The U.S. Department of Health & Human Services announced a new focus prioritizing four objectives: primary prevention, harm reduction, evidence-based treatment and recovery support.  Earlier this year, the Centers for Disease Control and Prevention determined that the rate of rural overdose deaths from 1999 to 2019 rose from 4.0 to 19.6 per 100,000 people.  In 2019, rates in rural counties were higher than in urban counties in California, Connecticut, North Carolina, Vermont, and Virginia.

See New Federal Strategy for Overdose Prevention for more information.

HRSA Payment Program for Buprenorphine-Trained Clinicians. In June 2021, the Health Resources and Services Administration (HRSA) launched an effort to improve access to substance use disorder treatment by paying for clinicians who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder.  Rural Health Clinics still have the opportunity to apply for a $3,000 payment for each clinician who trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019.  Approximately $1.5 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted.  Send questions to DATA2000WaiverPayments@hrsa.gov. There is ongoing availability of a free online course for waiver eligibility training from the American Osteopathic Academy of Addiction Medicine and the Providers Clinical Support System.

United States Department of Agriculture (USDA) Under Secretary for Rural Development Xochitl Torres Small announced that USDA is seeking applications to implement projects supported by regional economic and community development planning to help the people of rural America build back better.

The 2018 Farm Bill authorized USDA to make this funding available under the Strategic Economic and Community Development (SECD) initiative. It can be used to implement projects that are supported by multi-jurisdictional and multi-sectoral strategic community investment plans. In fiscal year 2022, this funding is available under the following USDA Rural Development programs:

• Community Facilities Direct Loan and Grant Program
• Community Facilities Loan Guarantee Program
• Water and Waste Disposal Direct Loan and Grant Program
• Water and Waste Disposal Loan Guarantees
• Rural Business Development Grants
• Community Connect Grants

To be eligible for SECD reserved funding, applicants must meet the requirements and deadlines under the covered programs. Applicants must also submit a Form 1980-88 to USDA. See additional requirements below.

• To apply for SECD reserved funding under the Water and Waste Disposal Direct Loan and Grant Program, applicants must submit forms electronically via RD Apply or submit paper forms at the USDA Rural Development office where the project is located.
• USDA will issue an announcement in the coming months when the application window opens for the Community Connect Grants program. To apply for SECD reserved funding under this program, applicants must submit forms electronically at https://www.rd.usda.gov/community-connect.
• To apply for SECD reserved funding under other grant programs or direct loan programs, applicants must submit forms to the USDA Rural Development office where the project is located.
• To apply for SECD reserved funding under loan guarantee programs, applicants must submit their Form 1980-88 concurrent with the 5001-1 and any documentation required under the OneRD Guarantee Loan Initiative application guidelines.

For more information on requirements and deadlines under the covered programs, visit www.rd.usda.gov. For additional information on SECD funding, see page 57409 of the Oct. 15, 2021, Federal Register.

USDA Rural Development encourages applicants to consider projects that will advance key priorities under the Biden-Harris Administration to help rural America build back better and stronger. Key priorities include combatting the COVID-19 pandemic, addressing the impacts of climate change and/or advancing equity in rural America. For more information, visit https://www.rd.usda.gov/priority-points.

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

Domestic violence and healthcare are closely linked. The month of October is National Domestic Violence Awareness Month and according to a survey of contacts with the National Domestic Violence Hotline (see 2021-10-04_Hotline-HRSA-focus-survey-report), 53% of respondents reported that an abusive partner has also controlled/and or restricted access to healthcare.

HRSA’s Office of Women’s Health and Bureau of Primary Healthcare are working with the Administration of Children and Families and the National Domestic Violence Hotline to address these intersections.  Learn more about other HRSA intimate partner violence work or view last year’s webinar, Sheltering in Place, Intimate Partner Violence, and the Healthcare Response.

Thank you for your efforts to bring awareness to this public health issue in your communities.

Domestic violence and health care are closely linked. The month of October is National Domestic Violence Awareness Month and according to a survey of contacts with the National Domestic Violence Hotline, 53% of respondents reported that an abusive partner has also controlled/and or restricted access to health care.

HRSA’s Office of Women’s Health and Bureau of Primary Healthcare are working with the Administration of Children and Families and the National Domestic Violence Hotline to address these intersections.  Visit the linked text to learn about other HRSA intimate partner violence work or view last year’s webinar, Sheltering in Place, Intimate Partner Violence, and the Healthcare Response.

HRSA IEA is appreciative of your efforts to bring awareness to this public health issue in your communities.  Please do not hesitate to reach out to us with questions, concerns, or requests for support and engagement.

The Centers for Medicare & Medicaid Services (CMS) launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Home and community-based services allow people enrolled in Medicaid to receive services and supports in a preferred setting outside of an institution, such as in their own home. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).

CMS also approved a new Medicaid section 1115 demonstration in Alabama, entitled the “Community Waiver Program,” to operate concurrently with a home and community-based services 1915(c) waiver. This new opportunity in the state’s Medicaid program will increase access to home and community-based services, and allow the state to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting.

“One-stop Shop” for Plans to Enhance, Expand & Strengthen Home and Community-based Services 

To encourage states to expand home and community-based services and strengthen their programs, the Biden-Harris Administration implemented a funding increase established by the ARP. The ARP provided states with a temporary 10 percentage point increase in federal Medicaid funding for certain Medicaid home and community-based services from April 1, 2021 through March 31, 2022, if they meet certain requirements. As the COVID-19 pandemic continues, the additional federal funding made available under the ARP allows those enrolled in Medicaid who need long-term services and supports to receive the assistance required to reside in the setting of their choice.

“The Biden-Harris Administration recognizes the value and dignity that come with access to home and community-based services,” said HHS Secretary Xavier Becerra. “Thanks to the American Rescue Plan, we can support states working to expand access to home and community-based services for Medicaid beneficiaries. With the launch of this new online hub, we’re making it easy for states to exchange ideas on how best to care for their residents.”

“The ability to access health care at home or in the community is essential for many low-income families, older adults, and individuals with disabilities who rely on Medicaid services — especially during this unprecedented public health emergency,” said CMS Administrator Chiquita Brooks-LaSure. “Thanks to the American Rescue Plan, CMS is providing state Medicaid agencies with the tools and funding needed to expand this important care. We welcome the opportunity to work with states to expand home and community-based services to meet the needs of their communities.”

The announcement issued today reinforces CMS’s commitment to assist states in response to the public health emergency. State administrators and stakeholders are encouraged to visit Medicaid.gov to view states’ programs and activities to identify innovative approaches that can support home and community-based services and improve capacity building and infrastructure in their area by drawing inspiration from other states.

For example, some states are delivering vaccines to people with disabilities and older adults through mobile COVID-19 vaccination programs. Other states are focusing on the potential of home and community-based services to help people with Medicaid coverage receive care outside a skilled nursing facility after a hospitalization, when aligned with the beneficiary’s goals. Other activities may include expanding and implementing new, community-based behavioral health crisis response services, ensuring that a qualified provider with training quickly and properly responds to mental health and substance use-related crisis situations. Many states are also providing recruitment and retention bonuses and increasing pay for direct support professionals, as well as implementing new training programs and other strategies to strengthen the direct support workforce. These actions allow Medicaid enrollees to receive care in the comfort of their own home or in a preferred community setting.

To view the home and community-based services webpage with states’ ARP section 9817 spending plans and narratives, letters issued to states on their spending plans and narratives, and other important information related to the implementation of ARP section 9817, please visit https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

For additional information on ARP funding for home and community-based services, see the guidance that CMS issued to states via a State Medicaid Director Letter in May of this year.

New Demonstration for Home and Community-based Services in Alabama

The Biden-Harris Administration is proud to help states that have long been at work to advance home and community-based services. Separate from the new website launched today, CMS has approved Alabama’s earlier application for a section 1115 demonstration, entitled “Community Waiver Program.” The 1115 demonstration will operate concurrently with a home and community-based services 1915(c) waiver in Alabama, a new opportunity in the state’s Medicaid program to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting. Together, Alabama’s 1115 demonstration and 1915(c) waiver will increase access to home and community-based services for many Alabamans who are currently on a waiting list.

The state will now be able to redesign its home and community-based services delivery system to address concerns, such as long waiting lists, high use of residential services and out-of-home placements, and low integrated community employment rates among its residents. CMS will also provide the authority needed for Alabama to create a new program that supports individuals with intellectual disabilities who choose to work, live with family, or live independently.

“It is important we find ways to collaborate to help Alabamians in need, particularly those with intellectual disabilities. My Administration is pleased to offer the Community Waiver Program, which focuses on serving individuals with intellectual disabilities before they are in crisis,” said Alabama Governor Kay Ivey. “The partnership between the Alabama Department of Mental Health and the Alabama Medicaid Agency will help integrate these individuals in the community, giving them a better chance to develop skills to work and live independently.”

Department Also Invests $50 Million to Improve Access to Telemedicine, Distance Learning for 7.6 Million People in Rural Areas

U.S. Department of Agriculture (USDA) Secretary Tom Vilsack announced a significant expansion of access to high-speed internet, health care and educational services for millions of rural Americans nationwide. Today’s announcement continues to move forward President Biden’s Build Back Better Agenda by prioritizing economic growth in rural America and investing in the backbone of our country – the middle class.

“For too long, the ‘digital divide’ has left too many people living in rural communities behind: unable to compete in the global economy and unable to access the services and resources that all Americans need,” Vilsack said. “As we build back better than we were before, the actions I am announcing today will go a long way toward ensuring that people who live or work in rural areas are able to tap into the benefits of broadband, including access to specialized health care, educational opportunities and the global marketplace. Rural people, businesses and communities must have affordable, reliable, high-speed internet so they can fully participate in modern society and the modern economy.”

Background: ReConnect Program

Secretary Vilsack spoke about USDA’s commitment to helping rural Americans get improved access to broadband and health care during a visit to the newly renovated emergency department at Hammond Henry Hospital. The project was financed in part by a USDA loan.

He announced that on November 24 USDA will begin accepting applications for up to $1.15 billion in loans and grants to expand the availability of broadband in rural areas. USDA is making the funding available through the ReConnect Program.

To be eligible for ReConnect Program funding, an applicant must serve an area without broadband service at speeds of 100 megabits per second (Mbps) (download) and 20 Mbps (upload), and commit to building facilities capable of providing broadband service at speeds of 100 Mbps (download and upload) to every location in its proposed service area. In making funding decisions, USDA will prioritize projects that will serve low-density rural areas with locations lacking internet access services at speeds of at least 25 Mbps (download) and 3 Mbps (upload). In making funding decisions, the USDA will also consider, among other things, the economic needs of the community to be served; the extent to which a provider will offer affordable service options; a project’s commitment to strong labor standards; and whether a project is serving tribal lands or is submitted by a local government, Tribal Government, non-profit or cooperative.

USDA has simplified the application process and has expanded the program significantly. For example, ReConnect will now offer 100 percent grants for certain projects on tribal lands and in socially vulnerable communities.

The Department plans to make available up to $200 million in ReConnect Program loans, up to $250 million in loan/grant combinations, up to $350 million in grants with a 25 percent matching requirement, and up to $350 million in grants with no matching requirement for projects in tribal and socially vulnerable communities.

Background: Distance Learning and Telemedicine Grants

Vilsack also announced today a $50 million investment in 105 rural distance learning and telemedicine projects in 37 states and Puerto Rico. These awards are being funded through USDA’s Distance Learning and Telemedicine (DLT) program. This program helps fund distance learning and telemedicine services in rural areas to increase access to education, training and health care resources that are otherwise limited or unavailable.

In Pennsylvania, Cen-Clear Child Services, Inc., received a grant of $157,025 to expand a telehealth project to those with substance use disorders in rural central Pennsylvania. Interactive telehealth equipment will be utilized for the provision of drug and alcohol outpatient services, including Medication Assisted Treatment to over 2,200 patients and their families. Additionally, interactive video equipment will be installed in group rooms at five drug and alcohol clinics in the Pennsylvania counties of Clearfield, Jefferson, and Clarion. This project will increase rural access to services, reduce travel and reduce drug related emergencies.

Penn Highland DuBois received a grant of $791,474 to expand its current telemedicine program and capability across rural northwestern and central Pennsylvania through its network of hospitals, outpatient clinics, pharmacies, and medical practices. The project will focus on behavioral health with an emphasis on addressing opioid and substance abuse patients. The project will enhance telemedicine opportunities for 79,000 residents in the served communities.

USDA’s distance learning and telemedicine investment includes a $387,000 grant to OSF Healthcare System to help establish a telehealth network for 107,000 rural residents in central Illinois. Additionally, UHS of Texoma, Inc. is receiving a $199,015 grant to implement a distance learning system to improve mental health services for 8,000 people in the Choctaw and Chickasaw Nation in Oklahoma.

For additional information on the upcoming ReConnect Program funding opportunity, see the Oct. 22, 2021, Federal Register. Once the application window opens, applications must be submitted through USDA Rural Development’s online application system on the ReConnect webpage. All required materials for completing an application are included in the online system.

To learn more about ReConnect Program eligibility, technical assistance and recent announcements, visit www.usda.gov/reconnect.

Under the Biden-Harris Administration, Rural Development provides loans and grants to help expand economic opportunities, create jobs and improve the quality of life for millions of Americans in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural, Tribal and high-poverty areas. For more information, visit www.rd.usda.gov. If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.

USDA touches the lives of all Americans each day in so many positive ways. In the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, fairer markets for all producers, ensuring access to safe, healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate-smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov.

The Biden-Harris Administration is ensuring that 144 million people enrolled in Medicare, Medicaid and Children’s Health Insurance Program (CHIP) have access to COVID-19 treatments. The Centers for Medicare & Medicaid Services (CMS) issued guidance to states about the statutory requirement for states to cover COVID-19-related treatment without cost-sharing in Medicaid and CHIP for many seniors, low-income adults, pregnant women, children, and people with disabilities who receive health coverage through these programs. This life-saving health care coverage, supported through the American Rescue Plan (ARP), includes care for conditions that could complicate the treatment of COVID-19 in patients who are presumed positive for the virus or have been diagnosed with COVID-19.

This guidance furthers the Biden-Harris Administration’s efforts to improve Medicaid and CHIP beneficiaries’ health outcomes and reduce health disparities.

In addition to issuing today’s Medicaid and CHIP guidance, CMS recognizes and applauds the efforts that many private issuers have taken to waive cost sharing for COVID-19-related treatment in the commercial market. Along with today’s guidance, CMS encourages private health plans to continue to take steps to ensure consumers have coverage for treatment for COVID-19, including for long COVID, without cost barriers.

“The American Rescue Plan expanded coverage for COVID-19 care. The pandemic has exacerbated the inequities that underlie our health care system, and we must continue to work on both the federal and state levels to improve access to and quality of care for everyone,” said CMS Administrator Chiquita Brooks-LaSure. “This guidance will guarantee COVID treatment for people with Medicaid coverage, including those who have been disproportionately harmed by COVID-19. Now that people with Medicaid and CHIP coverage have the comfort in knowing that their COVID treatment is covered, we encourage private health plans to take steps to ensure cost is not a barrier for consumers’ access to treatment for COVID-19, including for long COVID.”

Under the ARP, states are required to cover COVID-19 treatments without cost-sharing, including preventive therapies and specialized equipment, beginning March 11, 2021 and generally ending over a year after the COVID-19 public health emergency ends. This coverage also includes treatments for post-COVID conditions, which are often described as “long COVID.” Long COVID includes a range of symptoms that can last weeks or months after infection. Additionally, during the same time frame, states are required to cover, without cost-sharing, treatments for conditions that may seriously complicate the treatment of COVID-19 for individuals who have or are presumed to have COVID-19, if otherwise covered under the state plan (or waiver of such plan, including a section 1115 demonstration), during the period when they are diagnosed with or presumed to have COVID-19.

In accordance with these provisions of the ARP, states must cover drugs that have been approved, or authorized by the U.S. Food & Drug Administration (FDA) to treat or prevent COVID-19, consistent with the applicable authorizations.

CMS continues to work to expand coverage, increase benefits, and improve care for beneficiaries across Medicaid, CHIP, Medicare, and the Marketplaces.

For more information on Medicaid and CHIP coverage of COVID-19-related treatments, visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho102221.pdf.

For more information on Medicare and Marketplace coverage of COVID-19-related treatments visit:

Medicare: https://www.medicare.gov/coverage?coverage_search=covid

Marketplace: https://www.healthcare.gov/coronavirus/