CMS Beyond the Policy Podcast: New Episode on Value-Based Care. The episode features a discussion on the direction of the CMS Innovation Center with the CMS Administrator, Seema Verma and the CMS Innovation Center Director, Adam Boehler, that was moderated by Tom Corry, the CMS Director of the Office of Communications. This includes a mention of new models for rural health care.

 CMS Publishes PACE Final Rule– The Centers for Medicare & Medicaid Services (CMS) finalized a rule updating and modernizing the Programs of All-Inclusive Care for the Elderly (PACE), which provides comprehensive medical and social services to certain frail, elderly individuals (many of whom are “dually eligible” for both Medicare and Medicaid) who qualify for nursing home care but can still live safely in the community.  This rule strengthens protections for PACE participants,  provides administrative flexibility  for PACE organizations, and reduces administrative burden for  clinicians. The  RHI Hub provides examples of PACE programs in rural areas as well as toolkits on how to get started. 

New Opportunity to Apply to be a Medicare Shared Savings Program ACO—Notice of Intent June 28.  For provider groups interested in becoming a Medicare Shared Savings Program Accountable Care Organization (ACO) in 2020, CMS will accept Notices of Intent Apply (NOIA) between June 11 and June 28, 2019.  An NOIA is required in order to submit an application, which will be due by July 29.  The ACO Program was restructured for 2019 and offers rural providers a path to take on financial risk for shared savings and losses.   Email questions to SSPACO_Applications@cms.hhs.gov. 

Meeting Summary – HHS and HRSA Rural Summit. Earlier this year, HHS and HRSA convened a forum of rural health care stakeholders to discuss challenges rural communities face in providing and accessing health care and how HRSA and HHS can address these challenges in the course of program and policy development. The summary from this discussion is now available online at the Federal Office of Rural Health Policy’s Rural Health Resource Guide.

AHA Rural Report Podcast Series.  The American Hospital Association (AHA) has a podcast built around their recently published “Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access and High-quality, Affordable Care.” The first episode, 14 minutes in duration, features experts discussing current approaches to mental and behavioral health.

The Pennsylvania House of Representatives Insurance Committee unanimously adopted House Bill 3, a bi-partisan bill sponsored by House Majority Leader Bryan Cutler (R-Lancaster) and Minority Leader Frank Dermody (D-Allegheny) to create a state-based insurance exchange. This exchange would supersede Pennsylvania’s current participation in the Federally Facilitated Marketplace via healthcare.gov by creating state-level infrastructure to replace the current enrollment process and its oversight. The transition is intended to create a health insurance marketplace comparable to the federal marketplace originally created by the Affordable Care Act rather than the continually volatile marketplace that exists today. It will also establish a reinsurance program that aims to lower premium costs of plans offered and helps sustain the program. HB 3 has been fast-tracked by the administration and legislature with the current expectation that it will be enacted along with the state budget later in June.

By Tom Marema, The Daily Yonder, June 3, 2019

Rural counties added one job for every $10,000 in extra SNAP reimbursements during the Great Recession, says a first-of-its-kind study. Metro counties also gained jobs from SNAP, but at a lesser rate.

Increased food-assistance spending that was part of the 2009 economic stimulus package helped increase employment at the peak of the Great Recession, especially in rural areas, a first-of-its-kind study says.

During the peak and immediate aftermath of the Great Recession, nonmetropolitan counties gained one job for every $10,000 in increased snapped redemptions, said the study, which was conducted by USDA Economic Research Service.

The economic impact in metropolitan areas was measurable but not as great. Metropolitan counties saw an increase of 0.4 jobs for every $10,000 in additional SNAP redemptions during the height of the recession, according to the study.

The American Recovery and Reinvestment Act of 2009 allotted an additional $40 billion in total SNAP benefits for low-income Americans from 2009 to 2013. The increase was enough to give each recipient an extra 13% in benefits. Part of the rationale for including increased SNAP benefits in the stimulus package was that the program would help both SNAP families and the greater economy, which would benefit from an infusion of cash-like benefits.

Previous studies have predicted that’s what happens with increased SNAP benefits. The ERS study is the first to confirm that prediction using historical economic data after the fact.

The study is also the first to look at the county-level impact of SNAP expenditures, giving economists a way to compare the economic impact in metropolitan vs. nonmetropolitan areas.

As expected, the economic impact was greater in rural areas, because the poverty rate is higher and a greater percentage of families participate in SNAP in nonmetropolitan counties.

The study controlled for other federal transfer payments, meaning the increase in employment is related to SNAP payments exclusively, not to other forms of government funding that went to individuals during the study period.

As expected, the economic impact of SNAP redemptions was less before and after the Great Recession of 2018.

The study examined three time periods – before the recession (2001-07), the recession and its immediate aftermath (2008-10), and post-recession (2011-14). Both metropolitan and nonmetropolitan counties saw statistically significant numbers of jobs created during the recession and its aftermath.

Surprisingly, while pre-recession SNAP reimbursement correlated with job-creation in nonmetro counties, in metro counties before the recession, SNAP had the opposite impact. Metro counties had a 0.2 job reduction for every $10,000 in SNAP redemptions. Researchers said that finding “is not robust” and needs further investigation.

“The main findings … — that SNAP redemptions have a positive and statistically significant impact on county-level employment, that these impacts were larger during the Great Recession than before or after it, and that the impacts were larger in nonmetro than metro counties – are robust across the models estimated,” the study stated.

The study also found that SNAP spending has a “spill over” effect. Increased SNAP reimbursements in one county were linked to job creation in adjoining counties, as well.

To view the article, including graphs and maps, visit https://www.dailyyonder.com/study-links-snap-spending-job-creation/2019/06/03/32155/

By Liz Carey, The Daily Yonder, June 5, 2019

Sexually transmitted diseases like gonorrhea, chlamydia, and syphilis can spread quickly in rural areas, where access to medical screening is harder to find and fewer people are aware of the problem.

An increase in sexually transmitted diseases across the country isn’t as surprising to health professionals as is the insight that rates of STDs are rising more in rural areas than in urban areas.

Health officials are working to educate rural residents about the dangers of unprotected sex and to make residents aware that STDs are present in their area.

According to the US Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance Report, rates for chlamydia, gonorrhea and syphilis all increased from 2016 to 2017. Chlamydia rates rose by 6.9 percent to more than 1.7 million cases, while gonorrhea rates increased 18.6 percent to more than 555,000 case and syphilis increased by 10.5 percent to over 30,000 cases.

Recent research suggests the spread of these infections might be particularly affecting rural areas where the diseases are not as common. While STDs are generally associated with more urban areas, research across the country found that rural areas are seeing more incidents of sexually transmitted diseases.

“Compared with urban hubs, rural populations tend to have less access to public health resources, less experience with syphilis and less willingness to address it because of socially conservative views toward homosexuality and non-marital sex,” Lauren Weber said in Kaiser Health News.

In one study, “Does Core Area Theory Apply to Sexually Transmitted Diseases in Rural Environments” by Dionne Gesink published in Sexually Transmitted Diseases January edition in 2013, researchers found that some rural areas were seeing high rates of gonorrhea and syphilis infections. Gonorrhea rates were the “highest in the rural parts of the eastern coastal region of the state” while the syphilis rates were “particularly high” in the southern part of the state.

But rural communities were more likely to recover more quickly from high STD rates than some urban areas. The study authors theorized that “the communities of rural North Carolina are too small and isolated for STI epidemics to persist at endemic levels…”

Other studies showed that residents in rural areas were less likely to be screened for STDs, and that residents in higher poverty areas had higher case rates for both gonorrhea and chlamydia.

In Farmerville, Louisiana, located in Union Parrish, a community health assessment by Union General Hospital there found that sexually transmitted diseases were alarmingly high. Not only were the rates higher than the rest of the state, but the rates in some cases were higher than the rest of the country.

Union Parish has a population of about 23,000, 80 percent of whom live in rural areas, according to the U.S. Census. Union is part of the Monroe, Louisiana, metropolitan statistical area, a small MSA on the border with Arkansas. Union General’s Community Health Assessment in 2012 found that rates of syphilis and gonorrhea were increasing, particularly in black women. “For 2008, the female chlamydia rate in Union Parish (887.4 per 100,000) was higher than the State rate (790.79 per 100,000). For 2008, the female chlamydia rate in Union Parish among Black females (2421.21 per 100,000) was significantly higher than the State rate (1574.07 per 100,000),” the assessment found. The rates within Louisiana at the time put it among the top three states for sexually transmitted diseases across the board for the nation.

The hospital developed a program targeting young women to reduce STDs, teen pregnancy, low birth rates and drug and alcohol abuse. Called “It’s a Girl Thing,” the program was open to girls in middle and high school in the county. Mentors within the program met with girls in their schools once a week as well as provided them with larger programs once a month at the hospital. The programs focused on self-esteem issues, education and hygiene and helped girls develop the tools to deal with the complex issues surrounding sexual health.

Mykalia Alexander, one of the first girls to go through the program, said the program helped her to delay sexual activity until she was ready, while preparing her for life after high school.

“In a sense, it helped me become a woman. We talked about our daily struggles, our body, our self-esteem… The program really helps girls shape their values and what they want to do with their lives,” Alexander said. “Sex wise, I wasn’t active at all. There were people around me who were, but the program helped prevent me from doing that. It helped me make the right decisions.”

Alexander said it helped those girls who were in the program with her make better choices too.

“I think becoming sexually active is 50 percent your environment and 50 percent your education,” she said. “I think ‘It’s a Girl Thing’ helps to educate girls about their bodies. But it’s not just a program, it’s a support system. So it’s not just a sex and pregnancy prevention program, it goes much farther than that. It’s so much more about self-worth and self-esteem.”

Claudia Wade, program director for It’s A Girl Thing and community development manager for Union General, said the decision was made to address the issue through education.

“Lack of education is the main reason for the increase,” Wade said. “Lack of self-esteem – a lot of girls, many who come from broken families and unstable situations – it’s a pattern that they come from that’s hard to break.”

Targeting girls, she said, was decided on based on resources, and responsibility.

“It depends probably more on our reactions (as women) when a boy approaches a lady for them to take that next step forward,” Wade said. “Also it’s our responsibility to say no. It’s hard for the little girls to learn how to say no. Their self-esteem, if they know who they are and what they want in life, makes it easy.”

Since implementing the program, the rate of STDs has decreased, according to the hospital’s latest community assessment report. Teen birth rates and infant mortality rates have also declined.

To view the article, including charts and graphs, access https://www.dailyyonder.com/health-officials-battle-increase-rural-std-rates/2019/06/05/32200/

Governor Tom Wolf announced a first-of-its-kind, statewide Suicide Prevention Task Force to develop the state’s suicide prevention plan, a long-term strategy to reduce suicide in Pennsylvania, and let Pennsylvanians in crisis know their lives are valuable and help is available. The announcement was made by various state agencies that will be represented on the task force, Rep. Mike Schlossberg, Rep. Malcolm Kenyatta, and Prevent Suicide PA.

It is vital that people with lived experience with mental health recovery and/or who have survived suicide attempts participate in this task force. To apply, get more information or to be added to the task force email distribution list, please email Caitlin Palmer, caipalmer@pa.gov, special adviser.

Harrisburg (June 3, 2019) – Pennsylvania Assistive Technology Foundation Celebrates Its Successes in 2018 and Releases its 2018-2019 Annual Report that Outlines the Organization’s Latest Accomplishments, Including the Publication of Funding Your Assistive Technology: A Guide to Funding Resources in Pennsylvania.

The latest accomplishments of Pennsylvania Assistive Technology Foundation (PATF) were highlighted at a press conference held today at the Capitol Rotunda at 10:30 a.m., hosted by Nancy Murray, President of The Arc of Greater Pittsburgh/ACHIEVA and the in-coming Board President of PATF, and Susan Tachau, Chief Executive Officer of PATF.

PATF continues to achieve outstanding results for individuals with disabilities and older Pennsylvanians, helping them purchase the assistive technology (AT) devices and services they need. The program leverages a small amount of public funding into a large number of loans that strengthen our communities. In addition, the repayment of loans from past borrowers provides funding for future borrowers. Remarkably, even though PATF makes many non-traditional loans, its loan loss rate for the last year is only 2.1%, which is better than the industry nonperformance average.

Through loans valued at more than $36M ($1.5M in 2018) and with over 14,000 Pennsylvanians helped since its founding in 1998, PATF is the only Community Development Financial Institution (CDFI) in Pennsylvania that extends consumer loans to individuals with disabilities and their families.

At today’s press conference, PATF released its 2018-2019 Annual Report, demonstrating a continued demand for its financial products. The Report highlights the following noteworthy statistics for 2018-19:

• 278 no-interest or low-interest consumer loans were extended worth $1.5M.
• More than 1,178 people were helped through Information & Assistance (I&A) services.
• 122 trainings were conducted about financial education, funding resources and assistive technology.

Nancy Murray spoke about the importance of helping people with disabilities and family members navigate the complexities of financing their AT needs. She urged everyone to pick up a copy of PATF’s new, comprehensive book, Funding Your Assistive Technology: A Guide to Funding Resources in Pennsylvania. Published in April, 454 people have already downloaded the book from PATF’s website, www.patf.us.

Susan Tachau thanked Governor Wolf and the General Assembly for their long-standing support of PATF. She stated, “We are so grateful to the Governor and our elected officials for making it possible for PATF to help Pennsylvanians with disabilities of all ages and incomes help themselves. Most of our borrowers do not have access to conventional lending markets-and therefore, do not have access to the capital that’s needed to purchase assistive technology. We remain committed to creating programs that are meaningful and respond to our ever-changing world of technology.”

Pennsylvania policymakers spoke about their continued commitment to provide essential public and private funding for the program. Speakers included:

• Senators Camera Bartolotta, Bob Mensch, and Christine Tartaglione; and
• Representatives Sheryl Delozier, Patty Kim, Brandon Markosek, and Melissa Shusterman.

Additional speakers included:

• Ms. D.J. Stemmler, PATF borrower featured in the 2018-2019 Annual Report, stated “PATF was willing to fund the van and the adaptive equipment-something most commercial banks won’t do. Without this loan, I wouldn’t have been able to continue to work.”
• David Gates, Esq., Senior Attorney, PA Health Law Project and PATF Board member, who discussed the importance of integrating financial education into community programming and he encouraged attendance at PATF’s upcoming conference, Vision for the Future: Financial Empowerment for Individuals with Disabilities on October 3, 2019 at the Keystone Building, Harrisburg.
• Matthew Seeley, Esq., Executive Director, PA Statewide Independent Living Council, who discussed blending PATF funding with PA Office of Vocational Rehabilitation (OVR) funds for the purchase of his van so that he could work and be active in the community.
• Abbie Spackman and Kendra Martin, PA AgrAbility Project, who talked about PA’s AgrAbility Program, a program that helps farmers with disabilities remain in production agriculture, and their collaboration with PATF.

Nancy Murray closed the press conference by announcing that PATF was honored to be included again in the Governor’s proposed budget for fiscal year 2020 in a line item called Assistive Technology Financing (or Devices), within the Department of Labor & Industry. The appropriation supports PATF’s operations on behalf of people with disabilities of all ages and incomes throughout the Commonwealth. PATF is advocating for an increase of $50,000 (total of $500,000) to support the costs associated with outreach and underwriting new loan applications and providing financial education trainings and one-on-one coaching.

About PATF

Pennsylvania Assistive Technology Foundation (PATF), founded in 1998, provides education and financing opportunities for people with disabilities and older Pennsylvanians, helping them to acquire assistive technology devices and services that improve the quality of their lives. It is headquartered in King of Prussia, PA and uses a network of Funding Assistance Coordinators across the state to assist prospective borrowers. The organization’s website is www.patf.us. Contact them at (888) 744-1938, or patf@patf.us. PATF is also on Facebook and Twitter.

Contact:

Susan Tachau, CEO

1-888-744-1938

stachau@patf.us