More than 25% of rural U.S. residents had trouble accessing health care in the last few years, and almost half of them reported it was because they could not afford the care, according to a survey by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health released this week. The survey found that 49% of respondents said they would not be able to afford an unexpected expense, such as a medical bill totaling $1,000. (Source: NPR’s “Shots,” 5/21)

Virtual Training for Trauma-Informed Care.  The Office on Women’s Health at the U.S. Department of Health and Human Services offers free online courses with continuing education credits to help providers integrate  the principles of trauma-informed care into clinical practice.  The course work is informed by research findings demonstrating that exposure to traumatic events, particularly in childhood, is highly prevalent in our society. A recent report from the National Advisory Committee on Rural Health and Human Services examined the long-term health effects of Adverse Childhood Experiences for rural, tribal and other at-risk populations.

CMS Finalizes Medicare Prescription Drug Pricing Rule.  Last week, CMS finalized a rule  that will improve the transparency of prescription drug costs in Medicare Part D and Medicare Advantage health plans and lower beneficiary out-of-pocket costs. For example, beginning in 2021, the Explanation of Benefits that Part D plans send members must display drug price increases as well as lower cost therapeutic alternatives.  In addition, beginning in 2020, Part D sponsors cannot prohibit or penalize a pharmacy from disclosing a lower cash price to an enrollee.  About 70 percent of rural Medicare beneficiaries had prescription drug coverage in 2017, mostly through stand-alone Part D plans as opposed to Medicare Advantage plans.

 Hardship Exclusion for Medicare Interoperability – July 1. Beginning in 2019, all eligible professionals (EPs), eligible hospitals, dual-eligible hospitals, and Critical Access Hospitals (CAHs) are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability (PI) Programs.  Eligible hospitals and CAHs may be exempted from the Medicare downward payment adjustment if they can show that compliance with the requirements would result in a significant hardship. Hardship exceptions are valid for only one payment adjustment year, so hospitals must submit an exclusion application each year.  The deadline to submit an application is July 1, 2019 for eligible hospitals and November 30, 2019 for CAHs.

CDC Opioid Rapid Response Teams.   The Centers for Disease Control and Prevention (CDC) is working with the U.S. Public Health Service Commission Corps to support state and local agencies when there is a spike in opioid-related overdoses or closure of a clinic where patients are prescribed opioid therapy.   The Opioid Rapid Response Teams (ORRTs) include technical expertise in epidemiology, clinical provider outreach, and community outreach, providing short term (28 days) support to public health partners, while also working to build a jurisdiction’s long-term response capacity.

May 21, 20194:53 PM ET, Heard on NPR All Things Considered

Taylor Walker is wiping down tables after the lunch rush at the Bunkhouse Bar and Grill in remote Arthur, Nebraska, a tiny dot of a town ringed by cattle ranches.

The 25-year-old has her young son in tow, and she is expecting another baby in August.

“I was just having some terrible pain with this pregnancy and I couldn’t get in with my doctor,” she says.

Visiting her obstetrician in North Platte is a four-hour, round-trip endeavor that usually means missing a day of work. She arrived to a recent visit only to learn that another doctor was on call and hers wasn’t available.

“So then we had to make three trips down there just to get into my regular doctor,” Walker says.

This inconvenience is part of life in Arthur County, a 700-square-mile slice of western Nebraska prairie that’s home to only 465 people. According to census figures, it’s the fifth least-populated county in the nation.

To read the entire article, access https://www.npr.org/sections/health-shots/2019/05/21/725118232/the-struggle-to-hire-and-keep-doctors-in-rural-areas-means-patients-go-without-c?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=72930490&_hsenc=p2ANqtz-_8-QlDIoGMPkWS7MoIe0PEX6WyjcoUDc9OW0jv8O3Er6zHq0zOAaMf4vE0FiMSk6iomX9ISLE5v8b6RycSNzC1NmF8mw&_hsmi=72930490

The Centers for Disease Control & Prevention (CDC) has created a digital measles toolkit to support health care providers during the current multi-state measles outbreak. It contains products for clinicians and patients about vaccines and measles that include accurate, science-based evidence that can help counter misinformation about measles and MMR vaccine. It helps to support effective vaccine conversation with parent and resources to share with them. New resources will be added as they become available. For up-to-date answers to patients’ frequently asked questions about measles, visit Frequently Asked Questions About Measles in the U.S.

According to Opioids in Appalachia: The Role of Counties in Reversing a Regional Epidemic, a new report issued today by the National Association of Counties (NaCO) and the Appalachian Regional Commission (ARC), the 2017 death rate for opioid overdoses in Appalachian counties was an astounding 72 percent higher than non-Appalachian counties.

Since December, ARC has hosted six regional Recovery to Work Listening Sessions, each focusing on the role employment has in successful long term recovery. During the week of May 6, 2019, ARC announced the seating of the Substance Abuse Advisory Council (SAAC), a 24-member volunteer advisory group of leaders from law enforcement, recovery services, health, economic development, private industry, education, state government and other sectors. The SAAC will develop recommendations for ARC to consider as part of a strategic plan to build and strengthen a recovery ecosystem in Appalachian communities by drawing on their own expertise, as well as community insight gathered during the listening sessions.

Today, the SAAC wrapped up their inaugural meeting in Knoxville, Tennessee. Among the Council’s first tasks was to identify key needs in building a recovery ecosystem. This includes focused services to support those in recovery as they re-enter the workforce, as well as guidance to employers for how to successfully help these workers to be productive and professional. Other topics of discussion included the need for holistic strategies to help those in recovery access housing, transportation, and broadband.

“By focusing on the recovery ecosystem, which supports those in long-term recovery as they move back to the workforce, the Substance Abuse Advisory Council will be addressing an important piece of the overarching effort to combat substance use disorder in our Region,” said ARC Federal Co –Chair Tim Thomas.

The Council will to continue developing recommendations, which will then be formally presented to ARC later in the fall. More information about the Council, as well as other ARC work on this issue, is available at www.arc.gov/substanceabuse

The Health Resources and Services Administration (HRSA) has launched a new resource that makes it easy to find technical assistance centers associated with many of HRSAs programs.  Browse by topic, by bureau or office, or use the search function by accessing https://www.hrsa.gov/library/index.html.

Beginning June 11 through June 28. CMS announced Notice of Intent to Apply (NOIA) and application cycle dates for a January 1, 2020 start date for the Medicare Shared Savings Program (MSSP). Beginning June 11, 2019, CMS will start accepting NOIAs via the Accountable Care Organization (ACO) Management System (ACO-MS). You must submit a NOIA if you intend to apply to the BASIC or ENHANCED track of the Shared Savings Program, apply for a Skilled Nursing Facility 3-Day Rule Waiver, and/or establish and operate a Beneficiary Incentive Program. MSSP fast facts from January 2018 highlight that 1,210 rural health clinics and 421 critical access hospitals were included on ACO participant lists.