The Appalachian Regional Commission (ARC) has announced a series of public input sessions to identify critical opportunities and challenges facing Appalachia’s economic future. Envision Appalachia: Community Conversations for ARC’s Strategic Plan will gather insights from these public sessions, coupled with guidance from regional, state, and local partners, and will inform ARC’s strategic plan for fiscal years 2021-2025. ARC develops a new strategic plan every five years in accordance with the Office of Management and Budget (OMB). More than 3,000 Appalachians provided input to develop ARC’s current strategic plan, which expires on September 30, 2020.

“As we plan ARC’s investment strategy for the years to come, it is important that we be informed by the people we serve,” said ARC Federal Co-Chairman Tim Thomas. “These public input sessions for the next ARC Strategic Plan will provide Appalachian communities the opportunity to have a voice in this process, and I encourage the people of Appalachia to take part in one of these sessions.”

Each session, organized in conjunction with ARC’s state partner, runs from 9:30 am-3:00 pm, is open to the public and free to attend. Space is limited, so please register as soon as possible!

April 8 – Huntsville, AL
April 16 – Ashland, KY
April 22 – Youngstown, OH
April 30 – Abingdon, VA

If you cannot attend an event, ARC is also collecting input via this public survey.

Visit arc.gov/strategicplan to join this important conversation.

On February 27, 2020, the Secretary of the U.S. Department of Health & Human Services (HHS) announced new leadership for the National Advisory Committee on Rural Health and Human Services.  Former Kansas Governor Jeff Colyer will be the fifth chair in the 32-year history of the Committee.

Also known as the NACRHHS, the Committee was formed in 1987 as an independent advisory group focused on provision of health care in rural areas.  Joining the chair for two meetings each year are 20 committee members who include hospital CEOs, educators, experts on aging, physicians, certified registered nurse anesthetists, physician assistants, researchers, community health center directors and state office of rural health directors.  For each meeting, two areas of focus are selected; committee members conduct site visits and follow up with a policy brief and recommendations for the HHS Secretary.

Colyer, a surgeon by training, will be the fifth chair in the 32-year history of the Committee and the second chair from Kansas after Nancy Kassebaum Baker, who served during the Bush Administration. Colyer’s appointment coincides with a series of actions the Secretary has taken to bring more attention to rural health.

In late 2018, Secretary Azar created the HHS Rural Task Force to streamline efforts across HHS to be more focused on developing policy and program changes needed to transform health care in rural America.

“Improving healthcare in rural America is one of President Trump’s most important healthcare priorities, and addressing our rural health crisis is one of the key impactable health challenges the President has identified,” said Secretary Alex Azar. “President Trump’s administration has already put more attention on this challenge than it has seen for years, and we are delighted to welcome someone of Governor Colyer’s stature and experience to chair this Committee. The Committee will play an integral role in our ambitious ongoing efforts at HHS to transform rural healthcare, and Governor Colyer will work closely with me, Deputy Secretary Hargan, and the HHS Rural Health Task Force.”

The Committee was established by statute in 1987 to advise the Secretary on access to, delivery of, and financing for health care and human services in rural areas. The Committee produces policy briefs and reports on key rural issues, along with recommendations to address the challenges. The Committee is comprised of 21 members, including the chair, who represent the diversity of health and human service issues in rural America. In addition, the members represent an appropriate geographic representative mix from across the country, including the chair, selected by the Secretary from authorities knowledgeable in the fields of delivery, financing, research, development and administration of health care and human services in rural areas.

Members provide an array of expertise, including the range of rural-focused health programs under the purview of the Secretary, and are knowledgeable in the fields of rural human and social services. Examples include issues related to transportation, children and family services, social work, services for the elderly and rural economic development.

“As a Kansas doctor and a former governor, I know how important good medical care is to our rural communities,” said Governor Colyer. “President Trump’s and Secretary Azar’s insistence on improving rural health is a major step forward, and I want to thank the President and Secretary Azar for their push to improve the lives of rural Americans.”

Governor Jeff Colyer M.D. of Overland Park, Kansas finished his gubernatorial term in 2019. He is a fifth generation Kansan from Hays who practices craniofacial and reconstructive surgery. In addition to his medical practice, he is known for volunteering with International Medical Corps in war and conflict zones around the world including the Rwandan, Afghanistan, Iraq, South Sudan, and Libya.

Before becoming Governor, Colyer served in the House and Senate and was the longest serving Lt. Governor in Kansas history. He led Kansas’s Medicaid transformation into the first fully integrated managed care program in the United States and was noted for improving health outcomes, cutting waiting lists and saving over $2 billion through better care. As Governor he funded schools, saw more Kansans working than ever before, and left a $750 million budget surplus. He oversaw the first credit outlook upgrade in Kansas in more than a decade. He also emphasized improving rural health programs.

In addition to his service to the National Advisory Committee on Rural Health and Human Services, Governor Colyer also works with businesses in artificial intelligence, technology and healthcare. He was a White House Fellow to Presidents Reagan and Bush. He has degrees from Georgetown University (economics/premed), Cambridge University (Master’s in international relations), and the Kansas University School of Medicine with residency training in surgery and trauma, plastic surgery, and pediatric/craniofacial surgery. With his wife Ruth, they have three daughters.

The most recent meeting, in September of 2019, provided an opportunity for the Committee to identify topics aligned with HHS priorities.  Past meetings have covered topics such as Adverse Childhood Experiences, the impact of suicide, improving oral health care services, and modernizing Rural Health Clinic provisions.  Visit the NACRHHS for more details, including the Committee’s recommendations on each of these topics.  The Committee will host its first meeting of 2020 beginning Monday, March 2 and running through March 4 in Atlanta, Georgia.

Improved access will benefit rural areas with limited treatment options

WASHINGTON – The Drug Enforcement Administration announced on February 26, 2020, an important step to improve access to medication assisted treatment, especially in rural areas where those suffering with opioid use disorder may have limited treatment options.

“Thankfully, prescription opioid overdose deaths have declined more than 13 percent, but thousands of Americans still suffer from addiction and opioid use disorder,” said DEA Acting Administrator Uttam Dhillon. “Today’s proposal is an important step to improve access to medication assisted therapy, a successful evidence-based practice to treat opioid dependence. DEA is committed to ensuring that these tools and resources are available to everyone, especially in rural areas where treatment options may be limited.”

Under the proposal published today, narcotic treatment program registrants authorized to dispense narcotic drugs approved to treat opioid dependence would be authorized to implement a “mobile component” to their registration, eliminating the need for a separate DEA registration. This streamlined registration process will make it easier for providers to offer needed services in remote or underserved areas.

In April 2000, DEA, in association with the American Methadone Treatment Association – now the American Association for the Treatment of Opioid Dependence – developed guidelines for NTPs to ensure more uniform standards throughout the United States. As the opioid crisis evolves, DEA and their partners seek to provide additional tools and resources to further increase accessibility for persons with opioid use disorder. Alternative methods, such as mobile components of NTPs, can be used to bring treatment to those in rural or other underserved areas where NTPs are not accessible, or to allow people who are unable to travel to an NTP to receive care.

According to the Centers for Disease Control and Prevention (CDC), more than 67,000 Americans lost their lives to drugs in 2018, and more than half of those deaths involved opioids. The demand for evidence-based medication-assisted treatment for substance use disorders, including opioid use disorder, has increased over the years, especially for services provided by NTPs. In some areas of the country, this has resulted in long waiting lists and high services fees, especially in rural communities.

The distance to the nearest NTP or the lack of consistent access to transportation in rural and underserved communities may prevent or substantially impede access to these critical services. There are more than 1,700 NTPs registered with DEA, including opioid treatment programs, detoxification treatment services that utilize methadone, and compounders. This proposed rule builds on existing experience and provides additional flexibility for NTPs in operating mobile components, subject to the regulatory restrictions put into place to prevent the diversion of controlled substances.

The proposed rule is available here

On February 25, 2020, HHS released the following statement on the coronavirus supplemental request.

“The Administration has been effectively utilizing all available resources to protect the American people from COVID-19. Today, the White House sent a supplemental request to Congress to make $2.5 billion available for COVID-19 response efforts, including an emergency supplemental appropriation of $1.25 billion. HHS will also use the Secretary’s transfer authority to provide needed resources to continue the Department’s robust and multi-layered public health preparedness and response efforts – including public health surveillance, epidemiology, laboratory testing, support for state and local governments and other key partners, advanced research and development of new vaccines, therapeutics and diagnostics, advanced manufacturing enhancements, and support for the Strategic National Stockpile.”

Read the letter here: https://www.whitehouse.gov/wp-content/uploads/2020/02/Coronavirus-Supplemental-Request-Letter-Final.pdf

During his remarks at the National Rural Health Policy Institute, U.S. Department of Health and Human Services (HHS) Deputy Secretary Eric Hargan announced President Trump’s new rural health plan’s four main areas of focus: preventing diseases, creating sustainable financing, using technology to improve access, and laying the groundwork for a stronger workforce. Also, the new program will attempt to tackle maternal health and opioid issues. Deputy Secretary Hargan has signaled more details to come explaining the intricacies of the plan.

During the week of February 10, 2020, the Office of the President released its federal budget proposal for the FY2021. The annual release of the President’s budget is a non-binding document that is not expected to be adopted. The President’s budget provides a roadmap of programs and initiatives being prioritized by the administration in office. Here is a breakdown of proposed Health and Human Services program spending.

During the week of February 10, 2020, Congressman Jodey Arrington (R-TX-19) announced the introduction of the Save Rural Communities Act (H.R. 5808). This legislation seeks to grant rural hospitals more flexibility in the services they provide. Specifically, it allows them to convert to an outpatient only, 24-hour emergency care center. The proposed change would allow hospitals to tailor their business model and balance their budgets, while also meeting the health care needs of their community.

Harrisburg, PA – In February 2020, the Pennsylvania Department of Human Services (DHS) released a bulletin with guidance and requirements for providers that wish to become a specialized child residential setting under the Family First Prevention Services Act.

“The Wolf Administration remains committed to protecting vulnerable populations across Pennsylvania, and the Family First Prevention Services Act will help strengthen Pennsylvania’s child welfare system in line with this goal,” said DHS Secretary Teresa Miller. “We want to be sure that every service we provide offers the necessary supports to meet children and families’ needs and help them on a path to safe, healthy lives. This certification process will help DHS ensure that specialized settings for children will be available, safe, and suitable.”

The Family First Prevention Services Act is a federal law that prioritizes keeping children with their families. It allows states to use federal payments for trauma-informed evidence-based prevention services to allow children who would otherwise be placed in foster care to stay with their parents or relatives. The implementation of this law, scheduled for October 1, 2020, aligns with the Wolf Administration’s goals of serving children safely with their families or family-like settings when necessary.

In the event placement outside the home becomes necessary, the law directs federal funding towards family-like settings or other specialized settings that are best suited to a child’s individual needs. Specialized settings are trauma-informed child residential facilities or supervised independent living programs specializing in providing care and treatment for children and youth with special circumstances, including:

• Pregnant, expecting, and parenting youth;
• Youth who are transitioning to adulthood; or
• Youth who are, or at risk of becoming, sex trafficking victims.

Specialized settings should offer programming for participants and training for staff tailored to the needs of children and youth with these special circumstances. Public and private children and youth social service agencies, providers and stakeholders that provide services to these populations are encouraged to request certification as a specialized setting.

The specialized settings emphasize a trauma-informed approach to care. This approach integrates knowledge and effects of trauma into policies, procedures, and practices while actively seeking to avoid re-traumatization. Trauma-informed care is informed by six principles: organizational safety, trustworthiness and transparency, peer support, collaboration and reciprocal relationships, empowerment among and between staff and participants, and cultural sensitivity. Standards of trauma-informed care are in line with recommendations made by the Council on Reform established by Governor Wolf’s Vulnerable Populations Executive Order and the Wolf Administration’s effort to make Pennsylvania a trauma-informed state.

More information, the bulletin, and the certification approval process can be found here. Applications to be considered a specialized setting must be submitted by March 15, 2020.

DHS’ Office of Children, Youth, and Families is hosting webinars to review the bulletin and application process for child residential facilities or supervised independent living programs providing or planning to provide services to the above identified populations. Session opportunities are 9:30 a.m. to 12:00 p.m. on February 25 and 28. To register, email cwtpreg@pitt.edu.

Visit www.dhs.pa.gov or email ra-PWFamilyFirst@pa.gov for more information.

MEDIA CONTACT: Erin James – 717-425-7606

During the week of February 10, 2020, the Trump Administration released its federal FY 2021 budget proposal, and the bottom-line impact to programs serving kids and families is stark. The silver lining, if any, is that the likelihood of the plan gaining any momentum in Congress is slim to none.

The proposed budget cuts Medicaid spending by at least $1 trillion over the next 10 years and makes further cuts to CHIP, undoubtedly impacting health care coverage for kids in Pennsylvania and across the country. While little detail is provided in the proposal, what is known is that states would be allowed to select between moving to either a Medicaid block grant program or a per capita cap option.

The budget advances a one-time increase of $1 billion for child care, but masks other elements including the flat-funding of Head Start and the Child Care Development Block Grant, as well as the elimination of Preschool Development Grants, which Pennsylvania received in 2019. While a $1 billion increase is eye-catching, it should also be noted that Congress passed a $2.4 billion increase for child care in 2018.

Read more about the Medicaid proposal from the Georgetown Center for Children and Families.