VRHA Weekly Update
In this Issue December 5, 2016

VRHA News Virginia News National News Mark your calendar
Resources
Funding Opportunities
VRHA Site

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VRHA News

Behavioral Health

VRHA partner, VDH Office of Health Equity has released the Behavioral Health Loan Repayment Plan.  The purpose of the Virginia Behavioral Health Loan Repayment Plan (BHLRP) is to provide support for services and create access to behavioral health care by arranging for assets within communities that are chronically without mental health providers. 

The goal of the program is to ultimately increase the number of Virginia behavioral health practitioners by way of an educational loan repayment incentive that “complements and coordinates with existing efforts to recruit and retain Virginia behavioral health practitioners.” The stakeholder group reviewed a multitude of available state and national data pertaining to behavioral health workforce, identified gaps in those data and reviewed a thorough inventory of state sponsored programs that aim to incentivize the recruitment and retention of behavioral health providers. This plan is a product of a shared vision and many months of extensive stakeholder engagements.

VRHA thanks the Office of Health Equity for including many rural health stakeholders in the development of this document and congratulates them on a job well done.

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Take the Survey!

On October 18th, VRHA hosted a kick-off meeting for the Virginia Rural Health Telecommunications Consortium.  VRHTC will be working with rural providers to help them receive discounts on their telecommunications services through the FCC/USAC Healthcare Connect Fund.

Now we are asking all hospitals, FQHC, RHC, other clinics, SNFs, CSBs, and Schools of Nursing to complete the eligibility form so we can determine needs and gage interest in the consortium.

We encourage you to complete the survey even if you do not think you will join the consortium as VRHA will also use this information to compile a report for the Secretary of Technology.

Take the Survey!

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Virginia News

Administration Impact

wo Shenandoah Valley legislators have been named to a subcommittee that will hash out the impact the incoming Trump administration will have on the federal Affordable Care Act, better known as Obamacare. The subcommittee will also examine other health care concerns, including the cost of various programs, at the state level.

Del. Steve Landes, R-Weyers Cave, expects the subcommittee to convene in January. Should the subcommittee continue into 2018 and beyond, he said, funding to operate it would be allocated in future state budgets.  

State Sen. Emmett Hanger, R-Mount Solon, is also expected to serve on the General Assembly subcommittee. He and Landes say Virginia must be ready to react to changes in the federal health care law and understand how those changes could effect services in the commonwealth.

Hanger, the co-chair of the Senate Finance Committee, said one potential change could see federal Medicaid funding offered to states as a block grant, a move Trump has said should be considered. U.S. Speaker of the House Paul Ryan also favors a block grant approach.
 
"If a block grant happens, much depends on how the block grant is appropriated,'' Hanger said. Now, under Virginia’s existing Medicaid program, the state pays 50 percent of the cost for recipients, while the federal government pays the remaining 50 percent.

Read the full article and related story from the Cavalier Daily.

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Legislative Watch

Bills recently introduced at the General Assembly - 

HB 1449/SB 848 Dispensing of naloxone: Allows a person who is authorized by the Department of Behavioral Health and Developmental Services to train individuals on the administration of naloxone for use in opioid overdose reversal and who is acting on behalf of an organization that provides substance abuse treatment services to individuals at risk of experiencing opioid overdose or training in the administration of naloxone for overdose reversal and that has obtained a controlled substances registration from the Board of Pharmacy pursuant to § 54.1-3423 to dispense naloxone to a person who has completed a training program on the administration of naloxone for opioid overdose reversal, provided that such dispensing is (i) pursuant to a standing order issued by a prescriber, (ii) in accordance with protocols developed by the Board of Pharmacy in consultation with the Board of Medicine and the Department of Health, and (iii) without charge or compensation. The bill also provides that a person who dispenses naloxone shall not be liable for civil damages of ordinary negligence for acts or omissions resulting from the rendering of such treatment if he acts in good faith and that a person to whom naloxone has been dispensed pursuant to the provisions of the bill may possess naloxone and may administer naloxone to a person who is believed to be experiencing or about to experience a life-threatening opioid overdose. 

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Pulling Out the Rug

By Jim Nolan - Richmond Times-Dispatch

Sen. William M. Stanley Jr., R-Franklin County, asserted that “Medicaid expansion is not coming back,” taking note of the changes in Washington and the Republican control of the Virginia General Assembly. Stanley serves a Southside district that is among the poorest and most medically needy in the commonwealth. He said that if the ACA is repealed, it will be important that some protections exist to cover those who are currently receiving care.

“You can’t pull the rug out from those who have benefited from this program,” he told the journalists who convened for a series of panel discussions on state issues. “We must be thinking in order to replace this with something better. ... We must make sure we don’t create a gap that people fall into.”

Read the full article.

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Close to Home

By Thomas Goldsmith - North Carolina Health News


One day this June, Wilkes County Sheriff Chris Shew found 22 patients with mental health and substance abuse problems crowding the local hospital’s emergency department, waiting for treatment, transportation or other help. For Shew, the pileup required his department to provide a deputy around the clock due to the presence of people under voluntary or involuntary commitment at the Wilkes Regional Medical Center.

All too often, patients in need of psychiatric services end up in local hospital emergency departments, because there’s nowhere else to get services. This situation has played out frequently across North Carolina in recent years, but a partial solution is coming within the next year for people in mostly rural Wilkes, Ashe, Alleghany, Watauga and Avery counties. Daymark Enterprises, a service provider contracting with the Smoky Mountain LME-MCO, will open a 16-bed facility-based crisis center in North Wilkesboro.

Read the full article.
 

 

National News

Repeal and Replace in Rural?

By Maggie Elehwany - National Rural Health Association

Though the Republican establishment is still unsure about the road forward in a Trump Administration, two establishment Republicans are singing the praises of the cabinet pick of Rep. Tom Price (R-Ga.) for HHS Secretary. 

Price, an orthopedic surgeon based in northern Atlanta, has served in the House over a decade and is the point person for crafting legislation to replace the Affordable Care Act. It’s not a new task for Rep. Price. For the last several years, he has been working on a replacement health care bill called the Empowering Patients First Act.  His bill, which includes many of the tenants of a separate House leadership bill, repeals the Affordable Care Act and offers age-adjusted tax credits for the purchase of individual and family health insurance policies. It also creates incentives for people to contribute to health savings accounts, offers grants to states to subsidize insurance for “high-risk populations,” allows insurers licensed in one state to sell policies to residents of others, and authorize business and professional groups to provide coverage to members through “association health plans.”

Will this concept work for rural patients and providers? Price has a strong track record of advancing regulatory relief for both physicians and hospitals. But where will Price be on ensuring access to affordable quality care in rural communities? Georgia is the geographic epicenter of the rural hospital closures crisis and has rural populations with deep, systemic provider shortages. Will Price’s free-market approach to health care protect the safety-net hospitals in rural Georgia and other rural communities? Will he support ending devastating Medicare bad debt cuts and other harmful side effects of the ACA and its precursor legislation?

Now, more than ever, you need to join us at this year’s Rural Health Policy Institute. Repealing the Affordable Care Act without replacing it with legislation that recognizes the unique challenges of rural providers will fail rural America.

Read the full article.

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Freestanding Emergency Departments

By Jenn Lukens - Rural Health Information Hub

First conceptualized in the 1970s as a solution for rural communities, freestanding emergency departments have recently been getting another look from providers and policymakers. The FSED is just one of several models that are being considered as sustainable options for rural communities that can no longer support inpatient facilities. As of December 2015, 32 states have a collective total of 400 FSEDs, with just a handful of them located in rural areas.

An FSED differs from a hospital in that it does not have operating or inpatient rooms, meaning patients who need that level of care are transported to a hospital. Ken Beutke is President of OSF Saint Elizabeth Medical Center, the inpatient hospital that receives patients from OSF Center for Health – Streator on a regular basis. While some Streator residents don’t like the idea of being transferred for inpatient stays, he points out a big advantage of their FSED is the access Streator residents now have to the 1,000 primary care, specialist physicians, and advanced practice providers within the OSF HealthCare system.

When discussing FSEDs and their financial viability for rural areas, it is important to make the distinction between two different versions of the model: independent freestanding emergency centers (IFECs) and hospital-based off-campus emergency departments (OCEDs). The majority of FSEDs are OCEDs while about 37% are IFECs and are independently run by a group or partnership not affiliated with a hospital system.
 
An FSED that operates under an affiliate hospital is subject to the same CMS rules and regulations that also make them eligible to receive reimbursements for the facility fees, physician fees, and office visits. Because IFECs operate independently from hospital licensure, they are not eligible to receive Medicare reimbursements for the facility fees, making the model more difficult to sustain in rural areas with large Medicare and Medicaid populations. While Medicare reimbursements are regulated at the federal level, FSED licensure and requirements are regulated at the state level.

Read the full article.

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Distribution Issues

By David Templeton - Pittsburgh Post-Gazette

While the Association of American Medical Colleges said the nation has an ongoing shortage of family physicians, others said medical colleges are unwilling to change their philosophy to train a higher percentage of family doctors. Meanwhile, most medical students have an enormous educational debt-load and don’t want to earn low wages in America’s hinterlands.
 
In its most recent report, the AAMC said demand for physicians will continue growing faster than supply, even with a modest annual increase in newly trained primary-care physicians. The nation, it said, will fall short of 61,700 to 94,700 total physicians by 2025.

Other analysts said the actual problem is doctor distribution, with fewer than 25 percent of doctors in family medicine and more than 75 percent involved with medical specialties. Medical schools tend to admit students from upper-crust society who become doctors and return to upper-crust communities or university health centers to complete their medical residencies and launch careers. 
 
Too few students from rural, low-income areas lead to too few physicians returning home to practice medicine. The family doctor shortage especially affecting rural and low-income communities nationwide could be corrected simply by improving reimbursements for primary care and recruiting and encouraging more students from deficit areas to become doctors.

Read the full article.

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AHA Priorities

By Erik Rasmussen - American Hospital Association

Legislative priorities the American Hospital Association will be encouraging the current Congress to consider before adjourning are:

RCH Demo: H.R. 5273 (currently pending before the Senate) includes a five-year extension of the Rural Community Hospital demonstration program, something the AHA has strongly advocated for this year. The demonstration enables small rural hospitals with fewer than 51 acute care beds to test the feasibility of cost-based reimbursement. This program has become vital to participating hospitals and is providing valuable data on potential new models for these vulnerable hospitals. The Senate has also passed a standalone bill (S. 607) extending the demonstration. We will be working hard to ensure final passage of this important priority.

Direct Supervision: The AHA is strongly urging Congress to pass an enforcement moratorium for CY2016 on CMS’ “direct supervision” policy for outpatient therapeutic services provided in CAHs and certain small, rural hospitals. H.R. 2878 has already passed the House and the companion legislation is pending in the Senate.

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Mark Your Calendar

For more information about these and other events, visit the VRHA Calendar

December 16: Dental Care Approaches for Adults with Disabilities - Wytheville
December 16: 
SBIRT: An Integrated Model for a Lifespan Approach - Roanoke
February 5-8: Rural Healthcare Leadership Conference - Phoenix, AZ
February 7-9: 28th NHRA Rural Health Policy Institute - Washington, DC

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Resources

Model Program: Nevada Rural Opioid Overdose Reversal (NROOR)
Need: To reduce the number of overdoses and deaths related to opioid overdose in rural Nevada.
Intervention: The Nevada Rural Opioid Overdose Reversal (NROOR) Program, led by a Critical Access Hospital (CAH), furnishes naloxone and provides education on prescription opioid use and overdose.
Results: EMTs greatly appreciated the naloxone training and the naloxone kits.

Building the Federal Office of Rural Health Policy
This video chronicles the creation of the Federal Office of Rural Health Policy in 1987, exploring the need for such an office and discussing its charge. It describes some of FORHP’s early efforts, including the establishment of the National Advisory Committee on Rural Health and the Rural Health Research Center program.
 

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Funding Opportunities

For funding opportunities without a specific deadline, please visit the VRHA Resources page

Merck Foundation Bridging the Gap: Reducing Disparities in Diabetes Care 
Grants for projects designed to promote health equity through collaborations that bring together stakeholders from inside and outside the healthcare system to improve access to high-quality diabetes care and reduce health disparities for vulnerable and underserved populations with type 2 diabetes in the United States.
Letter of Intent (Required): Jan 24, 2017 
Application Deadline: Apr 17, 2017 

Cliff Bar Family Foundation
These grants are awarded for general organizational support as well as funding for specific projects. Small grants average approximately $7,000 each. Priority is given to applicants that address our funding priorities from a holistic perspective: Protect Earth's beauty and bounty; Create a robust, healthy food system; Increase opportunities for outdoor activity; Reduce environmental health hazards; Build stronger communities; Operate with clearly defined objectives and viable plans to achieve them; Demonstrate strong community ties and operate at the community level; Promote positive change through both the projects and their implementation process.
Deadline: Applications are reviewed three times a year; the deadlines are the 1st of February, June, and October.  

The Hospice and Palliative Nurses Foundation 
HPNF has collaborated with Sigma Theta Tau International (STTI) to offer a research grant in the amount of $10,000. The goal of this grant is to encourage qualified nurses’ contributions to the advancement of nursing care through research. Proposals for pilot and/or developmental research may be submitted for the grant. Application deadline is April 1.
 
HPNF offers the Certification Research Grant of up to $15,000 and awarded annually. Proposals are due on or before July 1 each year. The purpose of the HPNF Certification Research Grant is to conduct research related to certification.
 

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