Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  May 31, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Spring Newsletter





VRHA Publications

Two groups of students worked with VRHA to develop policy papers this spring.  We are proud to publish the results of their efforts:

Improving Access to Health Services for Children with Developmental Disabilities in Rural Virginia
This analysis has been completed to find the best way to adequately serve children with developmental disabilities in rural communities by increasing access to behavioral health services based on studies of trends in rural communities, studies of state budgeting and political climate, interviews with disability advocates and experts, and interviews of families with developmentally disabled children.
By Ross Glasser, Tara Hotaling, Samantha Magnes, Cara Mumford - University of Virginia Masters of Public Policy program

An Evaluative Analysis of School-Based Dental Sealant Programs in Virginia
This project is a continuation of research that aims to create an integrated approach for policymaking necessary to create an improved oral health status for school-aged children in Virginia, track oral health disparities, initiate public health action and guide state-level policy to improve school-based dental sealant programs. Dissemination of findings is also an important aspect of this project. In conclusion, a feasibility report will be created to guide future research and outline areas for alternative funding.
By Kimberly L. Birkett - Virginia Tech, Masters of Public Health program


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Members in the News

VRHA is proud to announce that memer James Werth has been selected for the 2016 recipient of the American Psychological Association Excellence in Rural Psychology Award!

The APA Committee on Rural Health's (CRH) mission is to achieve the full and optimal impact of the science, practice, and advocacy of psychology in rural and remote regions. CRH recognizes the unique experience of psychologists working in rural and remote environments. Moreover, CRH acknowledges the additional skill set needed to function in underserved areas. The establishment of the APA Committee on Rural Health: Excellence in Rural Psychology Award elevates the importance of psychologists in rural and remote regions and recognizes those who demonstrate exemplary leadership. The award demonstrates CRH's commitment to ensuring the availability of behavioral health care for rural and remote populations and that issues pertaining to rural and remote behavioral health professionals and consumers are kept at the forefront of psychological advocacy, research, education, and practice.

Congratulations, Jim!

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Virginia News

Reducing Financial Stress

By Aaron Williams - Commonwealth Institute Institute

One of the main benefits of health insurance is that - like other insurance - it protects families from financial ruin when they are most vulnerable. A growing body of research shows that Medicaid reduces excessive debt, bankruptcies, and catastrophic medical costs, and provides families with quality health care. Despite these benefits, Virginia lawmakers continue to withhold them from thousands of our neighbors. By refusing to close the Medicaid coverage gap, lawmakers are denying access to affordable health insurance options - and the financial protection they offer - for up to 400,000 Virginians who struggle to make ends meet.

Here are three studies that show just how much Medicaid helps to  prevent financial stress in states that have expanded eligibility:

  • The Effect of the Patient Protection and Affordable Care Act Medicaid Expansions on Financial Well-Being Medicaid is a proven way to help families reduce debt. A working paper released last month by the National Bureau of Economic Research estimates a reduction of $600 to $1,000 in debt for each individual who gained Medicaid coverage due to the Affordable Care Act.​
  • The Oregon Health Insurance Experiment
    Medicaid can also help families reduce other kinds of financial burdens, including catastrophic medical expenditures, medical debt, and out-of-pocket medical expenses. In 2008, Oregon randomly offered Medicaid-style coverage to about 30,000 of 75,000 people who applied for a rebooted program called Oregon Health Plan Standard. This created a randomized experiment. Research based on interviews found statistically significant reductions in the shares of people with out-of-pocket medical spending, catastrophic medical expenditures, medical debt, and who borrowed to pay or skipped bills.
  • Health Insurance and the Consumer Bankruptcy Decision
    Research showing that Medicaid protects families from financial ruin has been around since before the ACA. A study in the Journal of Public Economics by researchers from Columbia University and the University of Chicago found significant reductions in personal bankruptcies by looking at cross-state differences in Medicaid expansions from 1992 through 2004. They found that a 10 percentage point increase in Medicaid eligibility generally reduces personal bankruptcies by 8 percent.
Read the full article and related story from the Progress-Index.

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Medicaid Waivers

By Allison Norlian - WWBT 

Thousands of people with disabilities and families of the disabled have applied for “medical (Medicaid) waivers” over the last decade. Those waivers combine federal and state money to provide long-term support for individuals who are elderly or have disabilities. That includes medical and non-medical services without the requirement that a person lives in an institution in order to receive the services. The waiver program is being redesigned and is expected to be implemented on July 1. 

The redesign comes after a Department of Justice investigation in 2012 that found Virginia not to be in compliant with the Americans with Disability Act. The DOJ’s reasoning ranged from a waiting list of almost 11,000 people along with some inadequate reimbursement rates and a lack of providers who are able to offer services to the disabled. Some people are on the waiting list for a medical waiver for years, even decades.

Read the full article.

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Lee Hospital Update

By Kristen Quon - WJHL

People in part of the Tri-Cities said lives are being lost because a community does not have a local hospital. Wellmont Health System closed Lee Regional Medical Center in October 2013, pointing to federal reimbursement cuts and low community use among the reasons. Ever since, the Southwest Virginia community has rallied to reopen its doors.

Lee County officials took their concerns to the Southwest Virginia Health Authority Board. The board is currently reviewing the merger application filed by the region’s health systems. Some in Lee County fear that the on-going merger of Mountain States Health Alliance and Wellmont Health delayed the return of health care to their community. Residents are also concerned that if they do not get a commitment to open the hospital through the merger, it will not happen. 

“I’d say they are probably right,” said Southwest Virginia Health Alliance Chairman, Terry Kilgore. “Now is the time to get some kind of access for Lee County.”

Read the full article.

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National News

Time and Distance Standards

Mattie Quinn - Governing

The Obama administration released a new set of rules  for managed care plans under Medicaid and the Children’s Health Insurance Program (CHIP). The document, clocking in at 1,425 pages, mostly strengthens and modernizes existing rules. But there are some sweeping changes. Perhaps most notably, states now must set “maximum time and distance” standards to ensure that there are enough doctors in the right places. What the maximum time and distance will be is left up to the individual states to decide.

Health officials, though, wonder -- and worry about -- how these standards will be executed.

“How does a state like Nevada write such a standard when most people live in one area?” said Maggie Elehwany, government affairs and policy vice president for the National Rural Health Association. The sparsely populated state has a high concentration of people in the southern part, which could make it difficult to create a standard to serve all residents. "We know what CMS [the Centers for Medicare and Medicaid] is trying to do, so we’re happy about it because there is such a workforce shortage. But it is really hard right now to see what states are going to do." 

Read the full article.

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Addressing Autism

By Molly Rossiter - Iowa Now

A new University of Iowa study published in the journal Pediatrics shows that parents with children on the autism spectrum are able to have a specialist address challenging behavior by interacting with the children over the computer—and at less than half of the cost of receiving similar care in person. With telemedicine, families with limited access—particularly those in rural settings—will be able to connect with their provider without causing a big disruption to their child or their family.

Additionally, the study showed that total costs for treating a child for challenging behaviors was cut from nearly $6,000 to just over $2,100 through the use of telemedicine—or telehealth, as it is often called. Researchers saw cost savings in various areas, including travel expenses and the staff hours that were saved by removing the need to travel.

Read the full article.

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New Hospital Model

The Oklahoma Hospital Association floats a new plan to help struggling rural hospitals stay open with Medicaid reimbursement rates on the state’s chopping block. OHA’s 24-hour outpatient model would eliminate inpatient services at rural hospitals. Outpatient services like primary care and behavioral health would help offset losses from running emergency rooms. OHA’s Andy Fosmire said few rural ER visits turn into admissions at those hospitals.

Hospitals that adopt the new model, which is voluntary, would have minimal overnight staffing, though a doctor must be on call and able to arrive in 20 minutes at most. This model hasn’t been tried before, so the federal agency over Medicare and Medicaid doesn’t have a reimbursement schedule for it. Fosmire hopes to get several states to join Oklahoma in a pilot study soon and said bad things happen when rural hospitals close completely.

The Oklahoma Health Care Authority has proposed cutting Medicaid reimbursement rates 25 percent to deal with state budget cuts. Rural hospital administrators said that would force them to close entire departments and possibly more.

Read the full article and related story by KGOU.

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Long-Distance Caregiving

By Donna Kallner - Daily Yonder

The adult children of aging parents live an average of 480 miles away. You go anyway, because family is counting on you. But it’s often hard both mentally and physically, or at least it is at my age. It’s expensive, whether you fly or drive. And for many of us, it means taking time off work.

Social isolation is a common problem among the rural elderly, who may see no one but the mail carrier some days — and that’s only if the Post Office is asked to classify the individual as a hardship case so mail is brought closer to the door. Out here where you don’t find much in the way of sidewalks or public transportation, social isolation is a tough problem for long-distance caregivers to fix.

Read the full article.

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Mark Your Calendar

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

June 9: 2016 Health Care Conference - Richmond
June 15: Innovations in Patient Centered Medical Home Adoption - webinar
June 16: Provider Cost Containment in a Rural Healthcare Environment - webinar
June 21: Getting Fit for the Future: Community Hospitals in a Time of Transition - webinar
June 23: 3 Key Strategies to Battling the Nursing Shortage - webinar
July 13-15: Rural Quality & Clinical Conference - Oakland, CA
September 20-21: Rural Health Clinic Conference - Kansas City, MO
September 21-23: Critical Access Hospital Conference - Kansas City, MO

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Veterans Choice Program Toolkit for Outreach Partners
The fact sheets, social media content, frequently asked questions and other materials in this toolkit are designed to make it easy to share information and spread awareness about the Veterans Choice Program. It includes sample communications and templates you can customize for specific events.

Model Program: Total HEALTH
Total HEALTH provides service integration for patients in rural Pennsylvania, making it convenient to receive mental/behavioral and physical services from one location. 

CMS Provider News

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Funding Opportunities

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

Charlottesville Community Foundation
The Foundation will work with partners to outline a course of action to improve community health outcomes. The programs developed as a result of this process will be considered for grant funding. The Foundation is not seeking to develop only new or innovative approaches through this grant track, and will consider approaches that are currently being delivered in our community.  For programs affecting populations living in any geography within the City of Charlottesville and the Counties of Albemarle, Buckingham, Fluvanna, Greene, Louisa, Orange and Nelson.
Deadline: July 1

The Virginia Academy of Family Physicians (VAFP) Foundation is delighted to announce one new medical student scholarship and one new resident scholarship annually for assistance with education loan repayment.
Deadline: May 31

Fiscal Year 2017 New Access Points (NAP) Funding (HRSA-17-009)
HRSA has released the FY 2017 New Access Points funding opportunity announcement (FOA). Approximately $50 million will be available for 75 awards to new and existing health centers for operational support of new primary care service delivery sites.
Due:  In June 17, 2016 and in EHB July 15, 2016.
Applicants must meet BOTH deadlines.

Community Health Projects Related to Contamination at Brownfield/Land Reuse Sites
Awards funding to identify, address, and improve community health in revitalizing Brownfield/Land Reuse sites. Projects must pay particular attention to identifying and addressing health issues prior to redevelopment and assessing changes in community health associated with revitalization.
Letter of Intent (Optional): Jun 3, 2016
Application Deadline: Jul 5, 2016 

Community Access to Child Health (CATCH) Implementation Funds Program
Funding to support pediatricians in the initial and/or pilot stage of implementing community-based child health projects related to medical home access, immunization services, and specific health services not otherwise available.
Application Deadline: Jul 29, 2016 

Community Access to Child Health (CATCH) Planning Funds Program
Grants for pediatricians to develop community-based child health projects related to medical home access, immunization services, and specific health services not otherwise available.
Application Deadline: Jul 29, 2016 

Community Access to Child Health (CATCH) Resident Funds Program
Grants to support pediatric residents in the planning of community-based child health initiatives that increase children’s access to medical homes, immunization services, and specific health services not otherwise available.
Application Deadline: Jul 29, 2016 

Jim Meeks, PA-C, DFAAPA Memorial AFPPA Student Scholarship
Offers a scholarship to a physician assistant student who displays a commitment to family practice and rural health.
Application Deadline: Sep 1, 2016 

Engaging Businesses for Health
This Robert Wood Johnson Foundation solicitation seeks to build the evidence base for how private-sector investment can help build a Culture of Health. Funded studies are expected to include rigorous empirical research that will inform the business case for promoting greater well-being and health equity for all. 
Deadline: June 14

Rosalynn Carter Leadership in Caregiving Award 
Recognizes an individual or organization that has addressed the critical role family caregivers play in our nation’s long-term healthcare system. Click above to learn more about the funding guidelines and application process.
Deadline: August 1

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Virginia Rural Health Association
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Blacksburg, VA 24060

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