News & Research Reports

Rural Health Information Hub Latest News

Pennsylvania Nears Completion of Nursing Home Vaccinations

Posted on by hjr5089

Every one of the more than 600 Pennsylvania nursing homes participating in the federal partnership to get COVID-19 vaccinations to residents and staff have now had the first-dose clinics completed, and nearly all of them have had their second-dose clinics. More than 300,000 vaccinations have been given in Pennsylvania nursing homes.

Black Churches Play an Important Role in Vaccination Efforts

Posted on by hjr5089

Black churches across the country are playing an essential role in the nation’s COVID-19 vaccination efforts. These “faith-based vaccination partners” are helping to address the distrust in Black communities and encouraging skeptical congregants to get vaccinated. They are also helping Black seniors who struggle with online registration systems and sitting on hold. With COVID-19 disproportionately impacting Blacks, addressing fears through trusted partners is essential.

Updated HANs on COVID

Posted on by hjr5089

The Pennsylvania Department of Health (DOH) released updated guidance for making decisions about return to work for healthcare personnel (HCP) with confirmed COVID-19, or who have suspected COVID-19 (e.g., developed symptoms of COVID-19 but did not get tested for COVID-19). These updates are consistent with those published by the CDC on Feb. 16, 2021. This HAN replaces PA-HAN-516. DOH also released update guidance for Transmission-Based Precautions used by healthcare facilities to care for patients with confirmed or probable COVID-19, or in response to known or suspected exposure to COVID-19 according to PA-HAN-524 and CDC guidelines. This HAN replaces PA-HAN-517. For persons with COVID-19 that are undergoing home-based isolation, please refer to CDC Guidance. Click here to access all of the 2021 Health Alerts, Advisories and Updates.

CDC: Telehealth Use in Health Centers During the Pandemic

Posted on by hjr5089

Using data from 245 health centers that completed a voluntary weekly Health Center COVID-19 Survey, researchers at the Centers for Disease Control and Prevention (CDC) reviewed trends in telehealth use, including by U.S. Census region and urban/rural classifications, during a 20-week period. Study results underscore the need to sustain expanded telehealth use among health centers and to continue to address barriers to telehealth adoption, particularly in the South and rural geographies. Find more information here.

Rural Americans in Pharmacy Deserts Hurting for COVID Vaccines

Posted on by lad3
By Markian Hawryluk
landscape of Walden, Colorado with a red truck on a rural road

As the Biden administration accelerates a plan to use pharmacies to distribute COVID-19 vaccines, significant areas of the country lack brick-and-mortar pharmacies capable of administering the protective shots.

A recent analysis by the Rural Policy Research Institute found that 111 rural counties, mostly between the Mississippi River and the Rocky Mountains, have no pharmacy that can give the vaccines. That could leave thousands of vulnerable Americans struggling to find vaccines, which in turn threatens to prolong the pandemic in many hard-hit rural regions.

And in those areas without pharmacies, rural residents may have to drive long distances to get shots, and do so twice for two-dose vaccines. An analysis by the University of Pittsburgh School of Pharmacy and the West Health Policy Center found that 89% of Americans live within 5 miles of a pharmacy. But more than 1.6 million people must travel more than 20 miles to the nearest pharmacy, which can mean facing difficult weather and road conditions in remote areas.

“If pharmacies are closed, especially in places where there’s no other health care provider, then you’ve got essentially a health care desert,” said Michael Hogue, president of the American Pharmacists Association. “You have to be dependent on either a mobile clinic coming in from another area to provide vaccines, or the citizens are going to have to drive farther to get a vaccine.”

So far, with a limited quantity of doses and strict limitations on who is eligible, that hasn’t been a problem. But as vaccination opens up to the general public and supplies of the vaccines increase, local health departments may be overwhelmed with demand and may need to offload the task of vaccinating local residents to other health care providers.

“It’s probably not playing out yet because we’re not getting enough supply,” said Keith Mueller, director of the Rural Policy Research Institute’s Center for Rural Health Policy Analysis. “That means we have some time for those local health departments to figure this out: Who in my radius, if you will, has the capacity to administer vaccines?”

From 2003 to 2018, 1,231 independent rural pharmacies closed, Mueller’s team found, leaving some 630 rural communities with no retail drugstore. The changing economics in the pharmacy industry did them in, a combination of national pharmacy chains expanding and consolidating, big-box stores and supermarkets opening their own competing pharmacies and pharmacy benefit managers eating into small-pharmacy profits. Mail-order options siphoned off business.  And you can’t get vaccines in the mail.

In many towns, those pharmacies represented the last bastion of health care in their communities. Now more than ever, residents are feeling the void.

“We have no medical infrastructure,” said DeAnne Gallegos, a spokesperson for the San Juan County health department in southwestern Colorado. “We don’t even have a doctor.”

With the closest pharmacy located in a neighboring county an hour away in Durango, vaccinations in San Juan County have been handled by the public health director and two nurses. They hold weekly vaccination clinics if they get any doses. As of Feb. 18, the health department had fully vaccinated 298 of its 700 residents.

Counties are allocated doses based on their year-round populations, but the health department hopes to vaccinate out-of-staters who visit as well. San Juan County deals with an influx of tourists and second-home owners coming from states such as Texas, Arizona and Florida, where the pandemic has hit harder and vaccination rates are lagging. So the health department could end up vaccinating more than 200% of San Juan County’s official population to keep COVID out.

“Our attitude is, no matter what your driver’s license or your ZIP code says, if you are living within our tightknit community, that is someone we hope the state would allow us to bring into the fold,” Gallegos said.  But that stresses what she called the frail structure the department had in the first place.

“It’s our responsibility to make appointments, manage the data, make contact, receive phone calls,” Gallegos said. “When you don’t have the staff or the budget to hire additional staff, that also makes it very difficult.”

Farther east, Custer County hasn’t had a pharmacy for years. Only recently, a pharmacist who lives in the county but works in an adjacent county an hour away has started delivering prescriptions to Custer residents when she returns home after each shift.  But she can’t bring vaccines home from work.

Instead, a public health nurse who was due to retire at the end of 2020 decided to stay on to vaccinate residents with the help of another nurse and retired health care workers who maintained their licenses. According to Custer County Public Health Agency Director Dr. Clifford Brown, they have vaccinated more than 630 of the county’s 5,200 residents.  In an ideal world, they could have handed off the task to a pharmacy.  “We do feel the pinch,” Brown said. “I wake up about 3 o’clock in the morning thinking about, how in the world are we going to stretch things to cover for this day?”

Pharmacies offer distinct advantages as vaccine providers. Hospitals, which didn’t traditionally vaccinate the general public, have had to create programs to distribute their allocated doses.

In Colorado, pharmacies give over a million flu shots a year, said Emily Zadvorny, executive director of the Colorado Pharmacists Society, and, particularly in smaller towns, have a much closer relationship with their customers than larger health care providers do. She pointed to a pharmacist in Kiowa County, Colorado, who pulled a list of all his customers age 70 and up and called each of them to schedule their covid vaccinations.

“They have so much more capacity than they have supplies,” Zadvorny said. “It’s just a slow process of ramping up.”

Even where pharmacies exist, it’s been a challenge for independent drugstores to participate in the covid vaccine rollout. For influenza, pneumonia or shingles vaccines, stores typically order as many doses as they think they can sell, which get delivered alongside the pills they distribute.

The COVID vaccines, on the other hand, are being distributed through a national program that comes with a significant learning curve for pharmacies. The federal Centers for Disease Control and Prevention partnered with 21 pharmacy chains, including four networks of independent community pharmacies that give smaller drugstores more purchasing power. According to the National Community Pharmacists Association, those four networks include about 8,000 of the 21,000 community pharmacies nationwide. Pharmacies that are not part of those networks can apply to be vaccine providers in their states.

“The biggest hurdle for most pharmacies is just getting approved,” said Kyle Lancaster, pharmacy director for Our Valley Pharmacy, a three-pharmacy chain in rural Lincoln County, Wyoming.

Our Valley applied to federal and state health agencies and had to upgrade its freezers with digital data loggers, which upload the pharmacies’ refrigerator and freezer temperatures and report them directly to the CDC.

Most small pharmacies like his, he said, had been limited to the Moderna vaccine, which has less stringent temperature requirements than Pfizer’s version. The Johnson & Johnson vaccine, which was recently approved, would be even easier for rural pharmacies to handle.

Lancaster said he’s unsure how many doses of the vaccine his chain will get or when.

Those uncertainties leave residents such as Nan Burton, 63, worried about how to get vaccinated. Last year, she and her husband decided to ride out the pandemic in their vacation home in Lincoln County, trading apartment living in Seattle for the wide-open, physically distanced spaces of Star Valley Ranch, about 8 miles from the nearest Our Valley branch. With plans to retire fully next year, now they’re staying for good.

So far, Lincoln County — more than three times the size of Rhode Island — has vaccinated about 2,500 of its nearly 20,000 residents, mainly through the local hospital. But with no major chain pharmacies in the region, the county must wait for independent community pharmacies, such as Our Valley, to get up to speed.

Burton said she and her husband have little choice but to wait and hope that the vaccine distribution logistics are sorted out. They’d be willing to drive hours to get a vaccine if they knew they weren’t taking it away from someone else in need.

“Until there’s some kind of a national push to do outreach to rural communities, I think we’re going to be in trouble,” Burton said.

Pennsylvania Governor Revises Mitigation Order on Gatherings and Lifts Out-of-State Travel Restrictions

Posted on by lad3

As COVID-19 cases continue to decline and the state’s vaccination plan is amplified, the Wolf Administration announced revised and lifted mitigation restrictions that are effective statewide. Please read the revised mitigation orders below.

“Pennsylvania is taking a measured approach to revising or lifting mitigation orders,” Gov. Wolf said. “The reason we are seeing cases drop can be attributed, in part, to people following the mitigation efforts we have in place. Mask-wearing, social distancing and hand hygiene are making a difference and need to continue even as we see more and more people fully vaccinated. We need to balance protecting public health with leading the state to a robust economic recovery. We are lifting mitigation efforts only when we believe it is safe to do so.”

The revised mitigations restrictions announced today include:

  • Revised maximum occupancy limits for indoor events to allow for 15% of maximum occupancy, regardless of venue size. Core public health measures such as face covering (mask-wearing), social distancing, and hand hygiene still must be enforced. The 15% of maximum occupancy is permitted only if attendees and workers are able to comply with the 6-foot physical distancing requirement.
  • Revised maximum occupancy limits for outdoor events to allow for 20% of maximum occupancy, regardless of venue size. Core public health measures such as face covering (mask-wearing), social distancing, and hand hygiene still must be enforced. The 20% of maximum occupancy is permitted only if attendees and workers are able to comply with the 6-foot physical distancing requirement.
  • Eliminate out-of-state travel restrictions.  In November, the Department of Health provided an updated travel order requiring anyone over the age of 11 who visits from another state to provide evidence of a negative COVID-19 test or place themselves in a travel quarantine for 14 days upon entering Pennsylvania. Today, this order was rescinded. The current downward trend of cases nationwide and implementation of testing requirements and universal face covering on public transportation and transportation hubs are reducing the risk that interstate travel is a vector of disease transmission.

Along with these changes, there is caution. Reduced cases, hospitalizations and deaths, and the more than 2.3 million vaccinations are good signs, but the CDC advises that now is not the time to introduce expansive loosening of mitigation efforts known to put people at more risk. New cases of variants continue to appear, and some experts warn of a fourth surge in cases.

The Acting Secretary of Health’s revised order on gatherings can be found here.

The Acting Secretary of Health’s order rescinding travel restrictions can be found here.

Find FAQs for the mitigation order changes here: https://www.health.pa.gov/topics/disease/coronavirus/Pages/Guidance/Targeted-Mitigation-FAQ.aspx

CMS Announces Additional Navigator Funding to Support Marketplace Special Enrollment Period

Posted on by lad3

The Centers for Medicare & Medicaid Services (CMS) is making approximately $2.3 million in additional funding available to current Navigator grantees in Federally-facilitated Marketplace (FFM) states to support the outreach, education and enrollment efforts around the 2021 Special Enrollment Period (SEP) that runs through May 15, 2021. The 30 organizations eligible to receive these funds work across 28 FFM states to help consumers access financial assistance through HealthCare.gov, complete their applications, and enroll in coverage through the Marketplace, Medicaid, or the Children’s Health Insurance Program (CHIP).

“President Biden has made clear that every American deserves access to quality, affordable health care. Navigators help Americans understand their health insurance options, connecting consumers with financial help, and help them enroll in Marketplace plans, Medicaid, or CHIP,” said Jeff Wu, CMS Acting Deputy Administrator. “During a public health emergency, it is critical for consumers to have access assistance with finding affordable, comprehensive health coverage that best fits their needs.”

Navigators play a key role in reaching underserved communities that historically have experienced lower access to health coverage and greater disparities in health outcomes. Their mission focuses on assisting the uninsured and other vulnerable communities. The additional resources announced today will provide vital support and resources to these communities.

Navigator organizations can determine how best to utilize the additional funding made available by CMS based on their previously approved plans and current needs. CMS will review all updated plans and budget documentation that outline how Navigators plan to use the additional funding to enhance their previously approved program operations for the remainder of the 2020-2021 budget period.

CMS will invest in the future of the Navigator program this year, and plans to increase funding significantly for the upcoming 2021 Navigator Notice of Funding Opportunity (NOFO) grants to facilitate a robust applicant pool and increase access to assistance for consumers in the future.

CMS plans to publish the NOFO this spring to allow sufficient time to award a new round of Navigator grants in advance of Open Enrollment for the 2022 plan year. The current 2020 Navigator grant awards run through August 29, 2021.

For a list of current CMS Navigator grantees, please visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/2020-Navigator-Grant-Recipients.pdf

To view the Upper Limits for 2020 Navigator Supplemental Funding Allocations, please visit: https://www.cms.gov/files/document/upper-limits-2021-navigator-supplemental-funding-allocations.pdf

CMS: Outreach & Education Resources for Partners during the Pandemic

Posted on by lad3

As COVID-19 vaccines begin rolling out across the country, CMS is taking action to protect the health and safety of our nation’s patients and providers and keeping you updated on the latest COVID-19 resources from HHS, CDC and CMS.

With information coming from many different sources, CMS has compiled resources and materials to help you share important and relevant information on the COVID-19 vaccine with the people that you serve. You can find these and more resources on the COVID-19 Partner Resources Page and the HHS COVID Education Campaign page. We look forward to partnering with you to promote vaccine safety and encourage our beneficiaries to get vaccinated when they have the opportunity.

Promoting COVID-19 Vaccines in Your Community

CDC has designed a COVID-19 vaccine toolkit to help your organization educate community members about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns. It is full of free digital resources, templates, posters and ideas for how to work within your community to help promote the COVID vaccine.

HOW CAN YOU GET STARTED?

Know the COVID-19 Vaccine Resources that are Available to You

Use the COVID-19 Resources to Share your Messages

  • Adapt the key messages to the language, tone, and format that will resonate with your community. You know what works in your community.
  • Customize this template letter and send or email it to your community members to introduce your COVID-19 vaccine educational activities.
  • Print copies of the posters and use them as handouts or to hang in highly visible places in your community.
  • Organize a COVID-19 vaccine presentation for your community members and promote it via digital and community communication channels. If your community has internet access, organize a virtual presentation. If it does not, organize an in-person presentation following COVID-19 safety precautions. Ask if your local health department can provide a speaker if you do not have a health educator on staff.
  • Continue to educate your community via articles, blog posts, and CDC social media posts or retweet and share CMS Medicare social media messages on Twitter and Facebook.
  • Invite community members to wear stickers once they have been vaccinated and post vaccination selfies on social media.

Communicate with Your Community

  • Send an introductory letter to encourage your branches, chapters, or affiliates to review and use the toolkit materials, or a letter to members of your organization.
  • Drop the newsletter content into your e-newsletters or listservs to distributed and share information widely on COVID-19 vaccines.
  • Use the COVID-19 Vaccine Basic slide deck for virtual town halls or other informational meetings within your communities. You can use all or part of the set or also include your own organization’s information. Slides are also available in Spanish.
  • Share these key messages about COVID-19 vaccine to educate your communities. These key messages are also available in a printable PDF version.
  • Use the Frequently Asked Questions (FAQs) to help answer questions about COVID-19 vaccine in your communities. FAQs also available in a printable PDF version.
  • Share credible and accurate COVID-19 vaccine information from the Myths & Facts page.
  • Encourage your community members who are vaccinated to enroll in v-safe an after vaccination health checker.

Questions? Please e-mail us: Partnership@cms.hhs.gov

Update to Direct Ordering of Monoclonal Antibodies

Posted on by lad3

As part of the U.S. Department of Health and Human Services (HHS) pandemic response efforts, the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) oversees the allocation and distribution of COVID-19 therapeutics authorized by the U.S. Food and Drug Administration for emergency use. Two such monoclonal antibody therapies received Emergency Use Authorizations (EUA) in November for outpatient treatment of those diagnosed with mild to moderate cases of COVID-19 and meet the high-risk patient criteria noted within the EUAs. The two drugs were bamlanivimab (manufactured by Eli Lilly and Co.) and the therapeutic cocktail casirivimab/imdevimab (manufactured by Regeneron Pharmaceuticals, Inc.).

It is the goal of HHS to ensure fair and efficient access of monoclonal antibody treatments to the communities and facilities that need them. As such, HHS implemented a direct ordering system in January to complement our allocation process and offer treatment facilities the ability to quickly order monoclonal antibody treatments when they need them. There is no shortage in supply of these drugs, and we have enough on hand to meet the needs of all treatment facilities. For this reason, we are making both therapeutics (bamlanivimab and casirivimab/imdevimab) available through direct ordering only, as there is no longer a need for the federal government to allocate these drugs to health departments. All treatment sites meeting EUA requirements must now order bamlanivimab and casirivimab/imdevimab (when available for shipping) directly from AmerisourceBergen Corporation (ABC), the drugs’ sole distributor. The products remain free of charge to requesting sites.

HHS will continue to monitor all direct orders, and we retain the capacity to resume allocation of these and future therapies if needed. Treatment sites should review the direct ordering process guide and place orders directly with ABC at this site.

Please note that in addition to reporting therapeutics data in HHSProtect or the National Healthcare Safety Network, treatment sites wishing to place direct orders will be required to provide ABC with a board of pharmacy license or physician letter of authorization, attest to their designated class of trade, and ensure that product administration will be conducted according to the drugs’ EUAs.

Should you have any questions or concerns regarding the direct order process for COVID-19 monoclonal antibodies, you may contact HHS/ASPR at COVID19Therapeutics@hhs.gov or ABC at C19therapies@amerisourcebergen.com.