Virginia Rural Health Association - Weekly Update
VRHA Weekly Update
In this Issue  July 5, 2016

VRHA News Virginia News National News Mark your calendar
Funding Opportunities







Systematic Poverty and the Rural Health Safety Net

Keynote speaker for the VRHA Annual Conference will be Nikki King of Margaret Mary Health. Ms. King will give an account of growing up in the Central Appalachian coalfields during the rise of the opioid epidemic and the fall of the coal industry. She will highlight the issues of drug abuse, economic depression, broken families, and the damage these issues have inflicted on the culture of the area. Emphasizes the role the coalfields played in the development of America and the critical role of healthcare organizations in creating a brighter future.

A native of Southeast Kentucky, Ms. King has also recently addressed the NRHA Policy Institute and the Democratic Steering Committee’s Rural Summit.

Click the conference logo for detailed event information.
mag glass logo web 300 pixels 2

Back to the top

Members in the News

From SWVA Today

[VRHA member] Smyth County Community Hospital is welcoming patients with a cancer diagnosis to its new Regional Cancer Center. SCCH has consolidated its cancer treatment program on the hospital’s third floor with a three exam-room suite featuring nursing area, a new space allowing patients to check in and register at one site, and infusion room with outdoor views or televisions to watch during treatment. The center has working space for the providers, cancer navigator, social worker and dietitian.
The center consolidates the different elements of care into one area so patients can check in, see their provider, and receive infusion or chemotherapy services within the same area.

Read the full article.

Back to the top

More Members in the News

From Alexandria News

Health and Human Services Secretary Sylvia M. Burwell announced $1,400,000 in funding to support four health centers in Virginia. The funding will increase access to integrated oral health care services and improve oral health outcomes for Health Center Program patients.

The four health centers are [VRHA member] Eastern Shore Rural Health System, Incorporated in Onancock; Neighborhood Health in Alexandria; Kuumba Community Health & Wellness Center, Incorporated in Roanoke and Piedmont Access To Health Services, Incorporated in Danville.  

This funding enables health centers to expand integrated oral health care services and increase the number of patients served. With these awards from the Health Resources and Services Administration, health centers across the country will increase their oral health service capacity by hiring approximately 1,600 new dentists, dental hygienists, assistants, aides, and technicians to treat nearly 785,000 new patients.

Read the full article.

Back to the top

Virginia News

Welcome Mat

By Massey Whorley - Commonwealth Institute

More than 20,000 kids in Virginia may lack health insurance because lawmakers have refused to close the health care coverage gap for their parents. That’s because allowing more low-income adults to get health insurance also helps connect more low-income children with the coverage they’re already eligible for.

It’s called the “Welcome Mat” effect. As parents become eligible and enroll in their new coverage, they often learn that their children are also eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP) and enroll them as well. 

The gains in children’s coverage from 2013 to 2014 were substantially larger in states that expanded coverage for adults. Specifically, states that widened eligibility for adults saw a 67 percent larger increase in children’s participation than the states that have refused to cover more adults, like Virginia. In fact, Virginia may have slipped backwards: the data indicate Virginia’s Medicaid/CHIP participation rate may have actually declined slightly from 2013 to 2014. The flagging participation means Virginia is now second lowest only to Indiana among states east of the Mississippi. And the decline contributed to a 15 percent increase in the share of Medicaid/CHIP eligible children without insurance.

Read the full article and related commentary from Virginia Consumer Voices.

Back to the top

Early Intervention Funds

From the Office of the Governor

Governor Terry McAuliffe announced two federal grants that will improve services, supports and information availability for early intervention and education of children with disabilities. The grants are awarded through the Virginia Board for People with Disabilities, Virginia’s Developmental Disabilities Council.

The Virginia Hospital Research and Education Foundation will receive $125,000 for its Virginia Neonatal Intensive Care Unit (NICU) Early Intervention Collaborative, a statewide program designed to increase access to early intervention services for infants who have spent time in a NICU and may be at risk of developmental delay. 

The Virginia Department of Education (DOE) will also receive $150,000 for its project “Adult Curriculum on Critical Decision Making Points for Students with Disabilities. The goal of DOE’s project is to improve post-school outcomes and increase opportunities for employment and higher education through the development and implementation of a training curriculum for students, families, schools, staff, and others.

Read the full article.

Back to the top

Close to Home


For the second time in years, residents of Scott County, TN may be without a hospital. Pioneer Community Hospital sent a letter to the Tennessee Department of Health saying they are ceasing operation. The hospital said they regret the “drastic yet necessary course of action, but as it stands now Pioneer Health Services can no longer financially sustain operations.”

In April, Pioneer Health Service, Inc filed for Chapter 11 bankruptcy. The company cites changes to the healthcare industry for their financial strains.

Read the full article and related story from

Back to the top

National News

Rural Summit

By Katherine Jane Hall - National Rural Health Association

On June 29, National Rural Health Association members Tim Putnam and Nikki King spoke to the Democratic Steering Committee’s Rural Summit on the opioid crisis and other pressing concerns in rural health. NRHA staff and interns also attended the summit in D.C., which focused on improving the quality of life for rural Americans.

During opening remarks, committee members were adamant about ensuring fellow legislators understand the epidemic of opioid abuse is no longer just an “inner city” problem, as described by Sen. Dick Durbin (D-Ill.). Durbin went on to emphasize that no family is safe from being touched by this crisis.

USDA Secretary Tom Vilsack gave the keynote about the importance of rural populations to the economy, and how without them, we could not enjoy the same quality of life we are accustomed to as a nation. He also highlighted a wealth of improvements to the programs for rural areas as well as a decrease in poverty and unemployment in rural areas under the current administration.

Read the full article.

Back to the top

Mental Health for Vets

From the Wayne County Journal

One in five Americans face mental health challenges, according to the National Alliance on Mental Illness. Because of stigma, many people—especially veterans—who need mental health support remain hesitant to talk openly about it. Only about half of those who are affected receive treatment.

Although the majority of America’s 22 million veterans do not have a mental health issue, the number of veterans receiving mental health treatment from the U.S. Department of Veterans Affairs (VA) was 1.6 million in 2015. Many of those veterans live in small communities, far from mental health specialists.

To serve the growing need, VA is expanding access to mental health services, especially in rural areas where fewer clinicians practice. VA increased resources and staffing, allocating more than $24 million from VA’s Office of Rural Health toward innovative mental health programs for rural areas this year.

Read the full article.

Back to the top

SNF Funding

From the Office of Congressman Kevin Cramer 

The Rural Health Care Connectivity Act of 2016 aids rural skilled nursing facilities by giving them access to funding within the Universal Service Fund (USF).  Having access to such funding will allow skilled nursing facilities to better use telemedicine by upgrading broadband access in rural areas.

The new law amends the Communications Act of 1934 to permit public and nonprofit skilled nursing facilities to apply for support from the USF’s Rural Health Care Program.  This program funds telecommunications and broadband services used to provide health care in rural communities. This law addresses the broadband connectivity gap between rural and urban facilities and allows rural facilities to access health information at rates comparable to those charged in urban areas.

Read the full article.

Back to the top

Rural Publications

Medicare Accountable Care Organizations: Beneficiary Assignment Update
We report on significant Centers for Medicare and Medicaid Services (CMS) regulatory changes to beneficiary assignment to Accountable Care Organizations (ACO). Changes include prospective rather than retrospective assignment, will increase the likelihood beneficiaries receiving services only from certain non-primary care specialists are appropriately assigned. The regulations also improve the ability for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to participate in ACOs. 

Health Insurance Marketplaces: Premium Trends in Rural Areas
Analysis of premiums of plans offered during 2014 and 2015, the first years of HIM operation, showed very few definitive patterns in terms of rural/urban differences. However, at the time that 2015 premiums were determined, few insurance firms had significant quantities of claims data on which to base premium change decisions, and many new firms entered the marketplace in 2015 for the first time. Thus, to obtain a current picture of the evolution of HIMs it is extremely important to examine premium data on plans offered in 2016 to determine how rural people may be experiencing HIM changes relative to their urban counterparts. This brief assesses the changes in average HIM plan premiums from 2014 to 2016, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places. Since this brief focuses on premiums without accounting for subsidies, this is not intended to be an analysis of the “affordability” of ACA premiums, as that would require assessment of premiums actually paid, cost-sharing adjustments, and other factors. We find clear evidence that total (pre-subsidy) cost-of-living-adjusted premiums have grown disproportionately in rural places in 2016, and that they grew less in more highly populated places. Urban counties have an average of 4.2 firms offering coverage through the HIMs (an 8.0 percent decrease from 2015), while rural counties have an average of 3.2 firms participating (a 5.6 percent decrease from 2015). This may cause concern for policymakers since, at the county level, we also find that as the number of firms increases, premiums increase at a slower rate. 

Are Rural Older Adults Benefiting from Increased State Spending on Medicaid Home and Community-Based Services?
In a shift away from institutional long term services and supports (LTSS), the federal government and states have pursued an array of strategies for expanding access to home and community-based services (HCBS) over the past few decades. Yet, little is known about variations in the availability or use of Medicaid HCBS within states, across rural and urban areas. This study used the national Medicaid Analytical Extract claims data file (2008) to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS. The study found that rural Medicaid LTSS users were less likely to receive HCBS and more likely to receive nursing facility services than their urban counterparts. The proportion of LTSS spending for nursing facility services was significantly greater among rural than urban LTSS users and expenditures for personal care, home health, hospice, adult day care, and rehabilitation were all significantly lower for rural LTSS users compared with those living in urban areas. Multivariate analyses showed that beneficiary characteristics alone do not explain the observed rural-urban differences in HCBS use and expenditures. State policies and other factors such as urban and rural differences in the availability and supply of HCBS and nursing facility services, are likely important contributors to differences in HCBS use and expenditures. 

Quality Measures and Sociodemographic Risk Factors: The Rural Context
Researchers and policymakers have publicly discussed and debated whether or not to adjust provider quality measures for differences in patient characteristics. Lacking in this discussion, however, is a nuanced understanding of how adjustment should be conducted within a rural context and what impact it might have on patients and providers when quality measures are used for benchmarking and payment. 

State Variations in the Rural Obstetric Workforce
The overall frequency and the increasing rate of obstetric units closures in rural hospitals raises concerns about access to obstetric care among rural women, who experience poorer health outcomes than their urban counterparts. Rural hospitals face obstetric unit staffing challenges due to day-to-day variability in the census of obstetric patients, and as well as challenges with retention, recruitment, training, and scheduling of obstetric clinicians. Many types of staff are necessary to successfully run an obstetrics unit. Across both urban and rural settings, there is regional variation in the types of clinicians attending deliveries. 

Clinical training in the rural setting: using photovoice to understand student experiences
There are numerous initiatives to address recruitment and retention of health care providers in rural areas. This article reports on a rural track program among students to ascertain their experiences. Using photovoice participatory research increased understanding of the students' experiences.

Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program
This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings. 

Career expectancy of physicians active in patient care: evidence from Mississippi
Recruitment and retention of rural health care providers has been a long standing problem. This study focused on the typical length of practice among physicians in Mississippi providing helpful insights for enhancing retention of this group of providers

Association of blood lead levels in children 0-72 months with living in Mid-Appalachia
Are there disparities of lead exposure among rural populations? This study focused on lead exposure among children in Mid-Appalachia.

Identifying Rural Health Clinics in Medicaid Data
The North Carolina Rural Health Research Program identified and tested several methods for identifying Rural Health Clinics (RHCs) in Medicaid claims data. This brief describes and compares those different methods to identifying RHCs in the Medicaid claims of four states. Six potential methods of identifying RHCs in Medicaid claims are enumerated. The recommended method should assist policy makers and researchers who are attempting to use Medicaid data to answer health policy questions related to RHCs. 

Characteristics of Medicaid Beneficiaries Who Use Rural Health Clinics
Rural Health Clinics (RHCs) (currently numbering about 4,100) have served patients from underserved rural areas for nearly 40 years. Although Medicaid is an important payer for RHCs, little is known about Medicaid patients and the services provided to them. This study describes the population who used RHC services from four Medicaid states. A substantial number of RHC users in California, Georgia, North Carolina, and Texas are identified as Medicaid enrollees, ranging from approximately 100,000 to over 800,000 people per state. Demographic characteristics vary substantially by state. Fifty to 79% of the RHC user population are coded as living in a rural area following the Federal Office of Rural Health Policy definition. However, 20% of the RHCs in these four states are not in areas defined as rural. This description of RHC users should assist policy makers and researchers in understanding and planning for the population who receives services from RHCs. 

Adverse Childhood Experiences in Rural and Urban Contexts
Adverse childhood experiences (ACEs) are disturbances in family relationships that deprive children of the security and emotional support they need for healthy development. Although a recent report by the Health Resources and Service Administration indicated that rural children have higher rates of ACEs than their urban peers, we know of no studies examining rural-urban differences in adults’ exposure to ACEs. This study was designed to address this research gap and to inform health system initiatives geared toward mitigating the impacts of ACEs on rural populations. 

Back to the top


Mark Your Calendar

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

July 13-15: Rural Quality and Clinical Conference​ - Oakland, CA
July 20: Trauma Informed Care and the Health Care Safety Net​ - Richmond 
August 3: Opioid Prescribing: Safe Practice, Changing Lives ​- webinar
September 20-21: Rural Health Clinic Conference - Kansas City, MO
September 21-23: Critical Access Hospital Conference - Kansas City, MO
October 18: Rural Health Telecommunication Consortium Kick-Off Meeting - Abingdon
October 18-19:  Rural Health Coding & Billing Specialist Training  - Abingdon
October 19-20: VRHA Annual Conference - Abingdon

Back to the top


CMS Provider e-News

National Center for Farmworker Health
2015 webcasts are now archived and may be viewed at your convenience.

Brain Injury Services
The Department for Aging and Rehabilitative Services recognizes that deficits in non-vocational life areas may adversely affect the ability of a person with a brain injury to gain and/or maintain employment. Each of the listed groups provides the Department of Rehabilitative Services with a quarterly report of how they are serving Virginians with a brain injury.

Healthy Aging Data Portal
Provides easy access to CDC data on a range of key indicators of health and well-being, screenings and vaccinations, and mental health among older adults at the national and state levels. These indicators provide a snapshot of currently available surveillance information and can be useful for prioritization and evaluation of public health interventions.

Back to the top

Funding Opportunities

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

Service Area Competition Funding for Health Center Program 
Funding to provide comprehensive primary healthcare services to an underserved area or population.
Application Deadline: Aug 16, 2016 

Agricultural Health and Safety Special Project and Pilot Study Funds (Mini-grant Program)
Funding to support small-scale projects and pilot studies that address prevention of childhood agricultural disease and injury.
Application Deadline: Aug 17, 2016 

Christopher & Dana Reeve Foundation: Quality of Life Grants
The Christopher & Dana Reeve Foundation is dedicated to curing spinal cord injury by funding innovative research, and improving the quality of life for people living with paralysis through grants, information, and advocacy. The Quality of Life Grants program provides funding of up to $25,000 to nonprofit organizations that mirror the Foundation’s mission by providing programs and services for individuals with paralysis (caused by spinal cord injury, traumatic brain injury, cerebral palsy, ALS, spina bifida, multiple sclerosis, and other conditions) and their families and caregivers that foster independence, inclusion, and engagement in the community. Grants are provided in three thematic areas: Actively Achieving projects provide individuals with disabilities opportunities to participate in activities that engage their bodies and minds, including sports, arts, recreation, and education and employment initiatives. Bridging Barriers projects address and offer solutions to barriers for independent living across the disability community. Caring and Coping projects provide services that address the complex day-to-day health and personal issues for individuals living with disabilities, their families, and caregivers. Nonprofit organizations, municipal and state governments, school districts, recognized tribal entities, and other institutions such as community or veterans hospitals are eligible to apply.
The application submission period opens on July 1, with a deadline of August 15, 2016. 

Anthem Foundation
The Anthem Foundation is committed to enhancing the health and well-being of individuals and families in the communities that Anthem serves. The Foundation believes that targeting preventable health concerns by making strategic charitable choices will help create a healthier generation of Americans. The Foundation’s grantmaking focus is on initiatives that positively affect the conditions addressed in its Healthy Generations program: heart health, cancer prevention and smoking cessation, maternal and newborn health, diabetes prevention and management, and active lifestyles. The Foundation also supports behavioral health efforts and programs that benefit people with disabilities. The upcoming application deadline is August 19, 2016.

Healthy Tomorrows Partnership for Children Program (HTPCP)
The purpose of this program is to promote access to health care for children, youth and their families nationwide, and employ preventive health strategies through innovative community-based programs.  This program supports HRSA's goals to improve access to quality health care and services, to build healthy communities, and to improve health equity.  HTPCP funding supports projects that provide clinical or public health services, not research projects.  HTPCP applications MUST represent either a new initiative (i.e., project that was not previously in existence) within the community or an innovative new component that builds upon an existing community-based program or initiative.
The application deadline is August 2, 2016

Healthy Eating Research: Building Evidence to Prevent Childhood Obesity
A Robert Wood Johnson Foundation (RWJF) national program to support research on environmental and policy strategies with strong potential to promote healthy eating among children to prevent childhood obesity, especially among groups at highest risk for obesity: black, Latino, American Indian, Asian/Pacific Islander, and children who live in lower-income communities (urban, suburban, and/or rural). Findings are expected to advance RWJF’s efforts to help all children achieve a healthy weight, promote health equity, and build a Culture of Health.
Deadline: August 3, 2016

Programs to Reduce Obesity in High Obesity Areas to Boost Prevention
Awards funds to land grant colleges and universities for projects that will work to improve physical activity and nutrition; reduce obesity; and prevent and control diabetes, heart disease, and stroke in areas where adult obesity rates are high.
Geographic coverage: Available in 17 states.
Application Deadline: Aug 2, 2016 

Back to the top





Click to view this email in a browser

If you no longer wish to receive these emails, please reply to this message with "Unsubscribe" in the subject line or simply click on the following link: Unsubscribe

Click here to forward this email to a friend

Virginia Rural Health Association
2265 Kraft Drive
Blacksburg, VA 24060

Read the VerticalResponse marketing policy.

Non-Profits Email Free with VerticalResponse!