their Flu Shots This Season
- Study: Rural Residents More Likely to Struggle With Medical Debt
- Deaths From Cardiovascular Disease Increased Among Younger U.S Adults in Rural Areas
- VA Proposes to Eliminate Copays for Telehealth, Expand Access to Telehealth for Rural Veterans
- In Rural Avery County, Helene Washed Away One of the Only Dental Clinics
- Rural Veterans Are Struggling with Access to VA-Provided Care
- Community Health Workers Spread Across the US, Even in Rural Areas
- Idaho Gained Nurses. But Not Enough To Deal with Retirements and Population Boom.
- CMS Announces New Policies to Reduce Maternal Mortality, Increase Access to Care, and Advance Health Equity
Medical Journal Highlights HRSA Initiatives in Maternal Health
HRSA staff contributed to a recently published special supplement to the Annals of Internal Medicine journal, to focus on evidence-based approaches to reduce maternal mortality and morbidity rates in the United States. Experts at HRSA contributed to the journal articles, which address specific HRSA maternal health initiatives, the impact of opioid use during pregnancy and issues faced by rural populations. External authors include partners from the University of Chicago, Stanford University, University of North Carolina at Chapel Hill, the University of Utah and the World Health Organization.
New Study on Factors that Influence Children’s Healthy Development
The ability of 3- to 5-year-olds to practice self-control is an important developmental milestone predictive of later success. Dr. Reem Ghandour, an epidemiologist with HRSA’s Maternal and Child Health Bureau, collaborated with researchers at the CDC to examine the risks and protective factors that influence this aspect of a child’s development.
The newly published study, Factors Associated with Self-regulation in a Nationally Representative Sample of Children Ages 3–5 Years: United States, 2016, compared the qualities of parents who identify their preschoolers as “on track” to those “not on track” with this developmental skill. Children described as “on track” more often lived in financially and socially advantaged environments and less often experienced family adversity. Only half of children not “on track” received developmental screening and only 25% of children described as “not on track” received educational, mental health, or developmental services.
Learn more about the study, or contact Dr. Reem Ghandour.
HRSA Announces Highest HIV Viral Suppression Rate in New Ryan White HIV/AIDS Program Client-Level Data Report
A new report from HRSA released this week shows that clients receiving Ryan White HIV/AIDS Program medical care were virally suppressed at a record level – 88.1 percent – in 2019.
This means people with HIV who take medication daily as prescribed and reach and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner. Led by HRSA’s HIV/AIDS Bureau, the Ryan White HIV/AIDS Program Annual Client-Level Data Report, 2019, is the sixth annual publication of national client-level data from the Ryan White HIV/AIDS Program Services Report (RSR).
The RSR is HRSA HIV/AIDS Bureau’s primary source of annual, client-level data reported by more than 2,000 funded Ryan White HIV/AIDS Program recipients and subrecipients across the United States. The publication provides an in-depth look at demographic and socioeconomic factors among program clients served, including age, race/ethnicity, transmission risk category, federal poverty level, health care coverage and housing status. The report also assesses the demographics of those receiving services and highlights the progress and disparities in HIV-related outcomes – particularly viral suppression.
HHS Outlines New Plans to Reduce U.S. Pregnancy-related Deaths
December 3 – Today, the U.S. Department of Health and Human Services (HHS) released an important HHS Action Plan – PDF and announced a partnership to reduce maternal deaths and disparities that put women at risk prior to, during, and following pregnancy. The U.S. Surgeon General Jerome M. Adams issued a complementary Call to Action to Improve Maternal Health – PDF outlining the critical roles everyone can play to improve maternal health.
HHS Summarizes Current Treatments Available to Treat Those Infected with the Virus
Helpful overviews include FDA Combating Covid-19 with Therapeutics and a video interview with the Operation Warp Speed lead on types of treatments and ongoing research.
- What treatments for COVID-19 are approved for use? As of Nov. 23, the FDA has approved one treatment for COVID-19, the antiviral drug Veklury (remdesivir), for use in adult and pediatric patients 12 years of age and older. Five other treatments are currently authorized for Emergency Use – including convalescent plasma and monoclonal antibodies.
- What’s the difference between convalescent plasma and monoclonal antibodies? Basically, monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses. Convalescent plasma is from patients who have already recovered from COVID-19 and may contain antibodies against the virus.
- What other treatments are in development? FDA created the Coronavirus Treatment Acceleration Program (CTAP) to expedite the development of therapeutics. As of Oct. 31, there were more than 370 active trials and more than 560 development programs for therapeutic agents in the planning stages. Visit the CTAP’s dashboard.
- Why is there a national call for plasma? As COVID-19 infections spike nationwide, the demand for convalescent plasma is outpacing donations. Americans who have recovered from COVID-19 in the last three months can donate now. Visit local blood collection center, American Red Cross or America’s Blood Centers or visit org to become a donor.
HHS Announcements & News
Vaccine Development and Distribution Update
- CDC’s Advisory Committee on Immunization Practices (ACIP) met last week and voted on general recommendations for how to prioritize vaccine distribution when supply is initially scarce.
- CDC then published the MMWR with their vaccine priority recommendations to jurisdictions. Bottom line: The 24 million vaccines will first take care of the 21 million healthcare workers and then approximately 3 million seniors and frail living in long term care facilities second.
- The 64 jurisdictions are working on distribution plans and will use these recommendations and their own best judgment to develop allocation plans based on what makes sense in their circumstances.
- , Dec. 10, FDA’s Vaccine Advisory Board will meet to discuss an emergency use authorization request for Pfizer’s vaccine.
- , Dec. 17, FDA’s Vaccine Advisory board will review the clinical trial data submitted by Moderna for emergency authorization of its vaccine.
- What can we do? When vaccines become available, it’ll be our turn to get vaccinated and encourage our communities to do the same. Read and share the CDC’s website and videos with quick things to know about the science of vaccines.
New Study on First U.S. Cases of COVID-19
CDC highlighted a study that shows that the virus that causes COVID-19 may have been in the U.S. as early as mid-December 2019, a month before the first confirmed case, based on antibodies found in donated blood.
COVID-19 Infection, Hospitalizations, and Deaths Among Persons Hispanic/Latinos
CDC released an MMWR for the period between March and Oct. in Denver, Colorado. The majority of adult COVID-19 cases (55%), hospitalizations (62%), and deaths (51%) were among Hispanic adults, double the proportion of Hispanic adults (24.9%).
COVID-19 Emergency Webinar for Community Based Organizations: Vaccines
Wed., Dec. 16, 2020. 3:00 p.m. ET. Register here.
CDC Foundation President and CEO Dr. Judy Monroe, CDC Principal Deputy Director Dr. Anne Schuchat will discuss the current COVID-19 response, including the latest information about vaccines, and vaccine distribution plans. A local expert will also speak about vaccine-related challenges and opportunities.
Register now! USDA Faith Fellowship and Food Security Virtual Convening
USDA will host a Faith and Opportunity Fellowship convening bringing together faith leaders, faith-based organizations, and houses of worship to engage with peers, discuss common challenges, and hear best practices related to food security and community food system resilience. Register here. Reach out to alex.cordova@usda.gov with any questions.
CCMS Announces New Model to Advance Regional Value-Based Care in Medicare
Geographic Direct Contracting Model Builds on CMS’ Long-Standing Commitment to Improving Quality and Lowering Costs for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services announced a new and transformative voluntary payment model that builds on CMS’ focus to deliver Medicare beneficiaries value through better care and improved quality. The Geographic Direct Contracting Model (the “Model”) will test an approach to improving health outcomes and reducing the cost of care for Medicare beneficiaries in multiple regions and communities across the country. Through the model, participants will take responsibility for beneficiaries’ health outcomes, giving participants a direct incentive to improve care across entire geographic regions. Within each region, organizations with experience in risk-sharing arrangements and population health will partner with health care providers and community organizations to better coordinate care.
Beneficiaries in the model will maintain all of their existing Original Medicare benefits, including the ability to see any provider they choose. Beneficiaries may also receive enhanced benefits, including additional telehealth services, easier access to home care, access to skilled nursing care without having to stay in a hospital for three days, and concurrent hospice and curative care. Participants will also have the ability to reduce beneficiary cost sharing for Medicare Part A and Part B services as well as offer beneficiaries a Part B premium subsidy. Lower out-of-pocket costs will allow participants to encourage beneficiaries to seek high-value care while maintaining the freedom and choice beneficiaries have in the Original Medicare program. While providers and participants may choose to voluntarily enter into value-based arrangements, the Model will not change how Medicare-enrolled providers care for beneficiaries in Original Medicare today.
“The need to strengthen the Medicare program by moving to a system that aligns financial incentives to pay for keeping people health has long been a priority,” said CMS Administrator Seema Verma. “This model allows participating entities to build integrated relationships with healthcare providers and invest in population health in a region to better coordinate care, improve quality, and lower the cost of care for Medicare beneficiaries in a community.”
Participants will work within defined geographic regions to maintain and improve care coordination, leveraging beneficiaries’ existing provider relationships as well as developing innovative care delivery solutions that take into account a region’s unique, local needs.
Specifically, Model participants will coordinate care and clinical management for beneficiaries in Original Medicare in their region. This coordination may include care management services, telemedicine, as well as help for beneficiaries to understand which providers have a history of delivering better results and lower costs over the long-term. Beneficiaries in the model will remain in Original Medicare and maintain all of their benefits and coverage rights. Beneficiaries will also keep all of the protections of Original Medicare, including access to all Medicare providers and suppliers, the freedom to choose and change providers at any time, and a strong appeals and Ombudsman system.
To help with delivering improved outcomes, participants may create a network of preferred providers, armed with the Model’s enhanced flexibilities to provide the right care for beneficiaries at a lower cost. Participants and preferred providers may choose to enter into alternative payment arrangements, including prospective capitation and other value-based arrangements. Participants will also work to augment Medicare’s current program integrity efforts, reducing fraud, waste, and abuse in their region and decreasing costs for beneficiaries and taxpayers.
“The Geographic Direct Contracting Model is part of the Innovation Center’s suite of Direct Contracting models and is one of the Center’s largest bets to date on value-based care,” said CMMI Director Brad Smith. “The model offers participants enhanced flexibilities and tools to improve care for Medicare beneficiaries across an entire region while giving beneficiaries enhanced benefits and the possibility of lower out-of-pocket costs. By initially testing the model in a small number of geographies, we will be able to thoughtfully learn how these flexibilities are able to impact quality and costs.”
Organizations that are potentially interested in participating in the Model should submit a non-binding Letter of Interest to CMS by 11:59pm PT, December 21, 2020 through this link: Geographic Direct Contracting Model Letter of Interest. Letters of Interest will be used to determine the final regions in which CMS will solicit participants.
The Request for Applications will be made available in January 2021, and Applications will be due on April 2, 2021. Model Participants will be selected by June 30, 2021. The first three-year performance period will run from January 1, 2022 through December 31, 2024. A second three-year performance period will run from January 1, 2025 through December 31, 2027.
For more information, please visit: https://www.cms.gov/newsroom/fact-sheets/geographic-direct-contracting-model-geo
Colorado Hospital Association Releases New Playbook for Rural Health Care Emergency Response
The Colorado Hospital Association (CHA) and its partners released a new resource to assist rural health care systems nationwide develop emergency response plans for COVID-19 and beyond. This playbook, Re-imagining Leadership: A Pathway for Rural Health to Thrive in a COVID-19 World, seeks to empower rural health care leaders create tailored responses that take the unique identities of their communities into account.
Rural communities nationwide have been particularly hard-hit by the COVID-19 pandemic, and the disparities facing rural health care systems are more apparent now than ever. Creating a meaningful resource to assist rural health care leaders weather these challenges requires the insight and direction of those on the frontlines within those communities. With that in mind, CHA and its partners distilled dozens of personal interviews, extensive literature review and an analysis of rural health care data into this playbook.
“There can be no scripted guide or silver bullet to address the unique challenges faced by each rural community,” said Benjamin Anderson, CHA vice president of rural health and hospitals. “That is why this playbook offers a framework that can be tailored to fit the individual strengths, challenges and identities of our rural partners here in Colorado and across the country.”
CHA was proud to partner with the Eugene S. Farley, Jr. Health Policy Center at the University of Colorado Anschutz Medical Campus on this playbook, which was made possible by generous funding from the ZOMA Foundation and CPSI.
About Colorado Hospital Association
Colorado Hospital Association (CHA) is the leading voice of Colorado’s hospital and health system community. Representing more than 100 member hospitals and health systems throughout the state, CHA serves as a trusted, credible and reliable resource on health issues, hospital data and trends for its members, media, policymakers and the general public. Through CHA, Colorado’s hospitals and health systems work together in their shared commitment to improve health and health care in Colorado.
Updated COVID-19 Funding Sources Impacting Rural Providers Released
The Technical Assistance and Services Center (TASC), in coordination with the Federal Office of Rural Health Policy (FORHP), are pleased to provide another update of the COVID-19 Funding Sources Impacting Rural Providers guide. This funding resource is intended to support rural health care providers, along with their state and local partners, navigate the availability of federal funds to support the novel coronavirus (COVID-19) pandemic response and recovery efforts. This guide is updated regularly to capture changes in funding sources.
Seven tables, or matrices, are provided for quick reference at the beginning of this resource. The tables can be used to check eligibility of participation in funding sources by provider types: rural prospective payment system (PPS) and critical access hospitals (CAH), rural health clinics (RHC), federally qualified health centers (FQHC), long-term care (LTC) or skilled nursing facilities (SNF), tribal facilities, and emergency medical services (EMS). The tables also provide an at-a-glance view for each provider type sharing the different types of funds that may be accessed from various funding sources dependent on their participation eligibility. Each funding source is described in its own section of this resource with an executive summary followed by further detail on the use of funds, reporting requirements, hyperlinks to the legislation and detailed information.
One of the main updates for this version is the addition of the RHC COVID-19 Testing Program found on Page 57.
The guide can be found in COVID-19 Collection located on The National Rural Health Resource Center’s website. This collection consists of trusted and reliable resources, such as the COVID-19 Funding Sources Impacting Rural Providers Guide, along with standing links to additional organizations’ COVID-19 resources, FAQs, webinars, tools, and trainings. The Center aims to help direct the most up-to-date and relevant tools and resources to rural hospitals, clinics, and their communities. This Collection will be updated regularly to help assist with the abundance of circulating information relating to COVID-19.
Pennsylvania Cancels All Organized In-Person Events, Programs in State Parks, Forests in Response to Rising COVID-19 Cases
Pennsylvania Department of Conservation and Natural Resources (DCNR) Secretary Cindy Adams Dunn announced the department has canceled all in-person events and programs organized by its staff and volunteers in all state parks and forests, beginning Sunday, December 6.
“Safety of all our state park and forest visitors always has been paramount with DCNR and we are taking this temporary but necessary action in response to the continuing rise of COVID-19 cases across the state,” Dunn said. “Throughout the pandemic we have kept our lands open to all so they enjoy outdoor recreation and the positive physical and mental health it provides. That will not change but we must limit social interaction at this time.”
This decision, affecting approximately 150 planned events, will be in effect until further notice. People who have registered for programs will be notified.
This action also includes a move away from DCNR’s normally organized group First Day Hikes that were planned for New Year’s Day, January 1, 2021. Instead, many alternatives for individual hiking that day in state parks and forests will be made available later by DCNR.
State parks and forests will remain open for use by the public. DCNR staff will be taking additional steps to offer self-guided programming only or virtual events. Check the Calendar of Events for scheduled programs.
Out-of-state visitors who are planning to stay overnight at state park and forest facilities must have a negative COVID-19 test within 72 hours of entering the commonwealth. If someone cannot get a test or chooses not to, they must quarantine for 14 days upon arrival in Pennsylvania before visiting a state park or forest. Pennsylvanians visiting other states are required to have a negative COVID-19 test within 72 hours of their return to the commonwealth or to quarantine for 14 days upon return. Visitors who don’t comply may be fined between $25 and $300.
The department’s most recent action is in line with other preventive steps taken, including requiring testing or quarantining for all out-of-state visitors to parks and forests.
Visitor center exhibit halls and interpretive areas will be closed, and all indoor programs will be canceled. Restrooms will continue to be available.
Masks must be worn:
- In park and forest offices;
- In any other indoor public space, including restrooms; and
- Outdoors when visitors are unable to adequately social distance.
Dunn noted visits to Pennsylvania state parks have increased by more than a million visitors a month since the start of mitigation efforts, and that interest is expected to hold strong through the winter and spring.
To help avoid exposure to COVID-19 and still enjoy the outdoors:
- Don’t hike or recreate in groups – go with those under the same roof, and adhere to social distancing (stay 6 feet apart)
- Take hand sanitizer with you and use it regularly
- Avoid touching your face, eyes, and nose
- Cover your nose and mouth when coughing and sneezing with a tissue or flexed elbow
- If you are sick, stay home
Visitors can help keep state parks and forest lands safe by following these practices:
- Avoid crowded parking lots and trailheads
- Bring a bag and either carry out your trash or dispose of it properly
- Clean up after pets
- Avoid activities that put you at greater risk of injury, so you don’t require a trip to the emergency room
Pennsylvania has 121 state parks and 20 forest districts; all are open year-round.
Information about state parks and forests is available on the DCNR website. Updates also are being provided on DCNR’s Facebook and Twitter accounts.
Pennsylvania Department of Health Aligns COVID-19 Quarantine Guidance With CDC
The Pennsylvania Department of Health notified health care providers that, effective immediately, it has aligned its quarantine guidance for people exposed to COVID-19 with the new guidance from the Centers for Disease Control and Prevention (CDC) announced earlier this week that provides an option for a 10-day quarantine without testing or a seven-day quarantine with a negative test on or after day-five of quarantine.
This guidance does not apply to health care settings or those living in certain congregate settings such as nursing homes or prisons.
“We must stop the spread of this virus and quarantining once you have been exposed is essential,” Secretary of Health Dr. Rachel Levine said. “The incubation period for COVID-19 remains at 14 days and it is still most protective to quarantine for the full two weeks. However, the CDC has affirmed that quarantine can end after 10 days if the person doesn’t develop symptoms, or after seven days if the person tests negative and has no symptoms.”
The department issued a Health Alert Network advisory today for health care providers outlining how to implement the new quarantine guidance. Quarantine may not be shortened to less than seven days. CDC recommends that people who have been exposed monitor their symptoms for the full 14-days after their last exposure.
The recommendation for a 14-day quarantine was based on the incubation period of the virus. CDC’s intention with the option to shorten quarantine is to gain better compliance with quarantine and contact tracing activities.
“If you have been identified as a close contact to someone diagnosed with COVID-19, are in quarantine and have no symptoms, you may get a test as soon as your fifth day of quarantine. If the results are negative you may end your quarantine after the seventh day of quarantine,” Dr. Levine said. “However, you will need to wait for a negative test result to stop quarantining. Providers should know that people seeking tests who are symptomatic should be placed above those seeking tests to shorten their quarantine.”
This recommendation also applies to all quarantine orders, including the travel orders issued on Nov. 25 by Dr. Levine.
Dr. Levine stressed that this does not change the need for Pennsylvanians to continue to wear masks, wash hands, avoid all gatherings and social distance. These efforts must continue to stop the spread of COVID-19.