VRHA Weekly Update
In this Issue May 5, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


May Newsletter




Webinars This Week

The Rural Social Determinants of Health - Noon May 6  Click here to register
The health of rural communities is shaped by a multiple factors.  Limited access to medical care and providers in many rural communities is justifiably of significant concern.  But our health starts long before we need to see a doctor, in the places where we live, work, learn, and play.  Behavioral choices play an important role as well, but the choices individuals make are shaped by the choices they have.  This webinar will focus on the social, economic, and environmental factors that influence health outcomes, known as the social determinants of health (SDOH).  SDOH  include income, educational attainment, systems of discrimination,  housing, transportation, and other aspects of the neighborhood environment. Research shows that SDOH are the most important factors in determining the health, but they are often out of the control of individuals, and require collaboration across many sectors to change.  The webinar will highlight best and promising practices for rural communities to effectively address SDOH and create opportunities for all of their residents to be healthy.

Improving Health Care for Veterans Begins With You - 10am May 7 Click here to register
Veterans live in every community in our country, with many of them returning home to rural areas after their military service. Veterans in rural areas access health care through a variety of providers and agencies. It is important as a health care provider to be knowledgeable about Veterans issues and resources available. Veterans face different health care concerns, such as Agent Orange exposure, Traumatic Brain Injury, Post Traumatic Stress Disorder and many times have a propensity for other illnesses. This webinar will review common concerns that Veterans have and will provide you with screening tools to use when providing care to Veterans. It will also provide basic information about Veterans benefits and review existing resources.

Full webinar schedule.

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Members in the News

By Karen McNew - WSLS 

The economy and rural communities have benefited for more than 10 years since the first class began at [VRHA member] Edward Via College of Osteopathic Medicine- Virginia Campus  (VCOM) in Blacksburg.
According to research from National Center for Rural Health Works, the total VCOM economic impact for Virginia from June 2011 to June 2012 was $119,971,273.

1300 students have graduated from VCOM and 60% of those students have continued their medical career in rural communities throughout Appalachia.

Read the full article.

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I Am The Coverage Gap

To put a human face on the issue of the coverage gap, please visit IAmTheCoverageGap to hear from folks experiencing this problem first hand. Then share their stories on twitter and facebook!

If you know or work with people in the gap, please also help them tell their stories on this website.  And continue to contact your members of the General Assembly and talk to them about the importance of closing the coverage gap.

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Virginia News

Town Hall Outcomes

A summary of news reports regarding last week's Town Hall meetings:

Medicaid rallies draw fiery crowd in Ashburn - Loudoun Times-Mirror 
"Several audience members questioned what the Republican alternative to Medicaid expansion is. Given an estimated 1 million Virginians are without health insurance, how are lawmakers going to improve health care in the commonwealth, they asked. The delegates responded mostly by speaking in general about implementing reforms to Medicaid and "decoupling" expansion from the state budget."
Bell steps into lion's den on Medicaid expansion - News Virginian
"It was billed as a town hall regarding Medicaid expansion, but Del. Dickie Bell found himself squarely in the arena Monday night fending off questions of why Virginia can't expand the healthcare program."
Town hall meeting centers on Medicaid expansion - NBC 29 
"Jost says turning away federal money is an odd standard to use.  "We don't say that about any other kind of federal spending. We accept federal dollars for defense contracts. We accept federal dollars for agriculture. We accept federal dollars for education. We accept federal dollars for the highway and we're smart to do it," she said."
Medicaid expansion rallies held at Waynesboro library - WHSV 3 
"I feel anger, because I feel like why would you do this to me when I wouldn't do this to you," says Mercedies Harris who went to the rally, "people are going to die at home, the elderly don't get in ambulances because it costs $100 dollars a mile in some ambulances."

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Close to Home

By Tara Culp-Ressler - Think Progress

A rural hospital located in Brownsville, Tennessee is ending its inpatient and emergency services this summer because it can’t afford to keep operating them. Instead, the facility will become an urgent care clinic dealing with minor illnesses. W. Larry Cash, the chief financial officer for the community health group that operates the hospital, told the Tennessean that his state’s refusal to expand Medicaid was a “contributing factor” in the move.
Providers that serve a high number of poor and uninsured Americans, technically called “Disproportionate Share Hospitals,” often operate on a loss because their patients can’t always pay for their care. To compensate, the federal government offers reimbursements for those hospitals — but the Affordable Care Act changes the way the payments are structured. Because the health law intended every state to expand Medicaid, and therefore reduce the number of uninsured people who can’t pay their bills, the reimbursements for DSH hospitals have been reduced.
But if hospitals are located in states that continue to refuse Obamacare’s Medicaid expansion, that puts them in a difficult spot. They’re losing out on some of the federal government’s funding without making up the difference with an influx of insured patients.

Read the full article.

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Mental Health ‘1st Step’

By K. Burnell Evans - The (Charlottesville) Daily Progress

Gov. Terry McAuliffe pledged that an omnibus bill targeting gaps in Virginia’s patchwork mental health network is only the beginning of reforms to a system thrust into the national spotlight by the case of Austin C. “Gus” Deeds.

Seated beside Deeds’ father, state Sen. Creigh Deeds, in a second-floor conference room at the University of Virginia Medical Center, McAuliffe renewed his commitment to funding and improving public mental health services.

“Senator Deeds and I are in full agreement that this is an important first step,” the governor said, “but let us be crystal clear: We have a long, long way to go.”

The legislation, which the governor previously signed into law, targets pressure points in a system lawmakers and mental health advocates say should and could have been fixed long before Gus Deeds, 24, stabbed his father and killed himself at the family’s home in Millboro.

Read the full article.

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National News

Rural Hospitals Closing 

By Alan Morgan - National Rural Health Association

In the past year alone, more rural hospitals closed than in the prior 15 years combined. This is a staggering fact, which is under reported by national media.

When a rural hospital closes, the community often also loses affiliated rural health clinics, local ambulance service, mental health services, long-term care, rural surgery, rehab, home health and other vital services as well. What our nation is currently experiencing is the devastation, and in many cases the elimination, of the rural health safety net.

Read the full article.

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Poverty & Rural Health Rankings

By Tim Marema - the Daily Yonder

The nation’s most rural areas rank dead last in a majority of the measurements used to evaluate the health status of U.S. counties, researchers say. The findings are part of a study sponsored by the Robert Wood Johnson Foundation that ranks counties by a broad set of health and well-being indicators.

“Noncore” counties, which are located outside metro areas and have no towns of 10,000 residents or more, were last in 18 of 34 measurements used in the study. That’s the worst record of any group of counties when they are sorted by urban-rural status.

Read the full article.

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The Cost of EMR

By Eric Whitney - NPR

One of the biggest challenges American hospitals face right now is moving to electronic medical records from old-fashioned paper files. The switch is costing tens of billions of dollars, eating up tons of staff time, and it's especially tough for the country's 2,000 rural and small-town hospitals.

Rural hospitals are typically short on cash and people with information technology skills. So a lot of small hospitals are turning to bigger hospitals for help, and giving up some independence in exchange. The 10-bed Beartooth Billings Clinic in Red Lodge, Mont., is one hospital that did.

Read the full article.

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A New Step for Rural Georgia

By Maggie Lee - The Telegraph

In what looks like a novel tack to prop open the doors of rural emergency rooms in Georgia, a state regulator has voted to allow hospitals to create tiny, standalone triage centers in certain country communities. The next step is finding some money.

Georgia’s move for freestanding, rural ERs would be “the first ... in the country, as I understand it,” said Department of Community Health Commissioner Clyde Reese just ahead of his board’s unanimous vote Tuesday on the new rule.

The new type of license “would allow facilities who maybe are in danger of closing due to financial difficulties or those who have closed within the last 12 months to offer a lesser set of services and to enable them to maintain some sort of health care infrastructure in their community,” Reese said.

Read the full article.

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Mark Your Calendar

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

May 6: The Rural Social Determinants of Health - webinar
May 7: Improving Health Care for Veterans Begins With You - webinar
May 12-16: Behavioral Health and Integration Training Institute - Radford
May 14: Advance Directives - webinar
May 15: The Many Resources of Easter Seals - webinar
May 21: Project REVIVE! - webinar
May 22: Leadership Development for Rural Health - webinar
June 12: The  State Street Project: Health Across Borders - Bristol
June 20-21: Dental Care Approaches for Adults with Disabilities - Lynchburg
June 26: Addressing Disaster Preparedness in Rural Communities - Richmond & videoconference
July 16-18 Rural Quality & Clinical Confernce - Atlanta, GA
September 30-October 1: Rural Health Clinic Conference - Kansas City, MO
October 1-3: Critical Access Hospital Conference - Kansas City, MO

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www.famis.org is now www.coverva.org
The Cover Virginia website still has all the same great information about FAMIS you came to rely on. But now, on this single website you can also access information about Medicaid and Plan First, find out about eligibility, and the four ways to apply. You can even connect to the Federal Health Insurance Marketplace, find application assistance and order materials. So please replace famis.org on all of your materials and bookmarks with www.coverva.org.

CMS Final Rule
CMS issued a final rule that establishes methodology and payment rates for a prospective payment system (PPS) for Federally Qualified Health Center (FQHC) services under Medicare Part B beginning on October 1, 2014, in compliance with the statutory requirements of the Affordable Care Act. Medicare will pay FQHCs a single encounter-based rate per beneficiary per day, with some adjustments. Payment will be 80 percent of either the PPS rate of $158.85, or the total charges for services furnished, whichever is less. FQHCs will be able to bill for separate visits when a mental health visit occurs on the same day as a medical visit. The FQHC PPS rate will be adjusted for geographic differences in the cost of services by using an adaptation of the Geographic Practice Cost Indices used to adjust payment under the physician fee schedule. In addition, the rate will be increased by 34 percent to account for greater intensity and resource use when an FQHC furnishes care to a patient that is new to the FQHC or to a beneficiary receiving a comprehensive initial Medicare visit or an annual wellness visit. FQHCs will transition into the PPS beginning October 1, 2014, based on their cost reporting periods.
This final rule also:

  • Implements a policy that allows Rural Health Clinics to contract with non-physician practitioners when statutory requirements for employment of Nurse Practitioners and Physician Assistants are met
  • Amends the Clinical Laboratory Improvement Amendments (CLIA) of 1988 to be in alignment with the Taking Essential Steps for Testing (TEST) Act of 2012, proposing the regulatory changes needed to implement the TEST Act, and outlines the framework for the application of sanctions in proficiency testing (PT) referral cases

See also the press release and fact sheet.

State of the Air
From the American Lung Association: This is our 15th version of this annual report, and we found that although the air across the country is much cleaner than when we first started, much of the country actually had more ozone pollution than in the 2013 report. This is largely due to the hot weather we had in the time period the new report covers. Ozone, also known as smog, is formed when pollutants from vehicles, power plants, and other sources react in the presence of sunlight, so hotter temperatures make dangerous levels of ozone more likely to form. 

CMS MLN Connects™ Weekly Provider eNews:

Voices for Healthy Kids Competitive Foods Toolkit Available
Voices for Healthy Kids (VFHK), working with the Robert Wood Johnson Foundation and the American Heart Association, released a toolkit with sample materials and guidance on how to build, engage, and mobilize a social change movement on school foods. VFHK offers other toolkits designed to help coalitions work toward a vision of healthy and safe homes, schools, and communities.

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Funding Opportunities

Childhood and Youth Development Grants HCA Foundation
Deadline: 4/1/15
Funding to support organizations that have programs promoting health and well being. Examples of proposals include Programs that promote basic health and human needs such as healthcare, housing and food, as well as higher levels of mental and physical wellness.

Tony Hawk Foundation
The Tony Hawk Foundation is dedicated to funding the construction of new, quality skateboard parks located in low-income communities throughout the United States. The Foundation primarily considers projects that can demonstrate a strong grassroots commitment, particularly in the form of planning and fundraising by local skateboarders and other community groups. Priority is given to projects that are designed and built by qualified and experienced skateboard park contractors and include local skaters in the design process. Grants of $1,000 to $25,000 are provided to nonprofit organizations and state or local agencies, including public school systems or public projects. Requests are reviewed two times per year; the upcoming application deadline is June 18, 2014.

The Wounded Warrior Project
The Wounded Warrior Project (WWP) serves veterans and service members who incurred a physical or mental injury, illness, or wound, co-incident to their military service on or after September 11, 2001, and their families. WWP offers grants of up to $250,000 to support nonprofit organizations that provide direct programming and services to this generation of wounded veterans. Applying organizations should enhance the lives of injured service members and their families by supporting programs that fall into one or more of WWP's identified needs in the following categories: Mind, Body, Economic Empowerment, and Engagement. The deadline for letters of interest is May 19, 2014. 

Best Buy Community Grants Program
The Best Buy Community Grants Program provides support to nonprofit organizations that are located within 50 miles of a Best Buy facility. Grants promote programs that provide teens with places and opportunities to develop 21st century technology skills that will inspire future education and career choices. Eligible programs must build technology skills in teens ages 13-18, deliver community-based youth programs during out of school time, and serve a diverse population. Grants average $5,000, and will not exceed $10,000. Online proposals may be submitted between June 2 and June 27, 2014.

Child Welfare Foundation
Funding to support organizations that seek to contribute to the physical, mental, emotional and spiritual welfare of children through the dissemination of knowledge.
The Dennis Foundation
Funding to support organizations that operate in the areas of education, health, human services, and religion.
Fluor Foundation
Deadline: Ongoing
Funding to support organizations that provide food, shelter and prevention programs and emergency services.

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